14: Prostate

Question 0

Malignancy- zones

Answer 0

Peripheral

Question 1

BPH- zones

Answer 1

Transitional

Question 2

BPH- lobes

Answer 2

Lateral and Middle

Question 3

Malignancy- lobes

Answer 3

Posterior lobe

Question 4

BPH- physical exam

Answer 4

• Suprapubic area for signs of bladder distention
• External urinary meatus- pus (prostatitis*)
• Conduct a neurological exam for overall sensory and motor deficits
• DRE

Question 5

DRE

Answer 5

Size- fingerbreadth
BHP- Smooth, convex, firm, movable
Malignancy- Hard, fixed, nodules
Prostatitis- pain

Question 6

BPH- lab

Answer 6

Urinalysis
Urine culture
Electrolytes, BUN, creatinine: chronic renal insufficiency
PSA

Question 7

PSA

Answer 7

Normal: +4
BPH: +4 - +10

Question 8

Imaging

Answer 8

Trans rectal US (TRUS)- tumor size, volume

Question 9

International prostate symptom score (IPSS)

Answer 9

0-7: mildly symptomatic- watch and wait
8-19: moderately symptomatic- rx
20-35: severely symptomatic- rx

Question 10

BPH- rx: meds

Answer 10

a adrenergic antagonist
-Tamsulosin** (partial 1a)
-Phenoxybenzamine, Prazosin, Terazosin
5 a reductase inhibitors: Finasteride (Proscar)**
PDE 5 inhibitor: Tadalafil

Question 11

BPH- rx; surgical

Answer 11

Transurethral resection of the prostate (TURP)***
Indications
-acute retention unrelieved by catheterization
-failed voiding trials
-recurrent gross hematuria
-recurrent urinary tract infections

Question 12

Complications of surgery

Answer 12

• Bleeding
• Stricture formation
• Retrograde ejaculation* (MC)
• Erection disorder

Question 13

Spread of mets- Prostate carcinoma

Answer 13

Blood stream

• Bone (back bone)**
• Liver
• Lungs

Question 14

Prostate cancer- dx

Answer 14

• DRE
• PSA (>10)
• TRUS (dark is tumor)
• TRUS guided bx for Gleason score

Question 15

PSA- Density/ Velocity

Answer 15

PSA density = serum PSA/ weight of prostate
-0.15: Prostate CA
PSA velosity (if PSA is 4-10, it needs to be recorded every 3 months)
->0.75ng/mL rise per year is suggestive of CA

Question 16

Radical prostatectomy

Answer 16

• Indicated for CA that is limited to the prostate and has not invaded any other nearby structures
• the entire prostate is removed with seminal vesicles and ampulla of vas deferens

Question 17

Complication of radical surgery

Answer 17

• Bladder incontinence
• Bowel incontinence
• Impotency

Question 18

Radiation therapy

• External-beam radiation therapy
• Interstitial implantation radiation therapy (Brachytherapy- Radioactive seeds)

Answer 18

For localized cancer or CA with localized spread

Question 19

Hormonal therapy

Answer 19

• CA has spread to distant regions
  1: LHRH agonist: stops the production of testosterone (continuous stimulation)
• Leuprolide; Goserelin
  2: Anti-androgen
• Flutamide, Nilutamide

Question 20

Screening rate

Answer 20

For all men >50yrs
-annual DRE
-annual PSA testing
High risk: begin at 40yrs

Question 21

Lycopene- might reduce risk of Prostate CA

Answer 21

• Tomato
• Watermelons
• Pink grapefruit
• Guava
• Papaya

Question 22

Sulforaphane- slow down CA growth process

Answer 22

• Broccoli

- Cauliflower

Question 23

Reduce risk veggies- CA

Answer 23

• Green tea (polyphenols)
• Soy (isoflavone)
• vitE
• Selenium
• vitA