Disorders of the Prostate and Treatment

Question 1

most common benign tumor in men

Answer 1

BPH

Question 2

What happens pathophysiologically as the prostate gland enlarges?

Answer 2

Increased resistance to urine flow leads to bladder muscle hypertrophy. Predisposes to infection

Question 3

What are the irritative symptoms of BPH?

Answer 3

frequency, nocturia, urgency

Question 4

Obstructive symptoms include: hesitancy, weak stream, incomplete emptying, straining, dribble

Answer 4

BPH

Question 5

What labs should you order for BPH?

Answer 5

UA, Cr, PSA

Question 6

When is imaging such as IVU, IVP, CT or renal ultrasound ordered to evaluate BPH?

Answer 6

recommended only in the presence of concomitant urinary tract disease, or complications from benign prostatic hyperplasia

Question 7

Medication primarily used for symptomatic relief of BPH

Answer 7

alpha blockers

Question 8

Medication class used to reduce prostate size

Answer 8

5-alpha-reductase inhibitors

Question 9

Most common alternative supplement for BPH

Answer 9

saw palmetto

Question 10

What are the treatment recommendations for a man who has AUA score <7?

Answer 10

watchful waiting (limit fluids after dinner, avoid decongestants, void frequently)

Question 11

Indications include refractory acute retention, hydronephrosis, repeated UTIs, recurrent or refractory gross hematuria, or elevated Cr level that responds to catheter drainage

Answer 11

prostatectomy

Question 12

Most common surgical procedure for BPH

Answer 12

transurethral prostatectomy

Question 13

Common complication of transurethral prostatectomy

Answer 13

Retrograde ejaculation resulting in infertility

Question 14

Better surgical option for younger men with smaller prostates; reduces risk for retrograde ejaculation and subsequent infertility

Answer 14

Transurethral Incision of the Prostate (TUIP)

Question 15

Most common cancer detected in american men and second leading cause of cancer related death. ‘Merica!

Answer 15

prostate

Question 16

Clinical findings suggestive of prostate cancer

Answer 16

induration at time of DRE and elevated PSA

Question 17

Most common site of prostate cancer metastases

Answer 17

axial skeleton

Question 18

standard method for detection of prostate cancer. Taken from the apex, midportion and base of prostate

Answer 18

transrectal-guided biopsy

Question 19

Most frequently used to stage prostate cancer

Answer 19

transrectal ultrasound

Question 20

When should you order a bone scan for prostate cancer?

Answer 20

those with advanced local lesions, symptoms of mets, high grade prostate cancer and PSA’s >20

Question 21

Stage of cancer where tumor is microscopic and confined to prostate but is undetectable by a digital rectal exam (DRE) or by ultrasound

Answer 21

stage T1

Question 22

Stage of cancer where Tumor is confined to prostate and can be detected by DRE or ultrasound

Answer 22

stage T2

Question 23

Stage of cancer when it has spread to tissue adjacent to the prostate or to the seminal vesicles

Answer 23

stage T3 or T4

Question 24

Stage of cancer when it has spread to pelvic lymph nodes, lymph nodes, organs, or bones distant from the prostate

Answer 24

N+ or M+

Question 25

What stage tumors are candidates for curative therapy with either radiation therapy or radical prostatectomy. Usually external beam radiation therapy

Answer 25

T1 or T2

Question 26

Benefits of external beam radiation therapy

Answer 26

lower risk of erectile dysfunction and incontinence

Question 27

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

Answer 27

brachytherapy

Question 28

Abx treatment for acute bacterial prostatitis caused by STD

Answer 28

A shot of ceftriaxone followed by a 7-day course of doxycycline

Question 29

Common symptoms of acute prostatitis that are often not present with chronic prostatitis

Answer 29

perineal pain and exquisite tenderness of the prostate

Question 30

In men older than 35, what bacteria typically cause prostatitis?

Answer 30

e. coli

Question 31

Why are men over age 50 who have an enlarged prostate at increased risk for acute bacterial prostatitis?

Answer 31

due to their risk of urinary tract infection

Question 32

What should you avoid during physical exam if you suspect acute bacterial prostatitis due to risk of sepsis?

Answer 32

prostate massage or DRE

Question 33

Most common pathogens of chronic bacterial prostatitis

Answer 33

gram-negative rods

Question 34

Exam findings associated with chronic prostatitis

Answer 34

asymmetrical enlarged prostate that is boggy and tender

Question 35

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

Answer 35

nonbacterial prostatitis

Question 36

Treatment for chronic prostatitis

Answer 36

Bactrim for 2-3 months or cipro for 4 weeks

Question 37

Can help with symptoms of bacterial and nonbacterial prostatitis in addition to anti-inflammatories and sitz baths

Answer 37

alpha blockers

Question 38

What is back pain unrelieved or worsened by lying down often associated with?

Answer 38

a tumor