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14 Male Genital > 14.4 Prostate > Flashcards

14.4 Prostate Flashcards

1
Q

Chronic prostatitis

  • clinical presentation (2)
  • lab findings
A
  1. dysuria
  2. pelvic/low back pain
    - prostatic secretions show WBCs, but cultures are negative.
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1
Q

How to differentiate acute and chronic prostatitis?

  • by symptoms
  • by lab results
A
  1. symptoms:
    - both have dysuria
    acute: fever/chills
    chronic: pelvic/low back pain
  2. lab findings:
    - both have WBCs on prostatic secretions
    - acute: culture reveals bacteria
    - chronic: culture does not reveal bacteria
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1
Q

PSA

-what levels correlate to what disorders?

A

PSA comes from the # of prostate glands.

PSA 0-4: normal

4-10: slightly elevated (BPH)

>10: worrisome (possible adenocarcinoma)

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2
Q

Benign prostatic hyperplasia

  • cause
  • location of effect
  • increased risk of cancer?
A
  • 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
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3
Q

Prostate adenocarcinoma

  • clinical presentation
  • location of effect
A

-usu clinically silent, b/c grows in the periphery in posterior. no early urinary symptoms

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4
Q

Acute prostatitis

-infectious causes (4)

A

Same as orchitis!

young adults:

  1. clamydia
  2. gonnorhea

older adults

  1. E Coli
  2. pseudomonas
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5
Q

On DRE, prostate feels tender and boggy

-think what

A

acute prostatitis

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6
Q

What are the 2 alpha blockers used to tx BPH, and when to use each?

A
  1. terazosin–use in pt with HTN
  2. tamsulosin–use in pt with no HTN (does not block alpha 1 receptors in vessels)
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7
Q

5 alpha reductase inhibitor to tx BPH

  • onset of action
  • negative side effects (2)
  • positive side effect
A
  • months
    1. gynecomastia
    2. sexual dysfunction
    1. reduce male pattern baldness
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8
Q

Prostate:

-contains what 2 tissues

A
  1. glands
    - secrete alkaline, milky fluid that is added to sperm
  2. stroma
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9
Q

Prostate adenocarcinoma

-risk factors (3)

A
  • 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.
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10
Q

Acute prostatitis

  • clinical presentation (2)
  • DRE finding
  • lab findings
A
  1. dysuria
  2. fever, chills
    - Prostate is tender and boggy on DRE
    - prostatic secretions show WBCs, culture reveals bacteria
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11
Q

Prostate adenocarcinoma

  • histology
  • on biopsy, how is grading done?
A
  • 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
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12
Q

Prostate adenocarcinoma

  • tx, localized vs advanced disease
  • drugs (2)
A

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)

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13
Q

Prostate adenocarcinoma

  • describe screening (2)
  • what age to start screening
A

Screening starts age 50

  1. DRE–feel for enlarged prostate
  2. PSA– >10 is worrisome at any age.

decreased % of free PSA is suggestive of cancer, b/c cancer makes bound PSA

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14
Q

Free PSA %

A

Decrease free% PSA is suggestive of cancer, since cancer produces bound PSA

15
Q

Prostate adenocarcinoma

  • most common metastasis regions (2)
  • clinical presentation
  • lab results of metastasis
A
  1. lumbar spine
  2. 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
17
Q

Benign prostatic hyperplasia

  • clinical presentation symptoms (3)
  • what is a complication of the bladder wall hypertrophy?
A
  1. difficulty starting/stopping urine
  2. impaired bladder emptying. increased risk of infection and hydronephrosis
  3. dribbling of urine
    - bladder wall smooth m hypertrophies, increasing risk of diverticula
19
Q

Benign prostatic hyperplasia

-what complications can result from impaired bladder emptying? (2)

A
  1. infection
  2. hydronephrosis
20
Q

Prostate adenocarcinoma

-what are the serum tumor markers?

A
  1. PSA
  2. PAP (prostatic acid phosphatase)
21
Q

Benign prostatic hyperplasia

-lab findings (2)

A
  1. microscopic hematuria (may be present)
  2. slightly elevated PSA due to increased # of glands.

PSA normal: 0-4

slight elevation (BPH): 4-10

worrisome (maybe cancer): >10

22
Q

Benign prostatic hyperplasia

-tx (2 classes)

A
  1. alpha blocker
    - relax smooth m in prostate
    - Terazosin (also lowers BP)
    - Tamsulosin (more selective, does not lower BP)
  2. 5A-reductase inhibitors
    - reduce DHT. takes months to take effect

14 Male Genital (4 decks)

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