14.4 Prostate Flashcards
glands and stroma of prostate are maintained by what homo
androgens
how does prostate present on digital rectal exam in acute prostatitis (2) (HY)
tender and boggy
what bacteria cause acute prostatitis in: (2 each)
young
older
young: Neisseria gonorrhea, Chlamydia trachomatis
old: E. coli, pseudomonas
CP in acute prostatitis (3)? chronic? (2)
acute: fever, chills, dysuria
chronic: dysuria, pelvic or low back pain
What do prostate secretions show in acute prostatitis? chronic?
Acute: WBCs, bacteria
Chronic: only WBCs
what is hypertorphic in BPH (stroma or glands)
both
is BPH normal? increase risk for cancer?
yes normal age-related change
no increased risk for cancer
what homo is acting to cause BPH
DHT
What is DHT derived from and enzyme that converts
5@-reductase converts testosterone to BPH
On what receptor does DHT act in prostate
androgen receptor
what zone of prostate does BPH affect (HY)
central periurethral zone
what kidney issues are assc/czed by BPH (2)
can lead to impaired bladder emptying–> infx, hydronephrosis
what 2 things happen to bladder wall in BPH
hypertrophy of smooth muscle
diverticuli
What is found in urine in BPH
microscopic hematuria
Why is PSA elevated in BPH
proliferation of glands
What is normal function of PSA
to liquify semen
3 drugs used to treat BPH (one is a drug class)
terazosin = alpha-1 antagonist (relaxes sm)
tamsulosin = selective alpha-1 antagonist
5@-reductase inhibitors
which drug would be used to treat BPH in normotensive individuals and why? What receptor?
tamsulosin- doesn’t affect bvs via alpha-1b receptor
whaqt is problem of using 5@-reductase inhibitors (3)
takes months to achieve results
ADEs: gynecomastia, sexual dysfunction
5@-reductase inhibitors are also used to treat what
male pattern baldness
what is MC cancer in men
Prostatic adenocarcinoma
what rank is Prostatic adenocarcinoma in causing cancer-deaths in men
2nd MC
risk factors for Prostatic adenocarcinoma (3)
age, race, diet high in sat fat
rank 3 races in incidence of Prostatic adenocarcinoma
AA > whites > asians
how does Prostatic adenocarcinoma present
it is clinically silent-
why is Prostatic adenocarcinoma clinically silent (HY)
the tumor arises in the peripheral, posterior region of the prostate and doesn’t affect the urethra
what level of PSA is alarming at any age
> 10 ng/ml
Prostatic adenocarcinoma produces what type of PSA and why is this relevant
Prostatic adenocarcinoma produces bound-PSA. Decreased free-PSA % in serum –> suggestive of cancer
What is required to confrim dx of Prostatic adenocarcinoma
bx
What is seen in histo oif prostate in Prostatic adenocarcinoma (HY)
small, invasive glands with PROMINENT NUCLEOLI
what is the Gleason grading system of Prostatic adenocarcinoma based on? what is it NOT based on (HY)
based on architecture alone
NOT based on uclear atypia
lower or higher score in gleason grading system of Prostatic adenocarcinoma = worse px?
higher score
where does Prostatic adenocarcinoma like to spread (2)
lumbar spine or pelvis
osteoblastc metastases in Prostatic adenocarcinoma present in what 4 ways
low back pain elevated: serum alkaline phosphatase PSA PAP- prostatic acid phosphatase
what is serum alkaline phosphatase a sign of? both generally and in Prostatic adenocarcinoma
osteoblastic activity- indicating bone growth generally in Prostatic adenocarcinoma: metastasis
tx for localized in Prostatic adenocarcinoma
prostatectomy
advacned in Prostatic adenocarcinoma is treated with what? for what goal?
hormone suppression to reduce Testosterone and DHT
What 2 drugs treat in Prostatic adenocarcinoma
leuprolide, FLutamide
MOA of lutamide in in Prostatic adenocarcinoma tx
it is a GnRH analog–> shuts down anterior pituitary gland–> decreased LH, FSH –> decreased androgen production
MOA of flutamide in in Prostatic adenocarcinoma tx
competitive inhibitor of androgen receptors
