Benign Prostate Hyperplasia

Question 1

what does the prostate gland do?

Answer 1

contributes for 25% of the ejaculation fluid

Question 2

what is the role of citric acid in ejaculation fluid?

Answer 2

used in oxidative metabolism, which provides sperm with energy.

Question 3

what is the role of G Proteolytic enzymes in ejaculation fluid?

Answer 3

Examples: prostate specific antigen (PSA), pepsinogen and hyaluronidase
-which help facilitate sperm motility via liquefaction of seminal fluid.

Question 4

what is the role of G Seminal plasmin in ejaculation fluid?

Answer 4

contributes to sperm motility and also has potent antimicrobial activity, thereby reducing the number of naturally occurring bacteria in the ejaculate and the lower section of the female reproductive tract.

Question 5

what is the homologous gland in females for the prostate gland in males?

Answer 5

the scene’s gland

Question 6

where is the prostate gland found?

Answer 6

at the base of the bladder, surrounding the urethra and adjacent to the rectum

Question 7

what stimulates the growth of prostate?

Answer 7

rising levels of testosterone at puberty

Question 8

what does the seminal fluid do?

Answer 8

Functions to enhance motility of sperm

-seminal fluid is thin, milky coloured and alkaline

Question 9

what are the 5 lobes of the prostate?

Answer 9

1. Anterior – Front of urethra, no glands
2. Median – Between urethra and ejaculatory ducts; gland rich
3. Posterior – Behind urethra; contains glands (- Digital exam)
   4and5. Right/Left lateral – either side of urethra; many glands

Question 10

what are the 4 zones of the prostate?

Answer 10

1. transitional
2. central
3. peripheral
4. fibromuscular stroma

Question 11

where is the transitional zone?

Answer 11

-the smallest part of prostate surrounding the urethra - main location for BPH

Question 12

where is the central zone?

Answer 12

• Outside the transition zone.

- where the ejaculatory duct is found

Question 13

where is the peripheral zone?

Answer 13

main part of the prostate and is the common site for prostate cancer

Question 14

what is prostatitis?

Answer 14

Pain in the perineum, lower abdomen, testicles, penis, and with ejaculation, bladder irritation, bladder outlet obstruction, and sometimes blood in the semen

Question 15

is benign prostate hyperplasia (BPH) malignant or non-malignant?

Answer 15

non-malignant growth of the prostate

Question 16

does the size of the prostate affect the symptoms associated with the BPH?

Answer 16

Prostate size doesn’t correlate with degree of obstruction or symptom severity

Question 17

what is hyperplasia thought to be stimulated by?

Answer 17

dihydrotestosterone

Question 18

what are the symptoms for BPH?

Answer 18

1. lower urinary tract symptoms
2. frequency, urgency, straining, complete urinary retention, nocturia
3. peak urinary flow rate <10mL/s then subvesical obstruction seen in 90% of patients

Question 19

what is PSA?

Answer 19

Prostate specific antigen - a glycoprotein enzyme secreted by the epithelial membranes of prostate cells

Question 20

what does PSA do?

Answer 20

has a role in liquefaction of semen by cleaving semenogelins in the seminal coagulum and in dissolving cervical mucus, allowing better penetration of sperm into the female reproductive tract.

Question 21

how does PSA circulate in the blood?

Answer 21

in the free form or bound to alpha1-antichymotrypsin

Question 22

what happens to PSA levels in patients with prostatitis, BPH and prostate cancer?

Answer 22

it becomes elevated

Question 23

where does BPH affect?

Answer 23

• the transitional zone extending to the lateral lobes.
• affects nodules of glands and intervening stroma. Most hyperplasia from glandular proliferation, but the stroma is also increased

Question 24

what 5 factors cause the prostate glands to grow in men?

Answer 24

1. age
2. tissue remodelling
3. hormonal effects
4. metabolic effects
5. inflammation

Question 25

what happens in tissue remodelling to cause growth of the prostate glands?

Answer 25

- the balance between cell growth and apoptosis is disrupted | - Changes in signaling between stromal and epithelial cells may contribute to some of the abnormal growth patterns seen

Question 26

what is the effect of inflammation within the prostate?

Answer 26

- it triggers cytokine release and the resultant healing responses cause a proliferative environment to prevail - potentially leads to hypoxia within the tissue and subsequent angiogenesis to properly perfuse it, this is mediated by VEGF and other growth factors

Question 27

what is the issue with urinary retention?

Answer 27

1. extremely painful | 2. Can lead to renal failure, hypertension and chronic UTI.

Question 28

what are the aims of pharmacological treatment of BPH?

Answer 28

1. Reduce smooth muscle tone in the bladder or prostate. | 2. Alter the size of the prostate and thereby reduce resistance to urinary flow.

Question 29

how do alpha blockers work in BPH?

Answer 29

- work on the alpha 1 and 2 receptors in the bladder causing it to relax and also relaxing the prostate muscles by causing vasoconstriction. - all allowing for easier urine passage - however it does not alter the prostate size which is the main issue

Question 30

what are the side effects to alpha-blockers?

Answer 30

* Postural hypotension * Headache * Dizziness * Drowsiness * Sweating

Question 31

how does 5alpha-reductase inhibitor work?

Answer 31

- reduces prostate volume and increases urine flow by preventing testosterone conversion to dihydrotestosterone. - reduces PSA (but can be an issue for those who may have prostate cancer as may not make it detectable)

Question 32

give 2 examples of 5alpha-reductase inhibitors and how they work?

Answer 32

1. Dutasteride inhibits 1 and 2 2. Finasteride inhibits only 2 (1 is the enzyme predominant in extraprostatic tissues like skin and liver. 2 is the enzyme predominant in the prostate gland)

Question 33

what are the side effects to using 5alpha-reductase inhibitors?

Answer 33

* Loss of libido * Impotence * Ejaculatory/sexual dysfunction * Breast tenderness * decreased PSA

Question 34

how do phosphodiesterase-5 inhibitors work?

Answer 34

PDE5 inhibitors increase intracellular concentrations of cyclic guanosine monophosphate in the smooth muscle of the prostate, the bladder, and their vascular supply. Hence promoting relaxation.

Question 35

what surgical alternatives are available if medicine isn't working?

Answer 35

1. Transurethral needle ablation (TUNA) 2. Transurethral microwave therapy (TUMT) 3. Transurethral Electroevaporation of the prostate (TUVP) 4. Laser Prostatectomy 5. Endoscopy 6. Transurethral incision of the prostate (TUIP) 7. Transurethral resection of the prostate (TURP)