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RGU 3 > BPH and Prostate Cancer, PSA Screening > Flashcards

BPH and Prostate Cancer, PSA Screening Flashcards

1
Q

A 51 y/o caucasian male is at his PCP for his annual physical. He has a family hx of prostate cancer (father, diagnosed at age 74). Would you order a PSA screening for this patient?

A
  • Maybe.
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2
Q

A 57 y/o healthy caucasian male with no hx of prostate cancer. Should you order a PSA?

A
  • Maybe
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3
Q

Should you order a PSA on a 55 y/o African American male with no family history of prostate cancer?

A
  • Maybe
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4
Q

What is PSA?

A
  • serine protease of the kallikrein family primarily produced by prostatic luminal epithelial cells. It cleaves seminogelin (semen liquefaction).
  • found within serum as bound and unbound forms.
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5
Q

What conditions can elevate PSA?

A
  • prostate CA
  • BPH
  • infections (prostatitis, cystitis)
  • ejaculation
  • age
  • manipulation or trauma
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6
Q

What factors can reduce PSA?

A
  • 5-alpha reductase inhibitors
  • low serum testosterone
  • prostatic surgery
  • radiation therapy
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7
Q

Is PSA screening recommended in men over age 70?

A

NO, bc most would die without symptoms due to prostate cancer found at this time.

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8
Q

What are the benefits of PSA screening?

A
  • early detection

- may prolong survival

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9
Q

What are the disadvantages of PSA screening?

A
  • over-detection of indolent disease
  • false positives
  • testing associated with morbidity
  • over-treatment
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10
Q

What did the PLCO trial find?

A
  • no survival benefit for PSA based screening

* flaws however due to pre-screening and contamination in control arm (75% were screened at least once).

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11
Q

What did the ERSPC trial in Europe show?

A
  • 21% reduction in death in screened group

* flaws due to contamination issue

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12
Q

Is there a universal consensus for threshold for “elevated” PSA?

A

NO bc there is a trade off between sensitivity and specificity.
*must be adjusted to age and ethnicity.

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13
Q

How can we better diagnose the high risk cancers without over treating the low risk cancers?

A
  • genetics
  • blood tests
  • aka there are other modalities available.
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14
Q

What is the prostate health index (PHI)?

A
  • mathematical formula that combines total, free, and proPSA to help in your decision making process.
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15
Q

What is the 4K score?

A
  • panel of 4 serum kallikrein markers (tPSA, fPSA, single chain iPSA, and hK2) that can be found in your blood.
  • good test but expensive.
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16
Q

What is ConfirmMDX?

A
  • epigenetic assay of tissue biopsy looking for methylation changes associated with cancer.
  • 96% negative predictive value
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17
Q

What is PCA3?

A
  • urine test that looks at non-coding, large chain RNA that is highly over-expressed in prostate cancer compared with noncancerous prostate tissue.
  • independent of age, prostate volume, and PSA.
18
Q

** What would we expect to see now that the the newest USPSTF guidelines recommend against PSA testing? (TEST QUESTION)

A
  • higher risk of finding patients with advanced stage prostate cancer
19
Q

** What race has the highest risk for prostate cancer? (TEST QUESTION)

A
  • African Americans
20
Q

** To where does most prostate cancer metastasize? (TEST QUESTION)

A
  • bone (osteoblastic)

* NOT lytic

21
Q

** How do you treat localized vs metastatic prostate cancer? (TEST QUESTION)

A
  • localized= localized treatment (active surveillance, surgery, or radiation)
  • metastatic= systemic treatment (chemotherapy)
22
Q

How would you pick up prostate cancer?

A
  • rectal exam (DRE) and abnormal PSA
23
Q

What do symptoms such as bleeding, flank pain, or back pain usually indicate in relation to prostate cancer?

A
  • late stage disease :(
24
Q

What is the trifecta goal of treatment?

A
  • oncologic control
  • maintenance of erectile function
  • continence
25
Q

What are some newer treatment options for metastatic prostate cancer?

A
  • immunotherapy= sipuleucel
  • radium 223
  • abiraterone= CYP17 lyase inhibitor (must be taken with prednisone)
  • enzalutamide= ARB with high affinity for androgen receptor
26
Q

Is surgical therapy generally preferred for older or younger patients with localized cancer?

A
  • YOUNGER
27
Q

Is radiation therapy generally preferred for older or younger patients for localized cancer?

A
  • OLDER (70 and up)
28
Q

What is Benign Prostatic Hyperplasia (BPH)?

A
  • a PHYSIOLOGIC increase in the number of prostatic STROMAL and EPITHELIAL cells that commonly contribute to lower urinary tract symptoms (LUTS) in aging men.
29
Q

What are LUTS?

A
  • symptoms that include poor stream, intermittent stream or hesitancy, terminal dribbling, straining, urgency, nocturia, and sensation of incomplete bladder emptying.
30
Q

Does the size of the prostate always correlate with the degree of symptoms?

A

NO

31
Q

** Where in the prostate does BPH typically occur? (TEST QUESTION)

A
  • the TRANSITIONAL ZONE

* contrast this to prostate cancer which occurs in the peripheral zone.

32
Q

** Will alpha blockers (nonselective= terazosin, doxazosin, alfuzosin; or selective= tamsulosin and silodosin) or tadalafil (PDE5 inhibitor; cialis) affect your PSA? (TEST QUESTION)

A
  • NO
33
Q

** Will 5-alpha reductase inhibitors (finasteride or dutasteride) affect your PSA? (TEST QUESTION)

A
  • YES
34
Q

** What are the indications for surgical treatment for patients with BPH?

A
  • urinary retention
  • UTIs
  • gross hematuria
  • bladder or renal calculi stones
  • renal insufficiency or hydronephrosis
  • failed medical management
35
Q

What is the function of the prostate?

A
  • to secrete certain enzymes into semen to facilitate sperm survival in the female reproductive tract.
  • prostatic secretions have a large concentration of ZINC compared to blood.
  • also aids in emission of semen during ejaculation by contracting around the urethra.
36
Q

What are the main receptors found in the prostatic stroma?

A
  • alpha-1A receptors= contraction of smooth muscle and leads to restriction of urine flow
37
Q

What medications can exacerbate urinary retention?

A
  • anticholinergics (atropine, oxybutynin, dicycloamine, glycopyrrolate…)
  • antihistamines (diphenhydramine, hydroxyzine, chlopheniramine…)
  • antidepressants (TCAs)
  • sympathomimetics (alpha-adrenergic agonists; ephedrine, phenylephrine)
38
Q

What should be on your DDx for a patient that comes in with lower urinary tract symptoms (LUTS)?

A
  • BPH
  • UTI
  • bladder stones
  • neurogenic bladder
  • urethral stricture (scar tissue)
  • bladder cancer
  • urethritis
39
Q

What is a complication associated with the use of selective alpha blockers like Tamsulosin (Flowmax) or nonselective alpha blockers?

A
  • intraoperative floppy iris syndrome (IFIS).

* basically not a problem, but if going to the eye doctor, let them know before any eye surgery.

40
Q

When are 5-alpha reductase inhibitors used?

A
  • in men with larger prostates.

* can combine with alpha blocker

RGU 3 (19 decks)

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