14.4 Prostate Flashcards
Chronic prostatitis
- clinical presentation (2)
- lab findings
- dysuria
- pelvic/low back pain
- prostatic secretions show WBCs, but cultures are negative.
How to differentiate acute and chronic prostatitis?
- by symptoms
- by lab results
- symptoms:
- both have dysuria
acute: fever/chills
chronic: pelvic/low back pain - lab findings:
- both have WBCs on prostatic secretions
- acute: culture reveals bacteria
- chronic: culture does not reveal bacteria
PSA
-what levels correlate to what disorders?
PSA comes from the # of prostate glands.
PSA 0-4: normal
4-10: slightly elevated (BPH)
>10: worrisome (possible adenocarcinoma)
Benign prostatic hyperplasia
- cause
- location of effect
- increased risk of cancer?
- age related hyperplasia of stroma, glands
- related to DHT (DHT acts on stromal and epithelial cells, resulting in hyperplastic nodules)
- central periurethral zone
- no increased risk of cancer
Prostate adenocarcinoma
- clinical presentation
- location of effect
-usu clinically silent, b/c grows in the periphery in posterior. no early urinary symptoms
Acute prostatitis
-infectious causes (4)
Same as orchitis!
young adults:
- clamydia
- gonnorhea
older adults
- E Coli
- pseudomonas
On DRE, prostate feels tender and boggy
-think what
acute prostatitis
What are the 2 alpha blockers used to tx BPH, and when to use each?
- terazosin–use in pt with HTN
- tamsulosin–use in pt with no HTN (does not block alpha 1 receptors in vessels)
5 alpha reductase inhibitor to tx BPH
- onset of action
- negative side effects (2)
- positive side effect
- months
1. gynecomastia
2. sexual dysfunction
1. reduce male pattern baldness
Prostate:
-contains what 2 tissues
- glands
- secrete alkaline, milky fluid that is added to sperm - stroma
Prostate adenocarcinoma
-risk factors (3)
- most common cancer in men, 2nd most common cause of cancer related death
1. age
2. race (blacks>whites>asians)
3. diet high in sat fats.
Acute prostatitis
- clinical presentation (2)
- DRE finding
- lab findings
- dysuria
- fever, chills
- Prostate is tender and boggy on DRE
- prostatic secretions show WBCs, culture reveals bacteria
Prostate adenocarcinoma
- histology
- on biopsy, how is grading done?
- small, invasive glands with prominent nucleoli
- Gleason grading system used: based on architecture alone, not nuclear atypia. multiple regions need to be assessed b/c architecture varies from area to area
Prostate adenocarcinoma
- tx, localized vs advanced disease
- drugs (2)
localized: prostatectomy
advanced: hormone suppression to reduce T and DHT
1. leuprolide (GnRH analog–inhibits LH,FSH release when given continuous)
2. flutamide (5A reductase inhibitor)
Prostate adenocarcinoma
- describe screening (2)
- what age to start screening
Screening starts age 50
- DRE–feel for enlarged prostate
- PSA– >10 is worrisome at any age.
decreased % of free PSA is suggestive of cancer, b/c cancer makes bound PSA
Free PSA %
Decrease free% PSA is suggestive of cancer, since cancer produces bound PSA
Prostate adenocarcinoma
- most common metastasis regions (2)
- clinical presentation
- lab results of metastasis
- lumbar spine
- pelvis
- results in low back pain from osteoblastic metastases.
- look for increased ALP, PSA, PAP (prostatic acid phosphatase)
- PSA and PAP are serum tumor makers
Benign prostatic hyperplasia
- clinical presentation symptoms (3)
- what is a complication of the bladder wall hypertrophy?
- difficulty starting/stopping urine
- impaired bladder emptying. increased risk of infection and hydronephrosis
- dribbling of urine
- bladder wall smooth m hypertrophies, increasing risk of diverticula
Benign prostatic hyperplasia
-what complications can result from impaired bladder emptying? (2)
- infection
- hydronephrosis
Prostate adenocarcinoma
-what are the serum tumor markers?
- PSA
- PAP (prostatic acid phosphatase)
Benign prostatic hyperplasia
-lab findings (2)
- microscopic hematuria (may be present)
- slightly elevated PSA due to increased # of glands.
PSA normal: 0-4
slight elevation (BPH): 4-10
worrisome (maybe cancer): >10
Benign prostatic hyperplasia
-tx (2 classes)
- alpha blocker
- relax smooth m in prostate
- Terazosin (also lowers BP)
- Tamsulosin (more selective, does not lower BP) - 5A-reductase inhibitors
- reduce DHT. takes months to take effect
