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Prostate conditions Flashcards

(105 cards)

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1
Q

Prostate anatomy

A 
Single wall shaped gland
Golf Ball size
Inferior to bladder
Surrounds urethra
Continuos growth
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2
Q

Acute bacterial Prostatitis MC organism

A

GNB - E coli, Pseodomonas

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3
Q

Acute bacterial Prostatitis typically occurs how?

A

Ascending inf or infected urine into prostatic ducts

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4
Q

Acute bacterial Prostatitis can be concomitant w/?

A

UTI or epididymis

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5
Q

Two ducts of the prostate

A

Prostatic duct

Ejaculatiry duct

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6
Q

Acute bacterial Prostatitis S/S

A 
Abrupt
-Perineal, sacral, or suprapubic pain (vague)
Fever
Irritative voiding
\+- obstructive voiding
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7
Q

Acute bacterial Prostatitis PE

A 
High fever
Warm, inflamed very TTP prostate
— gentle DRE
— *NO prostatic massage
(dont risk septicemia)
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8
Q

Acute bacterial Prostatitis Labs

A 
UA/Cx*
-pyuria
-bacteriuria 
-hematuria
CBC ^WBC
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9
Q

Acute bacterial Prostatitis TXT

A

ABX per Cx/s, STI RFs for 4-6wks
1st Ampicillin + aminoglycoside prior Cx
(IV) Fluoro + aminoglycoside
(Ciprof/levof + gentam OR tobra)

(PO) fluro (ciprof/levof) OR TMP-SMX
-After 24-48 afebrile period

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10
Q

Acute bacterial Prostatitis Admit criteria

A

Septicemia
Comorbids
Unreliable pt (F/U)

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11
Q

Why is Acute bacterial Prostatitis ABX TXT so long?

A

4-6wk because prostate is hard to penetrate w/ ABX

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12
Q

Acute bacterial Prostatitis TXT of urinary retention?

A

PerQ suprapubic tube

CI - cath = septicemia

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13
Q

Acute bacterial Prostatitis Post TXT requirement

A

Test of cure - F/U UA, prostatic secretion Cx

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14
Q

Pts w/ Chronic bacterial Prostatitis may not present w/ what?

A

+- Hx of acute infection

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15
Q

Chronic bacterial Prostatitis S/S

A

Irritative voiding S/S
Low back pain
Perineal pain
+- hx of UTIs

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16
Q

Chronic bacterial Prostatitis PE

A 
Unremarkable or
Prostate is
-NL
-Boggy
-Indurated
Palpable prostatic calculi
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17
Q

Chronic bacterial Prostatitis Labs

A

UA/Cx
Prostatic massage secretions - >10/hpf WBC
-culture both
CBC - ^Wbc

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18
Q

Chronic bacterial Prostatitis TXT

A 
ABX - 6-12wks
TMP-SMX
Levof 750 or ciprof 500
BID all
Symptomatic care
-NSAIDs (indo/ibup)
-sitz bath
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19
Q

Chronic bacterial Prostatitis TXT failure step

A

Try 2nd longer course of Antibiotics

-consider infected prostate stone

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20
Q

MC prostatitis

A

Chronic Non-bacterial Prostatitis

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21
Q

How is Chronic Non-bacterial Prostatitis Dx?

A

Dx of exclusion

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22
Q

Chronic Non-bacterial Prostatitis presents

A

Same as Chronic bacterial Prostatitis but w/ absolutely no Hx of UTIs

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23
Q

Chronic Non-bacterial Prostatitis Labs

A

^WBC w/in prostatic secretions
-IND-inflam not inf
All Cx negative

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24
Q

Chronic Non-bacterial Prostatitis TXT

A

Warranted to use ABX against atypical organisms.
-Ureaplasma
-Mycoplasma
-Chlamydia
— erythromycin 250 PO QID x14d > reeval > alt txt or continue 3-6wks
NSAIDs
Sitz bath

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25
What is prostatodynia?
Non-inflammatory D/O of pain/uncomfortable sensations in the perineum.
26
MC prostatodynia pop
Young/middle aged males
27
Causes of prostatodynia?
Voiding dysfx | Pelvix floor musculature dysfx
28
W/ prostatodynia how is the pts prostate status?
Normal
29
prostatodynia S/S
Same as Chronic prostatitis -NO Fever/Hx UTI +- hesitating, flow interruption Hx of voiding difficulty
30
prostatodynia PE
Nothing
31
prostatodynia Labs
Normal UA/prostatic secretion
32
prostatodynia TXT
``` Spasms > alpha-blk -terazosin -doxazosin Pelvic floor muscle dysfx -Diazepam -biofeedback techniques Symptomatic -sitz bath ```
33
Unresponsive prostatodynia TXT reflex
Urodynamic testing - R/O voiding dysfx
34
Look at chart
Slide 29 prostatic deck
35
BPH pathogenesis
Multifactorial and under endocrine control otherwise unknown
36
2 factors essential for BPH?
Dihydrotestosterone (DHT) | Aging
37
DHT pathology of BPH
5-alpha-reductase converts testosterone to DHT which promotes prostate cell proliferation (hyperstatic process)
38
BPH growth pattern
Nodular w/ varying amounts of stroma or epithelial growth occuring in the transition zone surrounding urethra
39
Prostatic stroma composed of?
Smooth muscle and collagen | - adrenergic nerves
40
5-alpha-reductase inhibitor TXT concepts
- decreases prostate tone/outlet resistance | - responds better w/in Epithelium
41
prostate hyperplasia pathophysiology
Mechanical obstruction of urethra - higher bladder resistance
42
Efficency of DRE to eval prostate?
Poorly correlates w/ S/S
43
Types of S/S ass/w BPH?
Obstructive voiding - hyperplasia growth | Irritative voiding - 2/2 outlet resistance of the bladder
44
BPH obstructive S/S
``` Hesitancy/straining to void Decreased force/caliber Incomplete empyting sensation Double void Post void dribble ```
45
BPH irritative S/S
Urgency Frequency Nocturia
46
Most important tool for BPH evaluation?
American Urological Association (AUA) symptom index | -self administered 7- questionnaire
47
BPH Hx to R/O
Prostate cancer UTI Neurogenic bladder Urethral stricture
48
Prostate characteristics for BPH
Smooth, firm, elastic anlargement
49
Indurations of prostate req?
Further W/U req to R/O cancer - PSA, TRU/S, Bx
50
Abd exam for BPH?
Look for bladder distension (sig S/S of obstruction)
51
BPH labs
UA - (R/O hematuria/infection) PSA BUN/creatinine (R/O obstructive - postrenal azotemia)
52
If AUA score is >=8 consider special tests?
Urodynamic studies | Post void residual (PVR)
53
BPH - Renal U/S or CT is only recommended if
``` Concomitant urinary tract disease BPH complications -Hematuira -UTI -CKD -Hx stones ```
54
BPH obstructive DDx
``` Urethral stricture Bladder neck contracture Bladder stones Prostate cancer Other DDX - (UTI, Bladder cancer, nuerogenic bladder) ```
55
BPH - TXT options for AUA 0-7 (mild S/S)
Observation -progression uncertain; possible spon resolve possible F/U interval not defined
56
BPH - TXT options for AUA >8 (mod-severe S/S)
Observe Surgery Medical therapy
57
BPH - Absolute surgical indications*
``` Refrac UA retention (failing cath removal) LRG bladder diverticula BPH sequelae of - Recurrent UTI - Recurrent/persistent gross hematuria - Bladder stones - CKD (renal insufficiency/failure)* ```
58
BPH - Rx
Alpha blockers - Prazosin - Doxazosin - Terazosin Alpha-1a blockers (selective w/ fewer SEs) - Tamsulosin - Alfuzosin
59
BPH - 5-alpha-reductase inhibitors MOA
Blocks conversion of testosterone to DHT
60
5-alpha-reductase inhibitors use is best for?
Enlarged prostates >40mL on U/S - will have symptomatic* improvement
61
Durations req for 5-alpha-reductase inhibitors - BPH TXT
6mos for max efx
62
5-alpha-reductase inhibitors Rx's?
Finasteride | Dutasteride
63
Finasteride - important concept to consider w/ BPH?
Will reduce PSA by 50% - If pt takes Finasteride double PSA results and compare to pre-finasteride PSA levels (Improve or same or Worse?)
64
BPH combination therapies?
Alpha blocker + 5-alpha-reductase inhibitor (Doxazosin + finasteride) Safe/effective
65
Other BPH Rx therapy?
PDE-5 inhibitors | -Tadalafil - FDA approved for BPH and/or urinary tract S/S w/ ED
66
BPH pixie dust therapy
Phytotherapy
67
BPH minimally invasive prosecures
TULIP - transurethral laser-induced prostatectomy TUNA - transurethral needle ablation of prostate TUEV - transurethral electrovaporization of prostate Microwave hyperthermia (burn) Implant to open prostatic urethra
68
BPH conventional surgery?
TURP - transurethral resection of prostate - most performed endoscopically - req spinal anesthesia - 1-2d hospital stay Superior flow/symptom improvement vs minimal invasive therapy
69
If inable to perform TURP endoscopically then reflex?
TUIP - transurethral incision of prostate OR | Open simple prostatectomy - (too large to remove)
70
Other off-label TXTs of BPH?
Botox injection - not FDA approved
71
Essentials to Dx prostate Cancer?
Induration on DRE or PSA elevation | Asymptomatic (rarely systemic S/S (wgt loss/bone pain)
72
MC non-cutaneous cancer in men?
Prostate Cancer
73
2nd leading cause of cancer-related deaths?
Prostate cancer
74
RFs for prostate cancer?
Aging, black, Fam Hx prostate cancer, high fat intake
75
Prostate cancer S/S?
``` Most - early Dz = asymptomatic Symptoms = locally advanced or Mets - bone pain - lumbar spine pain Obstructive/irritative S/S ```
76
Prostate cancer PE?
DRE > induration | cant appreciate entire gland however
77
Prostate cancer labs?
PSA - NL = <4ng/mL -Most cancers confined to prostate = <10ng/mL -Advanced cancer Dz = >40ng/mL BUN/Cr - elevated if urinary retention/obstruction Increased ALP or hypercalcemia (Skeletal Mets)
78
Does PSA absolutely exclude/include cancer Dx?
No
79
Can initial TXT be based on PSA alone?
No
80
Elevated PSA pts should be?
Referred for U/S and Bx
81
Abnl PE but normal PSA level pts should be?
Referred for U/S and Bx
82
TRU/S guided Bx performed if?
Following ABNL DRE or elevated PSA - Definitive Dx
83
What is definitive Dx of prostate cancer?
TRU/S guided Bx
84
Other imaging for Prostate cancer?
MRI - eval prostatic lesions + regional lymph nodes | Bone scan - Mets/bone pain
85
Indications for bone scan in a pt w/ prostate cancer?
Advanced local lesions S/S of Mets- bone pain High-grade Dz PSA elevations >20ng/mL
86
TXT of localized prostate cancer is based on?
Based on tumor grade/stage, pt age/health
87
Prostate cancer TXT should always be considered for pts w/?
expected survival in excess of 10yrs
88
Older pts w/ low risk prostate cancer should be TXT how?
Active surveillance
89
Prostate cancer TXT?
Radical prostatectomy
90
What is removed w/ Radical prostatectomy
Seminal vesicles, prostate, ampullae or vas deferrens
91
Prostate cancer - Ideal candidates for Radical prostatectomy
Stage T1-T2 cancers (not advanced tumors or METs)
92
Recurrence rates posr Radical prostatectomy for prostate cancer?
Uncommon recurrence
93
Pts w/ positive prostate cancer margins considered for?
Adjuvant TXT | - radiaiton (POS margins or androgen deprivation for lymph node mets)
94
Prostate cancer - bracytherapy TXT is?
Implantation of permanent or temporary radioactive substance into prostate -Palladium, Iodine, Iridium
95
Prostate cancer - Cryosurgery TXT is?
Using liquid nitrogen to destroy tissue
96
Androgen deprivation is?
Suppressing androgens via hormonal therapy to control prostate cancer (Most are hormonal dependent)
97
Population indicated for androgen deprivation?
Men w/ Mets > imrpoves control of distant disease
98
Prostate cancer prognosis?
CAPRA nomogram - PSA - Gleason grade - staging - percent positive Bx - pt age
99
Prostate cancer PVT techniques?
``` Antioxidants - Lycopene/polyphenols (green tea) Cruciferous veggies - broccoli Vitamin D Omega-3's decreased BMI Smoking cessation/ETOH High fiber/low fat diet ```
100
Prostate cancer screening protocol?
``` Avg risk white male = 50yo 45yo if - Black -positve fam hx (1st degree Dx prior to 65yo) -BRCA1 mutation ```
101
AGE/PSA correlation?
PSA gradually increases w/ age
102
What age to D/C PSA tests?
If expected life is <10yrs
103
USPSTF screening recommends
against routine screening
104
PSA velocity notes
serial PSA values (better than random PSA) - may increase specificity for cancer detection - rate of PSA change >0/75ng/mL per yr = higher risk cancer
105
PSA density is? and results?
Free PSA/Total PSA - >25% free PSA > cancer unlikely - <10% free PSA > 50% chance of cancer

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