Benign Prostate Hyperplasia Flashcards
what does the prostate gland do?
contributes for 25% of the ejaculation fluid
what is the role of citric acid in ejaculation fluid?
used in oxidative metabolism, which provides sperm with energy.
what is the role of G Proteolytic enzymes in ejaculation fluid?
Examples: prostate specific antigen (PSA), pepsinogen and hyaluronidase
-which help facilitate sperm motility via liquefaction of seminal fluid.
what is the role of G Seminal plasmin in ejaculation fluid?
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.
what is the homologous gland in females for the prostate gland in males?
the scene’s gland
where is the prostate gland found?
at the base of the bladder, surrounding the urethra and adjacent to the rectum
what stimulates the growth of prostate?
rising levels of testosterone at puberty
what does the seminal fluid do?
Functions to enhance motility of sperm
-seminal fluid is thin, milky coloured and alkaline
what are the 5 lobes of the prostate?
- Anterior – Front of urethra, no glands
- Median – Between urethra and ejaculatory ducts; gland rich
- Posterior – Behind urethra; contains glands (- Digital exam)
4and5. Right/Left lateral – either side of urethra; many glands
what are the 4 zones of the prostate?
- transitional
- central
- peripheral
- fibromuscular stroma
where is the transitional zone?
-the smallest part of prostate surrounding the urethra - main location for BPH
where is the central zone?
- Outside the transition zone.
- where the ejaculatory duct is found
where is the peripheral zone?
main part of the prostate and is the common site for prostate cancer
what is prostatitis?
Pain in the perineum, lower abdomen, testicles, penis, and with ejaculation, bladder irritation, bladder outlet obstruction, and sometimes blood in the semen
is benign prostate hyperplasia (BPH) malignant or non-malignant?
non-malignant growth of the prostate
does the size of the prostate affect the symptoms associated with the BPH?
Prostate size doesn’t correlate with degree of obstruction or symptom severity
what is hyperplasia thought to be stimulated by?
dihydrotestosterone
what are the symptoms for BPH?
- lower urinary tract symptoms
- frequency, urgency, straining, complete urinary retention, nocturia
- peak urinary flow rate <10mL/s then subvesical obstruction seen in 90% of patients
what is PSA?
Prostate specific antigen - a glycoprotein enzyme secreted by the epithelial membranes of prostate cells
what does PSA do?
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.
how does PSA circulate in the blood?
in the free form or bound to alpha1-antichymotrypsin
what happens to PSA levels in patients with prostatitis, BPH and prostate cancer?
it becomes elevated
where does BPH affect?
- 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
what 5 factors cause the prostate glands to grow in men?
- age
- tissue remodelling
- hormonal effects
- metabolic effects
- inflammation
what happens in tissue remodelling to cause growth of the prostate glands?
- 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
what is the effect of inflammation within the prostate?
- 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
what is the issue with urinary retention?
- extremely painful
2. Can lead to renal failure, hypertension and chronic UTI.
what are the aims of pharmacological treatment of BPH?
- Reduce smooth muscle tone in the bladder or prostate.
2. Alter the size of the prostate and thereby reduce resistance to urinary flow.
how do alpha blockers work in BPH?
- 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
what are the side effects to alpha-blockers?
- Postural hypotension
- Headache
- Dizziness
- Drowsiness
- Sweating
how does 5alpha-reductase inhibitor work?
- 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)
give 2 examples of 5alpha-reductase inhibitors and how they work?
- Dutasteride inhibits 1 and 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)
what are the side effects to using 5alpha-reductase inhibitors?
- Loss of libido
- Impotence
- Ejaculatory/sexual dysfunction
- Breast tenderness
- decreased PSA
how do phosphodiesterase-5 inhibitors work?
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.
what surgical alternatives are available if medicine isn’t working?
- Transurethral needle ablation (TUNA)
- Transurethral microwave therapy (TUMT)
- Transurethral Electroevaporation of the prostate (TUVP)
- Laser Prostatectomy
- Endoscopy
- Transurethral incision of the prostate (TUIP)
- Transurethral resection of the prostate (TURP)
