80. Prostate (4%) Flashcards
En présence d’un cancer de la prostate, informez-vous des symptômes de quoi ?
d’une récidive locale ou d’envahissement métastatique.
Describe screening PSA
- No screening recommended for all ages as per Canadian Task Force
- Urological associations suggest discussing risks and benefits of PSA screening with patients >50yo (or >40yo if fam hx or african american) with >15y life expectancy
- Use prostate cancer risk calculator with PSA
Can consider PSA screening when ? (4)
- if patient concerned about prostate cancer
- high risk factors
- good health status
- and patient not concerned about risks of urinary incontinence and sexual dysfunction
Name risk factors : BPH
- Age
- obesity
- diabetes
- family history
Name Complications : BPH (5)
- UTI
- bladder stone
- urinary retention
- hydronephrosis
- renal failure
Name : DDx Urinary Retention (8)
- BPH
- Prostate CA
- Urethral stricture
- Urethral diverticulum (women)
- Medication
- Infection
- Trauma
- Neurological (Spinal cord injury)
Describe voiding sx (5)
- predominant in bladder outlet obstruction (BOO) secondary to BPH
- Hesitancy
- Weak Stream
- Intermittence
- Straining
Describe Storage sx (5)
- r/o overactive bladder (OAB)
- Urgency
- Frequency
- Urgency Incontinence
- Nocturia
Describe Postmicturition sx (2)
Dribbling, Incomplete Emptying
Describe : Management of nocturnal polyuria (3)
- Voiding/Frequency chart 2-3 days
- If urine output ≥3L = Decreased intake, aim for urine output 1L
- If nocturnal urine output >33% nocturnal polyuria diagnosed -> Consider Desmopressin
Describe : Management of BPO
Follow IPSS, DRE, PSA (if on 5-ARIs) as response to treatment
Describe investigations for prostate sx (3)
- Urinalysis +/- culture (r/o infection)
- PSA
- PVR if considering anticholinergics (eg. storage symptoms suggesting OAB)
Name score to follow prostate symptoms
International Prostate Symptom Score (IPSS)
Describe scoring : International Prostate Symptom Score (IPSS)
- 0 to 7 points: Mild symptoms
- 8 to 19 points: Moderate symptoms
- 20 to 35 points: Severe symptoms
Describe management BPO sx if MILD (Symptom score <8, or if not bothered by symptoms) (7)
Lifestyle and watchful waiting
* Fluid restriction particularly prior to bedtime
* Avoidance of alcohol, caffeine, spicy foods
* Avoidance/monitoring of some drugs (e.g., diuretics, decongestants, antihistamines, antidepressants)
* Timed or organized voiding (bladder retraining)
* Pelvic floor exercises
* Avoidance or treatment of constipation
* Phytotherapy/herbal medicine (Saw Palmetto) has very weak evidence, although minimal side effects
Describe management BPO sx if MOD-SEVERE (Symptom score <8, or if not bothered by symptoms) (5)
- For smaller prostates, Alpha-blockers alone = Tamsulosin (Flomax) (avoid in sulfa allergy)
- For larger prostates (eg. DRE>25mL or PSA>1.5 ng/dL), combination therapy more effective with **Inhibiteurs de la 5-alpha réductase ** = Finasteride (Proscar)
- After 6-9 months of combination therapy, consider stopping alpha blocker
- Consider addition of PDE-5 inhibitors for LUT symptoms, eg. Tadalafil (Cialis)
- Consider addition of anticholinergics (eg. Tolterodine, Oxybutynin, Mirabegron) especially if component of OAB (storage symptoms), caution if PVR >250mL
Describe : Tamsulosin (Flomax) (5)
- Alpha-blockers
- Rrelax smooth muscle
- Onset 3-5 days
- Avoid in sulfa allergy
- Side effects: Orthostatic hypotension, retrograde ejaculation (ejaculation failure)
Describe : Finasteride (Proscar) (4)
- 5-alpha reductase inhibitors
- Inhibit conversion of testosterone to DHT
- Onset 4-6 months
- Side effects: Decreased libido, erectile dysfunction
When to refer for prostate sx ?
- Failure of symptom control despite combination therapy, for possible Surgery (TURP)
- Complications: Hematuria, recurrent UTIs, urinary retention, renal failure
- Suspect prostate cancer (DRE/elevation in PSA)
When to suspect prostate cancer ?
- PSA<10 low risk (routine), PSA 10-20 (semiurgent referral), PSA>20 high risk (urgent)
- Upgrade urgency if DRE abnormal (firm or irregular)
Describe : Acute Bacterial Prostatitis
Tender prostate
Describe : Chronic Bacterial Prostatitis
Intermittent UTIs with same bacteria
Describe : Chronic Prostatitis / Chronic Pelvic Pain Syndrome
- Inflammatory Chronic Prostatitis
- Non-inflammatory Chronic Prostatitis
Describe : Asymptomatic Inflammatory Prostatitis
Leukocytosis
