14.4 Prostate

Question 1

glands and stroma of prostate are maintained by what homo

Answer 1

androgens

Question 2

how does prostate present on digital rectal exam in acute prostatitis (2) (HY)

Answer 2

tender and boggy

Question 3

what bacteria cause acute prostatitis in: (2 each)
young
older

Answer 3

young: Neisseria gonorrhea, Chlamydia trachomatis
old: E. coli, pseudomonas

Question 4

CP in acute prostatitis (3)? chronic? (2)

Answer 4

acute: fever, chills, dysuria
chronic: dysuria, pelvic or low back pain

Question 5

What do prostate secretions show in acute prostatitis? chronic?

Answer 5

Acute: WBCs, bacteria
Chronic: only WBCs

Question 6

what is hypertorphic in BPH (stroma or glands)

Answer 6

both

Question 7

is BPH normal? increase risk for cancer?

Answer 7

yes normal age-related change

no increased risk for cancer

Question 8

what homo is acting to cause BPH

Answer 8

DHT

Question 9

What is DHT derived from and enzyme that converts

Answer 9

5@-reductase converts testosterone to BPH

Question 10

On what receptor does DHT act in prostate

Answer 10

androgen receptor

Question 11

what zone of prostate does BPH affect (HY)

Answer 11

central periurethral zone

Question 12

what kidney issues are assc/czed by BPH (2)

Answer 12

can lead to impaired bladder emptying–> infx, hydronephrosis

Question 13

what 2 things happen to bladder wall in BPH

Answer 13

hypertrophy of smooth muscle

diverticuli

Question 14

What is found in urine in BPH

Answer 14

microscopic hematuria

Question 15

Why is PSA elevated in BPH

Answer 15

proliferation of glands

Question 16

What is normal function of PSA

Answer 16

to liquify semen

Question 17

3 drugs used to treat BPH (one is a drug class)

Answer 17

terazosin = alpha-1 antagonist (relaxes sm)
tamsulosin = selective alpha-1 antagonist
5@-reductase inhibitors

Question 18

which drug would be used to treat BPH in normotensive individuals and why? What receptor?

Answer 18

tamsulosin- doesn’t affect bvs via alpha-1b receptor

Question 19

whaqt is problem of using 5@-reductase inhibitors (3)

Answer 19

takes months to achieve results

ADEs: gynecomastia, sexual dysfunction

Question 20

5@-reductase inhibitors are also used to treat what

Answer 20

male pattern baldness

Question 21

what is MC cancer in men

Answer 21

Prostatic adenocarcinoma

Question 22

what rank is Prostatic adenocarcinoma in causing cancer-deaths in men

Answer 22

2nd MC

Question 23

risk factors for Prostatic adenocarcinoma (3)

Answer 23

age, race, diet high in sat fat

Question 24

rank 3 races in incidence of Prostatic adenocarcinoma

Answer 24

AA > whites > asians

Question 25

how does Prostatic adenocarcinoma present

Answer 25

it is clinically silent-

Question 26

why is Prostatic adenocarcinoma clinically silent (HY)

Answer 26

the tumor arises in the peripheral, posterior region of the prostate and doesn't affect the urethra

Question 27

what level of PSA is alarming at any age

Answer 27

> 10 ng/ml

Question 28

Prostatic adenocarcinoma produces what type of PSA and why is this relevant

Answer 28

Prostatic adenocarcinoma produces bound-PSA. Decreased free-PSA % in serum --> suggestive of cancer

Question 29

What is required to confrim dx of Prostatic adenocarcinoma

Answer 29

bx

Question 30

What is seen in histo oif prostate in Prostatic adenocarcinoma (HY)

Answer 30

small, invasive glands with PROMINENT NUCLEOLI

Question 31

what is the Gleason grading system of Prostatic adenocarcinoma based on? what is it NOT based on (HY)

Answer 31

based on architecture alone | NOT based on uclear atypia

Question 32

lower or higher score in gleason grading system of Prostatic adenocarcinoma = worse px?

Answer 32

higher score

Question 33

where does Prostatic adenocarcinoma like to spread (2)

Answer 33

lumbar spine or pelvis

Question 34

osteoblastc metastases in Prostatic adenocarcinoma present in what 4 ways

Answer 34

``` low back pain elevated: serum alkaline phosphatase PSA PAP- prostatic acid phosphatase ```

Question 35

what is serum alkaline phosphatase a sign of? both generally and in Prostatic adenocarcinoma

Answer 35

osteoblastic activity- indicating bone growth generally in Prostatic adenocarcinoma: metastasis

Question 36

tx for localized in Prostatic adenocarcinoma

Answer 36

prostatectomy

Question 37

advacned in Prostatic adenocarcinoma is treated with what? for what goal?

Answer 37

hormone suppression to reduce Testosterone and DHT

Question 38

What 2 drugs treat in Prostatic adenocarcinoma

Answer 38

leuprolide, FLutamide

Question 39

MOA of lutamide in in Prostatic adenocarcinoma tx

Answer 39

it is a GnRH analog--> shuts down anterior pituitary gland--> decreased LH, FSH --> decreased androgen production

Question 40

MOA of flutamide in in Prostatic adenocarcinoma tx

Answer 40

competitive inhibitor of androgen receptors