Flashcards in Prostate Deck (24):
1
Describe the location of the prostate.
What is near it and what runs through it?
• Prostate lies inferior and around the neck of bladder.
• Encapsulated
• Posterior surface in contact with rectum (can be palpated)
Urethra runs through it. (prostatic urethra)
2
What runs from the kidney to Bladder
Ureter
3
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.
4
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)
5
Incidence in Men by age?
• Very common as men age
o >40 years ~20% have BPH
o >60 years ~50%
o >80yrs ~90%
6
What is the Etiology of BPH
• Unclear
• 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??
7
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
8
What is the relationship of Estrogen to DHT
Sensitizes prostate to DHT
9
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
10
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)
11
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)
12
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
13
Common MNFTS of BPH
• Frequency (inc)
• Hesitancy (difficulty starting urine flow)
• Weak urine stream (r/t constriction)
• Terminal dribblings (post void dribbling)
• Complete obstruction?
14
What is the major complications from complete urethral obstruction
Eventually pressure prevents filtration of Nitrogenous compounds and kidney failure
15
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)
16
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
17
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
18
Pathology of Prostate CA
(TYPE, Origin, Spread)
• Adenocarcinomas
• 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
19
MNFTS of Prostate CA
• Prostatitis common
• Late hip and back pain (bone metastasis)
20
DX of Prostate CA
• Hx and Px
• Digital Rectal exam (needs to be decently large for effective screening)
• PSA
• Biopsy (US will guide it)
21
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
22
Pharma Tx of Prostate CA
Other Tx?
•1st line : antiandrogens (ex. estrogen)
o tumors nurtured by hormones
o radical prostatectomy (remove vesicals)
• Radiation
23
DHT stands for?
Dihydrotestoterone
5 alpha reductase is enzyme
24