Flashcards in Prostate Deck (24)
Describe the location of the prostate.
What is near it and what runs through it?
• Prostate lies inferior and around the neck of bladder.
• Posterior surface in contact with rectum (can be palpated)
Urethra runs through it. (prostatic urethra)
What runs from the kidney to Bladder
What is the role of the prostate?
Fibromuscular and glandular accessory organ that provides then, milky, alkaline fluid as a bulking agent to semen and contracting during ejaculation. Ejaculatory duct meets urethra within prostate.
What is Benign Prostatic Hyperplasia?
How would CA differ in location and MNFTS?
• Nodular Periurethral enlargement of prostate (both muscle and glands
(CA is peripheral and multi centric, not necessarily urinary complications)
Incidence in Men by age?
• Very common as men age
o >40 years ~20% have BPH
o >60 years ~50%
o >80yrs ~90%
What is the Etiology of BPH
• Ageing the major risk
o Age related changes in androgen levels??
• Altered Testoterone : Estrogern Balance?
• Genetic, race and diet (higher likelihood)
o Japanese men low/ African high
o Role of yellow vegetables??
What is the relationship between testosterone and DHT?
Testes produce testosterone (converted to DHT which impacts accessory oragns)
o T -> 5alpha reductase-> DHT
o DHT acts on prostate cell and supports growth and Fx
What is the relationship of Estrogen to DHT
Sensitizes prostate to DHT
How does aging lead to prostate enlargement?
Aging leads to T quantitative dec and relative inc estrogen. This Increases significance of estrogen impacts (i.e relative inc) (Androgens have opposing actions) In this case a further sensitization of cells to DHT due to Alteration T:E ratio
o Relative inc in E -> sensitizes prostate to DHT -> enlargement
Is growth of BPH in the prostate hypertrophy or hyperplasia?
Where does growth take place?
o Hyperplasia in periurethral tissue -> compresses urethra
o Also hypertrophy of smooth muscle
Note: There is peripheral growth as well (not just periurethral)
What is the complication with prostate enlargement?
Impedes urine flow
bladder wall thickens ( normally thin walled, overfill can cause rupture... it's a compensatory response)
o Trabeculations and diverticula develop in bladder
o Urine stasis (complications- stones, UTI’s, calculi)
NOTE (R/t future kidney notes)
What is a further complication once bladder back ups with urine?
o Ureter distention with urine -> hydroureter
o Ureter loop distends downward and creates “fishhook”
o Urine backs up in the kidney causing hydronephrosis
• Distention of renal pelvis and calicies with urine
Common MNFTS of BPH
• Frequency (inc)
• Hesitancy (difficulty starting urine flow)
• Weak urine stream (r/t constriction)
• Terminal dribblings (post void dribbling)
• Complete obstruction?
What is the major complications from complete urethral obstruction
Eventually pressure prevents filtration of Nitrogenous compounds and kidney failure
Dx of BPH
•Hx, MNFTS, Px
• Digital rectum exam (palpation of prostate through rectum)
• PSA (Prostate–specific antigen)
(Normally secreted by prostate in fluid, Inc should be proportional to Prostatic mass
o PSAD and PSAV (density and velocity) (requires size and PSA measure)
• Measure for benign and malignant growth
• BUN and Creatinine (No ischemic damage occurring here)
• Urinalysis (UTI’s?, stones?, hematuria)
Tx of BPH
• Often no Tx
• Based on severity and complications
• Alpha adrenergic antagonists
o Act on muscles
o Dec obstr -> improves urination
• 5 alpha reductase inhibitor (long term)
o reduces DHT
• If severe combine both drugs
• TURP (Trans urethral resection of prostate) or lazer prostatectomy
Describe Prostate CA (including Risks)
• Common Ca in Men
• 3rd CA death
• most after age 65
• Risks include: age, diet, ethnicity, familial (1rst and 2* relatives), androgens
Pathology of Prostate CA
(TYPE, Origin, Spread)
• Peripheral origin (beneath capsule), multicentric (arise in severeal areas)
• No early mnfts -> delays Dx
• MNFTS appear after invasion or metastasis
• Extension to bladder and Seminal vesical
• Metastasis to bone, liver and lung
MNFTS of Prostate CA
• Prostatitis common
• Late hip and back pain (bone metastasis)
DX of Prostate CA
• Hx and Px
• Digital Rectal exam (needs to be decently large for effective screening)
• Biopsy (US will guide it)
Common Non-pharma approach to prostate tx
• Stage, grade and age based
• Non aggressive forms might be put on active surveillance
• If Localized= low risk -> active surveillance
Pharma Tx of Prostate CA
•1st line : antiandrogens (ex. estrogen)
o tumors nurtured by hormones
o radical prostatectomy (remove vesicals)
DHT stands for?
5 alpha reductase is enzyme