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Prostate & Testes Flashcards

(57 cards)

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1
Q

MC nondermatological malignancy in males

A

Prostate cancer (adenocarcinoma)

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2
Q

MCC of cancer-related death in males

A
  1. Lung
  2. Prostate
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3
Q

Typical location/zone of prostate that cancer develops

A

Peripheral zones

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4
Q

RFs for prostate cancer

A
  1. Age - Most important (31-40) < (81-90)
  2. Prostatitis
  3. FHx of prostate cancer
  4. High fat diet
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5
Q

Sxs of Prostate cancer

A
  1. Asymptomatic (early bc of peripheral location)
  2. Urinary retention
  3. Weak urine flow
  4. Frequency
  5. Hesitancy
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6
Q

MC site of prostate cancer metastasis

A

Bone (Vertebrae) –> Pain & Fractures

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7
Q

Tx of non-metastatic prostate cancer

A
  1. External beam radiation
  2. Brachytherapy (radioactive seed implants)
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8
Q

Tx of extensive prostate cancer

A

Radical Prostatectomy - retropubic, perineal, laparoscopic or robotic

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9
Q

MC complications of radical prostatectomy

A

Impotence & Incontinence

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10
Q

Tx of metastatic prostate cancer

A
  1. GnRH agonist - Leuprolide
  2. Androgen receptor antagonist- Flutamide, Bicalutamide
  3. Chemotherapy (not very effective)
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11
Q

Tx of prostate cancer in older men

A

Observation - slow growing

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12
Q

Monitoring Prostate treatment

A

PSA

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13
Q

Screening for Prostate cancer

A
  1. PSA - large or acute change
  2. DRE - asymmetrical, nodular, indurated
    - Abnormal –> Biopsy (ALWAYS)
  3. Alkaline phosphatase- elevated when the cancer has invaded
  • Controversy — Case based — 40-50 years — PSA & DRE
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14
Q

Definite diagnosis of prostate cancer

A

Needle core biopsy guided by transrectal ultrasound

  • CT for extent & treatment
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15
Q

RFs for BPH

A

Increasing age (>50)

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16
Q

MC location of BPH

A

Peri-urethral/ transition zone –> Obstruction

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17
Q

Sxs of BPH

A
  • Hesitancy
  • Weak urine stream
  • Frequency
  • Urgency
  • Dysuria
  • Nocturia
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18
Q

Relation of BPH & Prostate cancer

A

BPH doesnt predispose to cancer

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19
Q

Diagnostic workup of BPH

A
  1. History
  2. Physical
    - DRE - uniform, enlarged, rubbery
  3. Mild PSA elevation
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20
Q

Complications of untreated BPH from urinary obstruction

A
  1. B/l hydronephrosis
  2. Bladder diverticula & smooth muscle hypertrophy
  3. Infection - urine stasis
  4. Infarction - painful, enlarged, firm gland w. increased PSA
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21
Q

Tx of BPH

A

Behavior modification
1. Avoid liquids before bed
2. dec. caffeine & alcohol
3. Double voiding to completely empty bladder

Medication
1 Mild- moderate –> Alpha blocker (Tamsulosin, terazosin)
2. Severe –> alpha blocker + 5-alpha-reductase inhibitor (Finasteride)

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22
Q

Tx of Refractory BPH

A

TURP (Transurethral Resection of the Prostate)

or

Transurethral needle ablation (cant undergo surgery)

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23
Q

Recommended studies to evaluate pts. w. lower UT symptoms

Study These Flashcards
A
  1. Urinalysis - Infection or blood
  2. Serum PSA
24
Q

SxS of testicular torsion

Study These Flashcards
A
  1. Acute testicular/ abdo pain
  2. N&V
  3. High-riding testicle w/ horizontal line
  4. Absent cremasteric reflex
25
RFs for testicular torsion
1. Adolescent or puberty --> Hormonal change --> Inc testicular weight 2. Vigorous exercise 3. "Bell Clapper" deformity- b/l defect in processus vaginalis -->inadequate anchoring of testis to posterior scrotal wall --> testes hang freely & horizontally
26
Cremasteric reflex
Superficial reflex --> stroking of superomedial thigh --> cremasteric muscle contraction--> testis elevation Sensory & motor innervation of Genitofemoral nerve
27
Diagnosis of testicular testis
1. Clinical 2. Color doppler US of scrotum --> Dec perfusion
28
Tx of testicular torsion
1. Emergent b/l orchiopexy w/i 4-6 hours 2. Manual detorsion --> Surgery - Med --> Lat then Lat --> Med
29
Appendix testis/ Epididymis torsion
1. Children (7-12) 2. Palpable nodule 1/ blue dot 3. Intact cremasteric reflex 4. Normal or Inc perfusion on doppler 5. Supportive treatment - analgesia, rest, ice 5. Spontaneous recovery in 1-2 weeks
30
MC solid malignancy in males 15-35 years
Testicular cancer
31
RFs for testicular cancer
1. Cryptorchidism 2. Testicular cancer in c/l testicle 3. Klinefelter syndrome
32
How does correction of Cryptorchidism affect the risk of testicular cancer?
Doesn't remove risk - allows for better surveillance
33
Classification & types of testicular cancer
1. Germinal cell tumors a. Seminoma b. Non-seminoma - Embryonal - Yolk sac - Choriocarcinoma - Teratoma 2. Stromal cell tumors - Leydig cell - Sertoli cell 3. Testicular lymphoma
34
CFs of testicular cancer
1. PAINLESS mass 2. Weight loss 3. Pain in lower abdomen, perineum or scrotum 4. Gynecomastia 5. Hyperthyroidism
35
Symptoms of testicular metastasis
1. Lings - cough, dyspnea 2. Bones- pain 3. Iliac or caval veins - obstruction --> leg swelling 4. GI - N&V, hemorrhage
36
Lab. investigation for diagnosis of testicular cancer
US- hypoechoic intratesticular mass Test to determine histology & extent - CT/MRI of abdo & pelvis - Serum tumor markers - Radical inguinal orchiectomy - definite diagnosis & treatment - Retroperitoneal lymph node dissection
37
What test should never be performed in suspected testicular cancer?
1. Trans-scrotal biopsy 2. Trans-scrotal orchiectomy - can cause local recurrence and/or metastasis
38
Important tumor markers in testicular cancer
1. B-hCG --> Embryonal & Choriocarcinoma 2. AFP --> Yolk sac 3. LDH Measure markers before and after treatment
39
Treatment of testicular cancer
Early stage seminomas - Orchiectomy +/- Chemo & radiation Early stage non-seminomas - Orchiectomy +/- chemo & radiation + Retroperitoneal lymph node dissection
40
Common Chemotherapy used in testicular cancer (BEP)
Bleomycin Etoposide Platinum-containing -- Cisplatin
41
MC type of testicular cancer in males >50
Testicular lymphoma
42
Spermatocele
Cystic structure containing sperm within the epedidymis
43
SxS of Spermatocele
1. Painless scrotal swelling - asymptomatic 2. Palpable mass separate from testis 3. Transilluminates
44
Tx of Spermatocele
- Support - Excision if symptomatic
45
Varicocele
Dilation of pampiniform veins that surround the spermatic cord
46
Causes of Varicocele
1. Blockage of Left spermatic vein as it enters the left renal vein 2. Inc venous pressure
47
Symptoms of Varicocele
1. Asymptomatic 2. Scrotal swelling 3. Aching scrotal pain 4. Sense of fullness in scrotum 5. Testicular atrophy Worse with standing; better by lying down
48
PE of Varicocele
1. "Bag of worms" 2. Inc in size w/ Valsalva 3. Dec in size when supine 4. NO transillumination
49
Management of Varicocele
Supportive Surgery if: 1. Dec sperm count 2. B/l 3. Pain
50
Complication of Varicocele
Infertility - Testicular atrophy - Hypogonadism <-- Inc scrotal temp
51
Hydrocele
Collection of peritoneal fluid between the visceral & parietal layers of tunica vaginalis
52
Types of Hydrocele
1. Communicating - Develops from closure defect of processus vaginalis 2. Non-communicating - Local secretion of fluid - Closed processus vaginalis --> No fluid in abdominal cavity
53
Symptoms of Hydrocele
1. Painless scrotal swelling 2. Scrotal fullness 3. Worsening throughout the day
54
PE findings of Hydrocele
1. Transillumination 2. Com - Inc in size with standing or Valsalva 3. NC- No dec or change in size
55
Diagnosis of hydrocele
1. Palpation 2. Transillumination 3. US
56
Management of Hydrocele
Support Surgery - symptomatic or present >1 year
57
How does spermatocele affect fertility?
No effect

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