Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GU > Lecture 9: Prostate Disorders > Flashcards

Lecture 9: Prostate Disorders Flashcards

1
Q

What is the primary function of the prostate?

A

Production of fluid that mixes with sperm to form semen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is gross hematuria always by default?

A

Cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the irritative voiding symptoms?

A
  • Urgency
  • Dysuria
  • Frequency
  • Nocturia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the obstructive voiding symptoms?

A
  • Hesitancy
  • Dribbling
  • Decreased force or caliber of stream
  • Interruption of stream
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 4 types of incontinence?

A
  • Overflow
  • Urge
  • Stress
  • Total
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the MC etiology of acute bacterial prostatitis?

A

G- rods, specifically E. coli

Others include pseudomonas or proteus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does acute bacterial prostatitis typically present?

A
  • Fever, chills, malaise
  • Pain - perineal, sacral, or suprapubic
  • Irritative voiding s/s
  • Obstructive voiding s/s (sometimes)
  • DRE will present with a hot, exquisitely tender prostate.

CI: Prostatic massage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do labs present for acute bacterial prostatitis?

A
  • CBC: leukocytosis w/ left shift
  • UA: pyuria, bacteriuria, hematuria
  • UC: for causative agent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If acute bacterial prostatitis has no response to abx after 24-48 hrs, what should we order?

A

Pelvic CT or transrectal US to r/o abscess.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are primary abx to use for acute bacterial prostatitis?

A
  • IV: fluroquinolone +/- aminoglycoside, or amp/gent empirically.
  • Oral: Bactrim DS, Cipro/levo.

4 weeks of therapy.

Should consider G+ coverage for younger pts.
Nosocomial will use carbapenems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can I differentiate acute from chronic bacterial prostatitis?

A
  • Chronic bacterial prostatitis usually presents with a NORMAL DRE.
  • No fever, chills, or malaise generally.

A hot prostate = acute.

Any other prostate finding is generally more suggestive of chronic.
Normal prostate/cervix = same texture as the tip of your nose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do labs for chronic bacterial prostatitis typically present?

A
  • UA: Normal unless cystitis present.
  • Prostatic secretions: Increased WBCs with lipid-laden macrophages.
  • UC: negative, but will be + for causative organism after massage.

Imaging is generally not needed.

If imaging is ordered, calculi may be seen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the two primary abx for chronic bacterial prostatitis?

A
  • Fluoroquinolones
  • Bactrim

6 weeks

May go up to 12 weeks, and may need to repeat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the primary SE a patient should be counseled on regarding fluoroquinolones?

A
  • C. diff diarrhea
  • CNS toxicity
  • Tendinopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the MC form of pelvic pain syndrome between CPPS and ABP?

A

Chronic/non-bacterial.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the S/S of CPPS?

A
  • Irritative voiding or obstructive voiding
  • Pain: perineal, lower abd, low back, often dull and poorly localized.
  • Less likely to have hx of UTI than in CBP
  • DRE: tenderness only in 50%.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do labs typically present for CPPS?

A
  • UA: normal
  • Prostatic secretions: Increased WBCs = inflammatory (chronic/nonbacterial prostatitis)
  • Normal secretions if non-inflammatory
  • Negative cultures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the difference between CPPS and nonbacterial/chronic prostatitis?

A
  • Inflammatory: Non-bacterial/chronic
  • Non-inflammatory: CPPS/prostatodynia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the treatment for newly diagnosed CPPS/NBP?

A

If abx-naive:

  • Fluoroquinolones
  • Erythromycin

6 weeks.

d/c after 2 weeks if no improvement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

For the urinary symptoms of CPPS/NBP, what is the first line treatment?

A

Alpha-1 blockers, such as tamsulosin.

Relaxes urethra and makes it bigger.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the adjunct therapies for CPPS/NBP?

A
  • 5-alpha-reductase inhibitors (finasteride)
  • NSAIDs
  • Sitz baths
  • CAM
  • PT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Summary of ABP, CBP, NBP, and CPPS

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the primary risk factors for BPH?

A
  • High free PSA
  • Prostatitis
  • Heart disease
  • BB use
  • Lack of exercise/obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the two ways BPH causes obstruction?

A
  • Mechanical obstruction (narrowing)
  • Dynamic obstruction (constriction due to alpha-receptor stimulation)

Size does not always correlate with symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How does BPH typically present?

A
  • Very slow onset.
  • Obstructive voiding
  • Irritative voiding
  • DRE: smooth, firm, elastic, symmetric enlargement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What can we use to assess the severity of BPH symptoms?

A

AUA symptom score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What DRE findings of a prostate might suggest cancer?

A

Induration or asymmetric enlargement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do labs typically present for BPH?

A
  • UA: normal or hematuria
  • PSA: can be elevated even if no cancer
  • Prostate Bx: only if concerned for cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What findings might prompt us to do an US for BPH?

A
  • High serum Cr
  • UTI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

For mildly symptomatic patients with BPH, what is the treatment?

A

Watchful waiting

Only concerned if they have complications.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the complications that would make us worried about a patient’s BPH?

A
  • Refractory urinary retention
  • Large bladder diverticula
  • Recurrent UTIs or gross hematuria
  • Bladder stones
  • CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 3 alpha receptors?

A
  1. a1a = 70% in prostate and bladder neck
  2. a1b = smooth muscle of vessels
  3. a1d = prostate, bladder, detrusor, sacral spinal
33
Q

What is the consensus regarding selective vs non-selective alpha blockers?

A

Generally same efficacy.

Doxazosin/terazosin are slightly better, but more SE.

Both are NON-selective

34
Q

What are the typical a1 blocker SEs?

A
  1. ORTHOSTATIC HYPOTENSION
  2. DIZZINESS
  3. Floppy iris syndrome post cataract surgery
35
Q

What drugs should we not use a1 blockers with generally?

A
  • AntiHTNs
  • PDE-5 inhibitors (Viagra)

Can bottom out someone’s BP very fast.

36
Q

What is the purpose of 5-alpha-reductase inhibitors?

A

Reducing size of prostate gland by preventing conversion of testosterone to DHT.

37
Q

What are the caveats to using a 5-alpha-reductase inhibitor?

A
  • 6 months to work
  • Reduces PSA by 50%
  • May reduce risk of prostate cancer
38
Q

What are the 5-alpha-reductase inhibitors and the main SE?

A
  • Finasteride (cheaper)
  • Dutasteride (more efficacious)
  • Jalyn (dutasteride+tamsulosin)
  • SEs: decreased libido, ED, or ejaculatory dysfunction.

Lower DHT.

39
Q

What is the first-line therapy for BPH?

A

Combo therapy of an alpha-1 blocker + 5-alpha-reductase inhibitor.

40
Q

What is tadalafil for?

A

Patients with both BPH and ED.

Not more efficacious

41
Q

What herbal can be used for BPH treatment?

A

Saw Palmetto

NOT FIRST-LINE, NOT FDA APPROVED

42
Q

What is the most common surgery for BPH?

A

TURP

Transurethral resection of the prostate (Endoscopically)

Generally longer hospital stays than the other procedures.

43
Q

What are the complications and risks of TURPs?

A
  • Risks: retrograde ejaculation, ED, urine incontinence
  • Complications: Bleeding, urethral stricture, bladder neck contracture, perforation of prostate capsule, TUR syndrome
44
Q

What is transurethral resection syndrome?

A
  • Hypervolemic, hyponatremic state
  • Caused by absorption of hypotonic irrigation solution
  • Presents as N/V, confusion, HTN, bradycardia, visual disturbances, muscle weakness/spasms, coma

MC in procedures that take longer than 90 minutes.

45
Q

What is the treatment for TUR syndrome?

A

Hypertonic saline + diuresis

Gettting rid of the hypervolemia and boosting the hyponatremia.

46
Q

What kind of patients is TUIP usually indicated for?

A
  • Mild-mod symptoms
  • Small prostates with elevated bladder neck

Quicker surgery and less complications.

47
Q

When is open/robotic simple prostatectomy indicated?

A
  • Prostate too big to remove endoscopically
  • Suprapubic/retropubic approach
  • High risk of complications and longer recovery.

Usually a gland > 100g

48
Q

What are the benefits/cons of a TULIP procedure?

Transurethral laser-induced prostatectomy

A
  • Pros: minimal blood loss, less TUR syndrome, OP, can use even with anticoags.
  • Cons: Can’t biopsy, higher cost, longer post-op catheterization, 3 months of prostate sloughing.
49
Q

What is a TUNA procedure?

Transurethral needle ablation of prostate

A
  • Radiofrequency needles to penetrate prostate
  • Heat tissues to cause necrosis
50
Q

What are the other 2 heat related therapies for prostate treatment besides TUNA and TULIP?

A
  • Transurethral electrovaporization of prostate
  • Hyperthermia (microwaves)
51
Q

What is the one surgery that does not involve damaging the prostate?

A
  • UroLift, which simply holds open the prostate.
  • Done OP w/ local anesthesia
  • Only works on glands < 80g
52
Q

What therapy uses steam to damage the prostate?

A

Water vapor thermal therapy (Rezum)

Minimal impact, with less sloughing.

53
Q

What are the risk factors for prostate cancer?

A
  • Black
  • FMHx of prostate cancer
  • High dietary fat intake
54
Q

How does prostate typically feel on DRE?

A
  • Normal (MC finding)
  • Focal nodules
  • Induration
55
Q

What is the MC symptom of prostate cancer metastasis?

A

Lower back pain, implying axial skeleton metastasis.

56
Q

What labs may be elevated in prostate cancer and what do they signify?

A
  • Elevated PSA: cancer
  • Elevated BUN/Cr: Urinary retention or obstruction
  • Elevated Alk Phos/hypercalcemia: bony metastases
57
Q

What is the standard method for detecting prostate cancer?

A

Transrectal US guided biopsy

Need multiple biopsies.

58
Q

What are CT and radionuclide bone scans mainly used for in prostate cancer?

A

Checking for metastases.

59
Q

How is prostate cancer staged?

A
  • Gleason system (1-5) for differentiation.
  • Spread is T1-T4

At T2 is when the tumor is visible/palpable.

60
Q

What tissue type are most prostate cancers?

A

Adenocarcinomas.

Periphery of prostate.

61
Q

When is tx indicated for prostate cancer?

A

Life expectancy > 10 yrs

62
Q

What is removed in a radical prostatectomy?

A
  • Prostate
  • Seminal vesicles
  • Ampullae of vas deferens

Only if NOT T4 or lymph node metastases.

Adding radiation post-sx may help as well.

63
Q

For a small prostate tumor, what are the alternatives to radical prostatectomy?

A
  • Radiation therapy using external beam radiotherapy or transperineal implantation of radioisotopes.
  • Cryosurgery with US guidance
64
Q

What is chemo used for in prostate cancer?

A

Treating metastases.

65
Q

What is the pharmacological therapy for prostate cancer?

A
  • Androgen deprivation therapy using either LHRH agonists (Leuprolide) or LHRH antagnonists (degarelix).
  • Adrenal suppressants (ketoconazole, or corticosteroids)
  • Orchiectomy as well can be done.
66
Q

Whats the main difference between using a LHRH agonist vs a LHRH antagonist?

A

There is no initial testosterone flare in antagonists.

67
Q

What grades of gleason and spread have the best outcomes for prostate cancer?

A
  • T1-T4 with no metastases = 100% 5-year survival.
  • Gleason 1-2 are usually confined to just the prostate.

80% of pts are T1-T2.

68
Q

What is PSA and what makes it?

A
  • Glycoprotein made by both benign and malignant prostate cells.
  • Correlates with prostate tissue size

PSA should normally be LOW.

69
Q

What kind of prostate cancer will potentially show normal PSA?

A

A highly localized tumor.

If metastasized, it should almost always be high.

70
Q

If a patient presents with a high PSA (> 10mcg/L) what is the likelihood they have prostate cancer?

A

50-70%

71
Q

What PSA level suggests advanced prostate cancer?

A

> 40mcg/L

If confined to the prostate, prob < 10 mcg/L

72
Q

What medications can affect PSA levels?

A
  • 5-a-reductase: 50%
  • NSAIDs or acetaminophen: lowers
  • Statins: lowers by 4.1% annually
  • Thiazides: 25% reduction over 5 yrs.
73
Q

What are the NON-cancerous causes of elevated PSA?

A
  • BPH
  • Prostatic inflammation/infection
  • Perineal trauma
74
Q

What is free PSA and when is it used?

A
  • Measures unbound vs total.
  • Used in intermediate (4.1-10 mcg/L) PSA levels.
  • Lower free PSA < 10% = much higher likelihood of cancer.
75
Q

What PSA velocity is suggestive of cancer?

A

> 0.35mcg/L/yr

76
Q

At what age should PSA NOT be screened in?

A

Over 70 is a nono

77
Q

When do we typically start PSA screenings?

A

55!

40 if higher risk

78
Q

When do we typically do DREs for prostate cancer?

A

Once at 40 and 45, unless the high risk factors are present.

GU (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions