BPH, Prostate and Testicular Cancer

Question 1

What is BPH?

Answer 1

An enlargement of the prostate gland

It develops in the inner portion of the prostate

Question 2

What are risk factors for BPH

Answer 2

family history
environment
diet
smoking 
chronic conditions 
increased weight

Question 3

What are the obstructive clinical manifestations of BPH

Answer 3

decrease in force of urinary stream
difficulty initiating voiding
intermittency
dribbling at the end of voiding

Question 4

What are the irrigtative clinical manifestations of BPH

Answer 4

urinary frequency 
urgency 
dysuria 
bladder pain 
nocturia 
incontinence

Question 5

What are complications of BPH

Answer 5

Acute urinary retention

UTI

Question 6

How do you diagnose BPH?

Answer 6

History and Physical
DRE (distal rectal exam)
PSA
Trans rectal ultrasound (TRUS)

Question 7

What are the goals for a patient with BPH?

Answer 7

restore bladder drainage
relieve the patients symptoms
prevent or treat complications

Question 8

Pharmacologically how do you treat BPH?

Answer 8

5 alpha reductase inhibitors 
   PROSCAR (finasteride)
   Avodart (dutasteride)
Alpha adranergic receptor blockers 
   Cardura (doxazosin)
   Hytrin (terazosin)

Question 9

What minimally invasive therapy can be done for BPH?

Answer 9

Transurethral microwave thermotherapy
Transurethral needle ablation of prostate
Laser prostatectomy
Intraprostatic urethral stents

Question 10

What is Transurethral Resection of the Prostate (TURP)?

Answer 10

Removal of prostate tissue
GOLD STANDARD FOR BPH
Bladder irrigation

Question 11

What occurs during a TURP procedure?

Answer 11

A movable loop is inserted and tissue is removed and coagulated
Irrigation solution carries out debris
Bleeding is common complication

Question 12

What are pre-op priorities for a TURP procedure?

Answer 12

Assess clotting factors

Question 13

Qht are post-op priorities for a TURP procedure?

Answer 13

Let them know that clots are normal for 24-36 hours post op

Hematuria is also normal

Question 14

What is continuous bladder irrigation?

Answer 14

Normal Saline irrigation for 24hrs after a TURP
Adjust irrigation fluid to maintain colorless or pink drainage return
Tape cath to leg to provide gentle traction-ballon at end of catheter is pulled down into prostatic tissue removal area to put pressure on area and maintain hemostasis

Question 15

What are complications of TURP and CBI?

Answer 15

Potential hemorrhage
depending on how much bleeding; hypovolemia could occur
Bladder spasms- antispasmotics such as oxybutynin (Ditropan)

Question 16

What does the patient need to know when they go home after having a TURP procedure?

Answer 16

May go home with catheter and need care of indwelling catheter
Increase oral fluids 2 to 3 L
S/S of UTI
Avoid heavy lifting
Driving and sexual intercourse after follow up care with the physician

Question 17

What are the pre-op goals for a patient having a TURP?

Answer 17

restoration of urinary drainage
treatment of UTI
understanding of procedure

Question 18

What are the post-op goals for a patient having a TURP?

Answer 18

No complications
Restoration of urinary control
Complete bladder emptying

Question 19

What is some basic info on prostate cancer?

Answer 19

asymptomatic in the early stages
family history increases risk
eventually may experience symptoms similar to BPH
5 year survival with diagnosis at local stage = 100%

Question 20

What are clinical manifestations of prostate cancer?

Answer 20

dysuria 
hesitancy 
dribbling 
frequency
urgency
hematuria 
nocturia
retention 
inability to urinate

Question 21

What are late signs of prostate cancer?

Answer 21

Pain in lumbosacral area that radiates to hips or legs when coupled with urinary symptoms, could indicate metastasis
Once cancer has spread to distant sites, pain management becomes a problem

Question 22

Where can prostate cancer metastasize to?

Answer 22

pelvic lymph nodes
bladder
lungs (SOB)
liver (jaundice, trouble metabolizing drugs, elevated LFTs)

Question 23

How do you diagnose prostate cancer?

Answer 23

PSA (prostate-specific antigen) blood test
elevated levels indicate prostate pathology, not necessarily cancer
also used to monitor success of treatment
some concern about false positive/negative
levels should decrease after successful treatment
normal level is between 0-4
Digital rectal examination (DRE)
CT
MRI

Question 24

How can you definitively diagnose prostate cancer

Answer 24

by a biopsy obtained using TRUS (trans-rectal ultrasound)

Question 25

What are the treatment options for prostate cancer?

Answer 25

``` surgery chemotherapy radiation hormone therapy watch and wait life expectancy of less than 10 yeaars presence of significant co-morbid condition low-grade, low-stage tumor ```

Question 26

What is a radical prostatectomy

Answer 26

The entire gland, seminal vesicles and part of the bladder neck are removed Retroperineal lymph node dissection usually done Considered most effective for long-term survival

Question 27

What are the complications of a radical prostatectomy?

Answer 27

``` Major complications are ED and urinary incontinence Hemorrhage Urinary retention Infection Wound dehiscence DVT/PE ```

Question 28

What are the detail of a nerve-sparing surgical procedure for prostate cancer?

Answer 28

spares nerve responsible for erection only for cancer confined to prostate no guarantee potency will be maintained success is variable

Question 29

Waht type of therapies can be done for prostate cancer?

Answer 29

``` external beam brachytherapy implantation of radioactive seed into prostate gland spares surrounding tissue hormonal therapy ```

Question 30

What is an orchiectomy?

Answer 30

surgical removal of testes for advanced stages of prostate cancer reduces circulating testosterone by 90% helps relieve bone pain with advanced tumors

Question 31

What are side effects of an orchiectomy?

Answer 31

``` hot flashes ED loss of libido irritability weight gain loss of muscle mass ```

Question 32

What are the outcomes for patients with prostate cancer?

Answer 32

be an active participant in the treatment plan achieve satisfactory control follow the therapeutic plan understand the effect of the treatment on sexual function satisfactory manage the impact on bowel and bladder function

Question 33

What is testicular cancer?

Answer 33

relatively rare most common type of cancer in young men (15-34) more common in males who have undescended testes occurs more commonly in the right testicle most develop from embryonic germ cells may have slow or rapid onset may notice lump or swelling in scrotum mass is typically non-tender and firm self-exam is vital in detection process

Question 34

how do you diagnose testicular cancer?

Answer 34

``` palpation of mass ultrasound AFP HCG LDH ```

Question 35

How do you treat testicular cancer?

Answer 35

``` orchiectomy radical orchiectomy removal of affected testes, spermatic cord and regional lymph nodes radiation chemo fertility issues ```