Block 5: BPH Flashcards
What is PSA?
Protease that breaks down HMW protein of the seminal coagulum into smaller polypeptides (liquid)
What is BPH?
Enlargement of the prostate gland
What are the causes of BPH?
α1-adrenergic receptors in prostate: causes smooth muscle contraction
DHT: Stimulates prostate tissue growth
What are the static factors of BPH?
- Anatomic enlargement
- Physically blocks the bladder neck thus preventing urine flow
- Depends on androgen stimulation of epithelial tissue
What are the dynamic factors of BPH?
- Excessive α1-adrenergic tone of smooth muscle tissue
- Contraction around urethra leads to decreased urethral lumen
What are the sx of BPH?
Bladder outlet obstruction
Irritative
What are the complications of BPH?
- Refractory urinary retention
- Renal impairment
- Urinary tract infections
- Gross hematuria
- Bladder stones
What are the labs of BPH?
- Increased BUN and sCr
- Elevated PSA level
What produces obstructive voiding sx of BPH?
- Refractory urinary retention
- Renal impairment
- Urinary tract infections
- Gross hematuria
- Bladder stones
What produces irritative voiding sx of BPH?
- Urinary infection, prostatitis
- Bladder cancer
- Bladder calculi
- Nonspecific cystitis
- Uninhibited bladder contractions
How do you diagnose BPH?
- digital rectal examination
- AUA Symptom Score
- u/A-screen for hematuria due to bladder cancer, stones, and infection
- peak and average urinary flow rate
- PVR urine volume
What is the questionaire for BPH?
AUA Symptom Index (AUASI)
What are the medications that worsen BPH?
- Testosterone replacement therapy
- α-adrenergic agonists
- Antihistamines
- caffeine, diuretics
- Tri-cyclic/antidepressants/SNRIs/Phenothiazines
- Antispasmodics
- Anti-parkinson’s medications
What are the tx for BPH?
- Transurethral resection of the prostate
- Open or laser prostatectomy
- Balloon dilation of the urethra
- Urethral stents
Pharm:
First line: Terazosin (Hytrin)
* Doxazosin (Cardura)
* Tamsulosin (Flomax)
5α-reductase inhibitors:
* Finasteride (Proscar)
* Dutasteride (Avodart)
What are the tx goals for BPH?
- Relieve bothersome sx
- Prevent dx progression
How does one choose tx for BPH?
- Symptom severity
- Quality of life
Cause of symptoms(prostate size/PSA):
* Dynamic (smooth muscle; α1-Adrenergic Receptor Antagonists)
* Static (enlarged prostate; 5 alpha reductase)
What is α1-Adrenergic Receptor Antagonists?
Smooth muscle relaxation of bladder neck, prostate capsule and prostatic urethra has NO effect on prostate size =Bothersome symptoms and small prostate or PSA ≤ 1.5 ng/ml
Benefits of using α1-Adrenergic Receptor Antagonists?
- Improve quality of life and decrease symptoms
- Non-uroselective: inexpensive and require dose titration
- Uroselective: increased cost
What are the non-uroselective agents?
- Prazosin (Minipress®)
- Terazosin (Hytrin®)
- Doxazosin § (Cardura®)
- Doxazosin XL § (Cardura XL®)
What are the uroselective agents?
- AlfuzosinXL (Uroxatral®)
- Tamsulosin (Flomax®)
- Silodosin (Rapaflo®)
Compare and contrast 5a reductase inhibitors?
Finasteride
ADR, CI
ADR: Breast tenderness, gynecomastia, hair growth, rash, impotence/decreased libido
CI: children and women, pregnancy
Reestablish baseline after 3 months of use
Dutasteride
MOA, ADR
MOA: inhibits both isoforms (type 1 and 2) of the 5-alpha reductase enzyme, lowers serum PSA
ADR: less effects on breast tissue
Describe BPH tx algorithm?
