14.4 Prostate Flashcards
What is the function of the secretions of the prostate? What maintains the glands?
- Milky fluid that nourishes the sperms
- Androgens maintain it
Acute prostatitis in young adults is usually what? Older adults?
Young = Chlamydia or Gonorrhea
Old = Pseudomonas or E. coli
What are the classic s/sx of acute prostatitis?
Tender/boggy prostate with dysuria, fever, and chills
What do prostatic secretions show on culturing?
WBCs and bacteria
What are the s/sx of chronic prostatitis? What do prostatic secretion cultures show?
- Dysuria with pelvic or LBP
- WBCs on culture, but no bacteria
What is BPH?
Hyperplasia of the prostatic stroma and glands
Is there an increased risk of CA with BPH?
Nah dawg
What is the hormone that is drives to BPH? What cells produce this?
- DHT
- Stromal cells
Where does in the prostate does BPH occur?
Periurethral zone of the prostate
What are the s/sx of BPH?
- Noctura
- Urine dribbling
- Trouble starting and stopping
- Stream is weak
(NUTS)
What are the UA findings of BPH?
Microscopic hematuria
Why is there a slight increase in PSA with BPH?
Increase in prostatic glands
What are the kidney sequelae of BPH?
Hydronephrosis 2/2 backed up urine
What is the MOA of terazosin in the treatment of BPH? Does this have an effect on systemic HTN?
- Alpha-1 antagonist to relax smooth muscle
- Reduces systemic HTN
What is the MOA of Tamsulosin in the treatment of BPH? Does this have an effect on systemic HTN?
- Selective alpha-1A antagonist
- No effects on systemic HTN
What is the MOA of Leuprolide in the treatment of BPH?
continuous GnRH analog that reduces testosterone
What is prostatic adenocarcinoma?
Malignant proliferation of prostatic glands
What is the most common cancer in men?
Prostatic adenocarcinoma
What are the risk factors for prostatic adenocarcinoma? (Age, race, diet)
-Old
African American ethnicity
-Diet high in sat fat
What is the most common location for prostatic adenocarcinoma in the prostate? What does this mean in terms of s/sx?
-Posterior periphery
Since this is far away from the urethra, s/sx do not present until late in the disease course
When does prostate screening begin? What is done?
- age 50
- DRE and PSA
PSA greater than what level is worrisome at any age?
10 ng/dL
Is an increase or decrease in the free PSA in the serum is worrisome for CA? Why?
Decrease in free PSA, since cancer produces bound PSA
What is absolutely required to diagnose prostatic cancer?
Bx
What are the histological characteristics of prostatic cancer?
Glands that invade the tubules, and contain dark nucleoli
What is the Gleason grading system of prostatic cancer based on?
Based on architecture, NOT nuclear atypia
Where does prostate cancer like to spread? What type of lesion is produced here?
Lumbar spine, with osteoblastic mets, thus you get sclerotic lesions
How does prostatic cancer often present?
LBP with increased alk phos, PSA, and Prostatic acid phos (PAP)
What is the difference between osteoblastic and osteolytic lesions?
Osteoblastic produce sclerotic lesions
Osteolytic produces punched out lesions
What is the treatment for local prostate cancer?
Cut it out
What is the MOA of flutamide?
Androgen receptor inhibitor
What is the MOA of leuprolide?
GnRH analog, that is given continuously to inhibit testosterone
