Disorders of the Prostate and Treatment Flashcards
most common benign tumor in men
BPH
What happens pathophysiologically as the prostate gland enlarges?
Increased resistance to urine flow leads to bladder muscle hypertrophy. Predisposes to infection
What are the irritative symptoms of BPH?
frequency, nocturia, urgency
Obstructive symptoms include: hesitancy, weak stream, incomplete emptying, straining, dribble
BPH
What labs should you order for BPH?
UA, Cr, PSA
When is imaging such as IVU, IVP, CT or renal ultrasound ordered to evaluate BPH?
recommended only in the presence of concomitant urinary tract disease, or complications from benign prostatic hyperplasia
Medication primarily used for symptomatic relief of BPH
alpha blockers
Medication class used to reduce prostate size
5-alpha-reductase inhibitors
Most common alternative supplement for BPH
saw palmetto
What are the treatment recommendations for a man who has AUA score <7?
watchful waiting (limit fluids after dinner, avoid decongestants, void frequently)
Indications include refractory acute retention, hydronephrosis, repeated UTIs, recurrent or refractory gross hematuria, or elevated Cr level that responds to catheter drainage
prostatectomy
Most common surgical procedure for BPH
transurethral prostatectomy
Common complication of transurethral prostatectomy
Retrograde ejaculation resulting in infertility
Better surgical option for younger men with smaller prostates; reduces risk for retrograde ejaculation and subsequent infertility
Transurethral Incision of the Prostate (TUIP)
Most common cancer detected in american men and second leading cause of cancer related death. ‘Merica!
prostate
Clinical findings suggestive of prostate cancer
induration at time of DRE and elevated PSA
Most common site of prostate cancer metastases
axial skeleton
standard method for detection of prostate cancer. Taken from the apex, midportion and base of prostate
transrectal-guided biopsy
Most frequently used to stage prostate cancer
transrectal ultrasound
When should you order a bone scan for prostate cancer?
those with advanced local lesions, symptoms of mets, high grade prostate cancer and PSA’s >20
Stage of cancer where tumor is microscopic and confined to prostate but is undetectable by a digital rectal exam (DRE) or by ultrasound
stage T1
Stage of cancer where Tumor is confined to prostate and can be detected by DRE or ultrasound
stage T2
Stage of cancer when it has spread to tissue adjacent to the prostate or to the seminal vesicles
stage T3 or T4
Stage of cancer when it has spread to pelvic lymph nodes, lymph nodes, organs, or bones distant from the prostate
N+ or M+
What stage tumors are candidates for curative therapy with either radiation therapy or radical prostatectomy. Usually external beam radiation therapy
T1 or T2
Benefits of external beam radiation therapy
lower risk of erectile dysfunction and incontinence
involves placing radioactive, rice-sized pellets directly into the prostate gland; the radiation is emitted from within the gland for a specified period of time and then dissipates
brachytherapy
Abx treatment for acute bacterial prostatitis caused by STD
A shot of ceftriaxone followed by a 7-day course of doxycycline
Common symptoms of acute prostatitis that are often not present with chronic prostatitis
perineal pain and exquisite tenderness of the prostate
In men older than 35, what bacteria typically cause prostatitis?
e. coli
Why are men over age 50 who have an enlarged prostate at increased risk for acute bacterial prostatitis?
due to their risk of urinary tract infection
What should you avoid during physical exam if you suspect acute bacterial prostatitis due to risk of sepsis?
prostate massage or DRE
Most common pathogens of chronic bacterial prostatitis
gram-negative rods
Exam findings associated with chronic prostatitis
asymmetrical enlarged prostate that is boggy and tender
Most common form of prostatitis. Presentation is identical to that of Chronic, without any UTI present. Recurrent symptomatic exacerbations, termed male chronic pelvic pain syndrome
nonbacterial prostatitis
Treatment for chronic prostatitis
Bactrim for 2-3 months or cipro for 4 weeks
Can help with symptoms of bacterial and nonbacterial prostatitis in addition to anti-inflammatories and sitz baths
alpha blockers
What is back pain unrelieved or worsened by lying down often associated with?
a tumor
