[Exam 1] Chapter 59: Assessment and Management of Patients with Male Reproductive Disorders Flashcards
Cancer of Prostate: Most common cancer in men other than
nonmelanoma skin cancer
Cancer of Prostate: Who has the highest risk of prostate cancer?
Blacks, and twice as likely to die.
Cancer of Prostate: Risk factors for this?
Increasing age, and those who have father or brother previously diagnosed
Cancer of Prostate: Genes that may be associated with this?
HPC1 and BRCA1/BRCA2 mutations.
Cancer of Prostate: What diet increases chances of this
those with excessive amounts of red meat or datiry products high in fat.
Cancer of Prostate, CMs: What signs may happen if cancer is large enough?
Signs of urinary obstruction may occur. Also may be blood in urine.semen and painful ejaculation. Hematuria may occur in urethra invaded.
Cancer of Prostate, CMs: What is common before diagnosis made?
Sexual dysfunction
Cancer of Prostate, CMs: This can spread where?
To lymph nodes and bone.
Cancer of Prostate, CMs: Symptoms of metastases?
Backache, hip pain, perineal and rectal discomfort , anemia, weight loss, weakness, oliguria, and spontaneous pathologic fractures.
Cancer of Prostate, Assess/Diagnostic: How can this be diagnosed?
Through an abnormal finding with DRE, Serum PSA< and Ultrasound-guided TRUS with biopsy.
Cancer of Prostate, Assess/Diagnostic: Why is routine repeated DRE important?
Because early cancer may be detected as nodule within gland or as extensive hardening on posterior lobe.
Cancer of Prostate, Assess/Diagnostic: Diagnosis of prostate cancer confirmed how
by histologic exam of tissue removed surgically by TURP, prostatectomy or ultrasound-guided transrectal needle biopsy.
Cancer of Prostate, Assess/Diagnostic: Why is fine-needle aspiration great?
Because it is quick, painless method of obtaining prostate cells.
Cancer of Prostate, Assess/Diagnostic: When are most prostate cancers detected?
When man seeks medical attention for symptoms of urinary obstruction or found by routine DRE and PSA.
Cancer of Prostate, Assess/Diagnostic: What levles of DRE and PSA may arise suspicion?
Abnormal DRE and elevated levels of PSA
Cancer of Prostate, Assess/Diagnostic: What does TRUS help detect?
Nonpalpable prostate cancers and helps assist with staging localized prostate cancer. Needle biopsies of prostate guided by TRUS.
Cancer of Prostate, Assess/Diagnostic: Most commonly used tumor grading system?
Gleason score. Scores it 1-5 for most predominant pattern of glands and secondary grae of 1-5 to the second most predominant pattern. Lower scores indicate well-differentiated and less aggressive tumor cells.
Cancer of Prostate, Assess/Diagnostic: Categorization of low, intermediate, and high risk prostate cancer determined by what
extent of cancer in prostate gland, whether it is localized , aggressiveness of cells, and spread to lymph nodes.
Cancer of Prostate, Assess/Diagnostic: What may be used to identify metastatic bone disease?
Bone scans, skeletal x-rays, and MRI
Cancer of Prostate, Assess/Diagnostic: What can be done to see if its spread to lymph nodes?
Pelvic computed tomography (CT) scan.
Cancer of Prostate, Assess/Diagnostic: What antibody can eb used to detect either recurrent prostate cancer at low PSA levels or metastatic disease?
radiolabeled monoclonal antibody capromab pendetide with indium 111
Cancer of Prostate, Medical Mx: Treatment based on what?
Patients life expectancy, symptoms, risk of recurrent, size of tumor, and psa levels.
Cancer of Prostate, Medical Mx: What is done when a patient chooses a nonsurgical watchful waiting?
They actively monitor the course of disease and intervening only if cancer progresses. For those with less than 5 years to live.
Cancer of Prostate, Medical Mx: Advantage of nonsurgical watchful waiting?
Absence of SE, improved quality of life, and avoidance of unneccessary treatment.
Cancer of Prostate, Medical Mx: What do therapeutic vaccines do?
Kill existing cancer cells and provide long-lasting immunity. Sipuleucel-T is used, a long with zbiraterone (zytiga) and cabaziaxel (jevtana)
Cancer of Prostate, Medical Mx, Surgical Mx: What is the first line of treatment?
Radical prostatectomy, and when its confined to the prostate. This is the complete surgical removal of prostate, seminal vesicles, tips of vas deferns and surrounding fat.
Cancer of Prostate, Medical Mx, Surgical Mx: Why is a laparoscopic radical prostatectomy preferred?
Results in low morbidity and more favorable postoperative outcomes, including less sexual dysfunction.
Cancer of Prostate, Medical Mx, Radiation Therapy: What are the two types?
Teletherapy (external) and brachytherapy (internal)
Cancer of Prostate, Medical Mx, Radiation Therapy: When is teletherapy prescribed?
For total dose over a certain time frame (28 tx over 5.5 weeks). For patients with low-risk prostate cancer.
Cancer of Prostate, Medical Mx, Radiation Therapy: Patients with intermediate and high-risk cancers may be candiates for what?
pelvic lymph node irradiation anda ndrogen deprivation therapy that entails surgical or medical castration.
Cancer of Prostate, Medical Mx, Radiation Therapy: What is intensity modulated radiation therapy (IMRT)?
Sets a dose for the target volume and restricts teh dose to surrounding tissue.
Cancer of Prostate, Medical Mx, Radiation Therapy: What is Brachytherapy?
Implantation of interstitial radioactive seeds under anesthesia. 80-100 seeds planted, then returns home, should aovid pregnant women.
Cancer of Prostate, Medical Mx, Radiation Therapy: Radiation safety guidelines for someone using brachytherapy?
Strainign urine for 2 weeks after implantation to catch seeds that pass.
Cancer of Prostate, Medical Mx, Radiation Therapy: What effects may be experienced with brachytherapy?
Inflammation of rectum, bowel, bladder because of promixity of these structures to prostate.
Cancer of Prostate, Medical Mx, Radiation Therapy: What can cause acute urinary dysfunction with brachytherapy?
inflammation and mucosal loss at the bladder neck, prostate, adn urethra.
Cancer of Prostate, Medical Mx, Radiation Therapy: Late side effects of brachytherapy?
Rectal proctitis ,bleeding, rectal fistula, painless hematuria, and erectile dysfunction.
Cancer of Prostate, Medical Mx, Hormonal Strategies: What is ADT?
Commonly used to suppress androgenic stimuli to the prostate by decreasing circulating plasma testosterone or interrupting the conversion to or bidning of DHT. Prostatic epithelium then atrophies (decreases size)
Cancer of Prostate, Medical Mx, Hormonal Strategies: How is the effect of prostatic epithelium atrophing accomplished?
Surgical castration (bilateral orchiectomy, removal of one or both testes), or medical castration through medsd.
Cancer of Prostate, Medical Mx, Hormonal Strategies: LHRH agonists include what?
Leuprolide and Goserelin.
Cancer of Prostate, Medical Mx, Hormonal Strategies: Why may additional hormonal manipulation be prescribed?
For patients who do not show adequate serum testosterone suppression with medical or surgical castration.
Cancer of Prostate, Medical Mx, Hormonal Strategies: What do LHRH and Antiandrogen receptor antagonsits do?
LHRH = Suppress testicular androgen
Antiandrogen receptor antagonists = cause adrenal androgen suppression.
Cancer of Prostate, Medical Mx, Hormonal Strategies: What happens when LHRH agonists are initiated?
Testosterone flare may occur, causing pain in bony metastatic disease. Antiandrogens given for first 7 days may reduce this uncomfortable symptom.
Cancer of Prostate, Medical Mx, Hormonal Strategies: Most common uses of LHRH?
- In adjuvant and neoadjuvant setting
- After radical prostatectomy
- In treatmetn of recurrent indicated by elevation in PSA.
Cancer of Prostate, Medical Mx, Hormonal Strategies: Hypogonadism is responsible for adverse effects of ADT, which include what
vasomotor flushing, loss of libido, decreased boen density, anemia, fatigue, and increased fat mass.
Cancer of Prostate, Medical Mx, Hormonal Strategies: Hypogonadism is associated with what
an increased risk of diabetes, resulting from insulin resistance, metabolic syndrome, and cardiovascular disease
Cancer of Prostate, Chemotherapy: REcent studies have shwon benefits for survival with chemotherapy treatment that includes what
a docetaxel-based regimen for androgen-dependent prostate cancer
Cancer of Prostate, Chemotherapy: Tumor angiogenesis is essential for what?
For tumor growth, so that is why antiangiogenic treatment play a role in treatment.
Cancer of Prostate, Other Therapies: What is Cryosurgery?
Used to ablate prostate cancer in patients who cannot tolerate surgery and in those with recurrent prostate cancer. TRansperineal probes inserted into prostate under ultrasound to freeze tissue directly.
Cancer of Prostate, Other Therapies: What can be done if there is bone pain from metastisis?
Opioid and nonopioid meds can be used, a long with EBRT that can be delivered to skeletal lesions.
Cancer of Prostate, Other Therapies: Why may bisphosphonate therapy be given?
To reduce the risk of pathologic fracture.
Patient Undergoing Prostate Surgery: Objectives before prostate surgery include
assess patient genral ehalth status and establish optimal kidney function.
Patient Undergoing Prostate Surgery: What procedures can be done to remove the hypertrophies portion of prostate gland?
TURP, suprapubic prostatectomy, perineal prostatectomy, retropubic prostatectomy, TUIP, and laparoscopic radical prostatectomy.
Patient Undergoing Prostate Surgery, TURP: How does this work?
Carried out through endoscopy. PRostate gland removed in small chips with electrical cutting loop.
Patient Undergoing Prostate Surgery, TURP: What does this method eliminate?
transurethral resection syndrome (hyponatremmia and hypovolemia