exam 2 Flashcards
What are the signs of urinary irritation?
- Urgency (need to pee now)
- Increased fq
- nocturia (need to pee at night
- dysuria (painful urination)
- incontinence due to urgency
What are the signs of urinary obstruction?
- hesitancy (trouble starting urination)
- weak or interupted stream
- incomplete emptying (feeling that bladder is still full after emptying.
- incontinence due to overflow from a distended bladder.
What are the clinical values that indicate prostate cancer?
abnormal prostate-specific antigen (PSA)
digital rectal exam
How long does it take from the develpement of cancer in situ (CIS) to clinical presentation of prostate cancer?
11-12 years
What % of suspucious looking prostatic nodules are actyally malignant?
50%
Typical age of men with prostate cancer?
65+ (true in 90% of cases)
What % of semen volume come from the protsate?
80%
What are the symptoms of BPH?
- weak urine stream/decreased caliber
- hesitancy starting
- incomplete voiding
- double voiding
- straining to empty bladder
- dysuria (painful urination)
- increased fq
- increased urgency
- nocturia
What are the signs of BPH?
- palpable bladder during abdominal exam
- symmetric prostate enlargment
- prostate palpates smooth/rubbery
- hematuria
- Palpates boggy, firm, but elastic
after what age should yearly screening for prostate cancer start? What should be done?
Age 50.
Prostate exam and PSA screening
What is a normal finding on a Digital rectal exam?
- prostate is symmetrical
- it is the consistency of a pencil eraser
- 1cm protrusion into the rectum
- median sulcus is palpable
What will you find during a digital rectal exam if the patient has BPH
- boggy
- smooth and rubbery
- more than 1cm protrusion
- symmetrical
- median sulcus may or may not be obliterated
What will you find during a digital rectal exam is the pt has prostate cancer?
- stony, hard, irregular nodule
- asymmetrical
- 1cm protrusion into the rectum
- median sulcus obliterated
Look at slides 23-25
did you do it yet?
where does BPH normal begin?
In the transition zone
Where is the transition zone?
it is the ring ot tissue that surrounds the urethra
Where does prostate cancer usually begin?
in the peripheral zone and grows outward.
What are the 4 areas of the prosate
- anterior fibromuscular area
- peripheral zone
- transitional zone
- central zone
break down where prostate cancer starts
70% peripheral
15-20% central
10-15% transition
What is AIPC?
Androgen independent prostate cancer
cancer cells do no depend on androgen for growth
What is ADPC?
Adrogen dependent prostate cancer
cells depend on androgens for continued cell growth
What is the gleason grading system
a system that assigns a grade to each of the 2 largest areas of cancer in the tissue samples
values range from 1-5 (b-m) values are added together to come up with the gleason score 2-4 = low (slow) 5-7 = med 8-10 = high (fast)
Define grade 1 gleason grade.
well differentiated
unifomly spaced circular acini in a circumscribed compact mass
define grade 2 gleason grade
well differentiated
acini are arranged more loosely
irregular shape
some acini invade neighboring tissue
define grade 3 gleason.
most common
moderately differentiated
acini varying in size from small to large
many acini invade neghboring tissue
define grade 4 gleason
poorly differentiated
unable to sepearte acinar units
highly irregular and distorted shapes
progressive invasion of neighboring tissue
define grade 5 gleason
cancer is undifferentiated
bears no resemblance to normal prostate cells
cells are unable to form acinar units
What is the PSA test?
a blood test that measures the level of prostate specific antigen, which is a protin that is make by the prostate gland. This protin natually leaks out into the blood stream.
What PSA values are we generally concerned with?
4-10ng/cu.mm = 22% of biopsies show cancer
> 10ng/cu.mm = 66% of prostate biopsies show cancer
note the “cut off” goes up with age
What is a better test than just a PSA test?
- PSA density test: serum PSA/Prostate volume
Prostate volume from TRUS (transrectal ultasonography)
- PSA Velocity test
greater than .75 ng/ml per yaer increase is considered clinically signigicant
does free or bound PSA increase more in BPH?
Free
does free or bound PSA increase more in Prostate cancer?
protein bound
What are the 2 surgical procedues to enlarge the urethra in BPH?
TURP
TUIP
aside from PSA, what other blood test could indicate prostate cancer?
Prostate Acid Phosphasate
what is cryoablation
technique of freezing prostate sections as a therapy
What is Nadir
the lowest PSA level acieved after prostate cancer treatment – usually 2ng/ml or less is needed to be considered in remission
what is brachytherapy?
radiotheraphy treatment with ionizing radiation whose source is applied to the surface of the body or is located a short distance from the body area being treated
What are the three main stages of cancer development?
- Initiation (ionizion radiaiont, visruses, enviomental factors, ect)
- Promotion (elevated IGF-1 levels, high concumption of animal fats, dietary deficency of protective factors such as vit C, D, E, or essentila fatty acitds
- Proliferatoin (prolonged exposute to DHT, estrogesnts, agen orange, xenobiotics, obesity, high insulin resistance
What are the suggestions for a natural approch to prostate problems?
- Chiro
- saw palmetto
- green tea
- zinc
- PC-SPES Herbal Formula
- Beta-Sitosterol
- Pygeum afticanum
- get rid of mercury fillings
- good water
- exercise
- avoid xenoestrogent
- increase number of ejaculations
- colon cleansing
What 3 amino acids are recommended for a natural approach to prostate problems?
glycine
alanine
glutamic acid
What glands secrect testosterone?
mostly testes
some from adrenal glands
What is testosterone converted to? by what enzyme?
DTH
by 5 alpha-reductase
What is the major factor in BPH and prostate cancer?
DHT (Dihydrotestosterone)
What is more powerful, DTH or testosterone?
DTH (5x more potent)
What is the avarage doubling time for prostate cancer tumor?
2-5 years
Where does prostate cancer metasizes to?
bones of the pelvis, upper legs, and lower spine
all bones of the body
urinary bladder/lymph nodes
25 yo male presents with fever, malaise, pain upon urination, hesitancy, tenderness at prostate during DRE, low back pain.
Ultrasound shows no prostatic enlargement. PSA is normal.
Prostatitis
What are the symptoms of prostatitis?
- dysuria
- difficulty urinating (dribbling/hestiant)
- noctuia
- urgency
- abdominal, groin, low back pain
- pain in the perineum
- pain in the penis or testicles
- painful ejaculations
What are the three possible pathophsilogies of prosatits?
- ascending infection from infected urethra
- direct or lymphatic spread from rectum
- hematogenous spread
what are the risk factors for prosatitis?
- catheters
- infected sexual contacts
- bladder outlet obstructins
- supressed immune system
- diabetes mellitus
what does prostities feel like on palpation?
warm, boggy, tender
What are the signs/symptoms of acute bacterial prostatisis?
high fever chills nausea vomiting generally feel unwell
What are the causes or ED?
vascular disease diabetes drugs hormone disorders neurologic disorders pelvic trama, surgry, radiation peyronie's disease venous leak psychological problems enlarged prostate
obesity tabacco use alcoholism anabolic steroids heroin marijuana
what percentage of couples in the US that want children can’t have them?
14%
what is hypospadia?
when the urethral meatus opens on the ventral side of the penis proximal to the tip of the glans penis
What will increase the likelyhood of hypospadia?
estrogent/progestin exposure to the mother during pregnancy
what are the types of hypospadia?
- glandular - slightly prox to normal opening
- coronal - on the coronal sulcus
- penile shaft
- penoscrotal - at penis and scrotum juntion
- perineal - below scrotum in the perineum
What are the most common types of hypospadia?
glandular and coronal (make up 70%)
