BPH

Question 1

Which zone of the prostate accounts for 70% of the volume?

Answer 1

Peripheral Zone

Question 2

The central zone accounts for what percentage of prostate volume?

Answer 2

25%

Question 3

The transition zone makes up what petcentage of prostate volume?

Answer 3

5%

Question 4

What is the most common benign tumor in men?

Answer 4

BPH

Question 5

The prevalence of histologic BPH in autopsy studies rises from: __ % in men aged 41-50, __% in men 51-60, and >__% in men older than 80 years.

Answer 5

20%
50%
>90%

Question 6

At age 55, what percentage of men report obstructive voiding symptoms?
A) 10%
B) 25%
C) 35%

Answer 6

B) 25%

Question 7

At age 75, what percentage of men report obstructive voiding symptoms?
A) 50%
B) 60%
C) 75%

Answer 7

A) 50% of men over 75 report a decrease in the force and caliber of their stream

Question 8

Approximately 50% of men younger than 60 who undergo surgery for BPH may have a heritable form of disease. This is most likely an autosomal dominant trait, and first-degree male reliatives of these patients carry an increased relative risk of approximately how much?

A) twofold
B) threefold
C) fourfold

Answer 8

C) fourfold increased relative risk of developing BPH

Question 9

True or False: BPH etiology seems to be multifactorial and endocrine controlled.

Answer 9

True. Castration results in the regression of established BPH and improvement in urinary symptoms. Other studies have shown a positive coorelation between levels of free testosterone and estrogen and the volume of BPH.

Question 10

BPH uniformly originates in this zone of the prostate?
A) central zone
B) transition zone
C) peripheral zone

Answer 10

B) transition zone

Question 11

Under microscopic evaluation, BPH is a nodular growth pattern that is composed of varying amounts of these two types of tissue.

Answer 11

Stroma and epithelium.

Question 12

Stroma is composed of carying degrees of these two things.

Answer 12

Collagen and smooth muscle.

Question 13

Would an alpha blocker be more beneficial in a patient with BPH that is composed of mostly smooth muscle or mostly epithelium?

Answer 13

Mostly smooth muscle. Terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) are all examples of Alpha blockers. These medications block norepinephrine from activating the alpha 1 receptors, causing widening of the blood vessels. This increases the free flow of blood and decreases blood pressure. These receptors also cause relaxation of the smooth muscle in the prostate and improve urine flow in patients with benign prostatic hyperplasia.

Question 14

A patient who has BPH predominately composed of ________ might respond better to a 5a-reductase inhibitor like finasteride.

Answer 14

Epithelium. 5a-reductase inhibitors block the conversion of testosterone (T) to dihydrotestosterone (DHT) and are efficacious in the treatment of LUTS due to prostate enlargement.

Question 15

BPH patients who have a significant amount of this in the stroma may not reapind to alpha blockers or 5a-reductase inhibitors.

Answer 15

Collagen

Question 16

BPH symptoms can be divided into these two categories.

Answer 16

Obstructive symptoms: hesitancy, decreased force and caliber of stream, sensation of incomplete bladder emptying, double voiding, straining, postvoid dribble.

Irritative or storage symptoms: frequency, urgency, nocturia.

Question 17

True or false: Prostate size on DRE coorelates poorly with symptoms of BPH.

Answer 17

True. The median lobe of the prostate is not readily palpated.

Question 18

What are some other differential diagnosis to rule out when a man complains of BPH symptoms?

Answer 18

Urethral stricture, bladder neck contracture, bladder stone, prostate cancer, bladder cancer, UTI, neurogenic bladder (may have neurogenic disease, stroke, DM, back injury).

Question 19

Name two common long acting alpha 1-blockers used for BPH.

Answer 19

Terazosin- 1mg x 3 days, then 2mg x 11 days, then 5mg PO OD, can go to 10mg PO OD.

Doxazosin- 1mg x 7 days, then 2mg x 7 days, then 4mg PO OD, can go to 8mg PO OD.

• It is important to titrate these long acting alpha-1 blockers, because they can cause more systemic side effects (like cardiovascular). This is because they are less selective in comparison to the alpha 1a receptors.

Question 20

What are some possible side effects of long-acting alpha-1 blockers like terazosin and doxazosin?

Answer 20

OH, dizziness, tiredness, retrograde ejaculation, rhinitis, headache.

Question 21

Name 3 selective alpha-1a blocking medications used in BPH.

Answer 21

Tamsulosin (flomax)- 0.4mg OD
Alfuzosin- 10mg OD
Silodosin- 8mg OD

Question 22

Name two areas of the body specific to BPH that contain a1-adrenoreceptors.

Answer 22

Human prostate and bladder base.

The contractile properties of the prostate and bladder neck seem to be mediated primarily by the subtype alpha-1a adrenoreceptors.