BPH/Prostate CA Flashcards
(21 cards)
BPH clinical presentation
Lower Urinary Tract Sx’s:
- Weak urinary stream
- Urinary hesitancy
- Stream intermittency
- Post void dribbling
- Nocturia
- Recurrent UTI’s
- Hx of cystolithiasis
Uroflow study findings in BPH
Low flow rate
Post void residual findings
high residual
Cystoscopy findings
- Trabeculation
- Obstructive prostate encroaching into urinary outlet lumen
- “kissing lobes”
Urodynamic study findings
- Low flow
2. Elevated intravsical pressures
What OTC meds do you want to avoid in BPH?
- Pseudoephedrine/ alpha agonists (Sudafed)
2. Anticholinergics (Benadryl):-Cause urinary retention
Pharmacologic treatment in BPH
- Phytotherapy
- Alpha-blockers
- 5-alpha-reductase inhibitors (5-ARI)
List a phototherapy
Saw palmetto
Alpha blocker MOA
Causes relaxation of smooth muscle of the stroma that allows freer passage of urine
What is a disadvantage of 5-alpha-reductase inhibitors
Can take 6 months to see effect
What does 5-alpha-reductase inhibitors decrease?
PSA by 50%
Who are 5-alpha-reductase inhibitors most beneficial in?
larger volume prostates >40 cc
PSAs greater than 1.4
What is gold standard surgical treatment of BPH?
Transurethral Resection of Prostate (TURP)
Complications of TURP
- Retrograde ejaculation
- TUR Syndrome
- Hematuria
Define TUR Syndrome
- Hyponatremia
- Mental confusion
- HTN
- Visual changes
What is the main risk factor in Prostate CA
Strong family hx
What are other conditions that can elevate the PSA?
- Acute urinary retention
- BPH
- Prostatitis
- Prostatic infarction
- Prostatic intraepithelial neoplasia (PIN)
- Cath
Genome testing in prostate CA
PCA 3
4K Score
Radical prostatectomy indications
Lesions clinically confined to the prostate
List the hormonal manipulation options
- B/L orchiectomy
- LH-RH Analogs
- Antiandrogens
List the LH-RH Analogs
- Leuprolide
2. Goserelin
