Male Clinical Cases - Jacobsohn Flashcards Preview

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Flashcards in Male Clinical Cases - Jacobsohn Deck (20):

In the context of BPH, what does PVR refer to?

What is a normal value for this?

Post-void residual urine.

Should be <50 in normal people (almost never 0); in BPH it is often elevated.


What are some conditions on the differential for BPH?

Urethral stricture (often resulting from prior STIs)

Bladder atony


Prostate cancer


BPH can be treated medically, surgically, or simply monitored.

What are some indications for surgical treatment?

Excessive urinary retention

Recurrent urinary tract infections

Recurrent/persistent gross hematuria

Bladder stones

Renal insufficiency


BPH can be treated medically, surgically, or simply monitored.

What medical treatments are used?

Alpha-blockers (eg Prazosin, Terazosin) to relax urinary sphincter.

5a-reductase inhibiters (eg Finasteride) to reduce DHT.


Distinguish between some symptoms of obstructive vs irritative lower urinary tract disorders.

Obstructive: Decreased force of stream, hesitancy, incomplete emptying, nocturia, straining.

Irritative: Urgency, frequency, dysuria.


Summarize the pathogenesis of BPH.

What regions are most affected?

Describe the histology.

DHT causes stromal and glandular proliferation (nodular).

Usually affects periurethral (transitional) zone.

Hyperplasia with preservation of inner/outer layer architecture.


A patient presents with difficulty urinating and a sense of fullness. He has three male family members with prostate cancer, as well as an elevated PSA (~20).

What is causing his symptoms?

BPH! Cancer rarely causes obstructive symptoms.

But yeah, he very well may have prostate cancer. Derp.


What is the function of PSA?

What lab measurements are generally made of it?

Which is especially useful for cancer screening?

A serine protease which degrades seminal coagulant.

Measure PSA density (PSA / prostate volume), and percent free PSA.

Cancer tends to produce "bound" PSA, so % free PSA is especially useful.


What more invasive tests are used for conclusive diagnosis of prostatic cancer?

Transrectal ultrasound with core biopsies (as many as 12 to sample a broad area).



Describe the spread of prostatic cancer by stage.

Stages I & II are confined to the prostate.

Stage III has local spread.

Stage IV has metastases to distant sites.


Recall the differential diagnosis for scrotal swelling.

Orchitis & Epididymo-orchitis

Hydrocele, Spermatocele, Varicocele



Inguinal hernia



What age group does testicular cancer usually affect?

What is their outlook?

Ages 20-39 (average is 34)

Quite good, 96% 5-year survival.


How does testicular cancer tend to present?

How is staging done?

Often painlessly, but 30-50% have pain. 10% have symptoms of metastases.

Staging is based on imaging and tumor markers.


How should elevated tumor markers post-orchiectomy be handled?

Adjuvant chemotherapy; the cancer is probably still present elsewhere.


Distinguish between the tumor markers AFP and hCG.

Name another highly nonspecific marker.

AFP: 5-7 day half-life. Not present in pure seminomas or choriocarcinomas.

b-hCG: 24-36 hour half-life. Present in choriocarcinomas, embryonal carcinomas, some seminomas.

LDH is non-specific.


Describe the approach taken in orchiectomy.

A slit is made inguinally, and the spermatic cord drawn out. Since cancer spreads up the cord, this decreases the likelihood of missed spread.


Name 4 risk factors for testicular cancers.


History of testicular atrophy

DES (diethylstilbestrol) exposure

HIV/AIDS (increases risk of seminoma)


What benefit is conferred by testicular self-examination.

Nothing, according to the lack of data to support it.

(this may be true of breast self-exam too)


Describe the treatments for Stages 1-3 NSGCT.

1: Observation or Chemotherapy (2x Bleomycin+Etoposide+Cisplatin) with retroperitoneal lymph node dissection (RPLND)

2a: RPLND & chemo. 2b, 2c: Chemo.

3 (mets, high markers): Chemo.


Describe the treatments for Stages 1-2 Seminoma.

1: Observation preferred. Alternatively, radiation to retroperitoneum.

2: Radiation for 2a, chemo for 2b (or worse)

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