Exam 3 - Male Reproductive Flashcards
risk factors for testicular cancer
- family history
- Caucasian
- cryptorchidism
- HIV infection
germ cell tumors
- seminomas
- noseminomas
seminomas
- arise from immature germ cells
- slow growing, nonaggressive
- easily cured with radiation
nonseminomas
- arise from mature germ cells
- more aggressive
- usually treated with surgery
early clinical manifestations of testicular cancer
- enlargement of testicle
- painless mass noted
- ache in groin
- sensation of heaviness
late clinical manifestations of testicular cancer
- possible frank pain
- manifestations based on metastatic spread:
- cough
- hemoptysis
- swelling of lower extremities
- back pain
- dizziness
the prostate
- gland surrounding the urethra
- produces seminal fluids
- weighs between 4-20 gm
definition of benign prostatic hyperplasia (BPH)
- nonmalignant enlargement of prostate
- increase of epithelial cells
- increase of smooth muscle cells
- stroll cells
- LUTS: lower urinary tract symptoms
risk factors of BPH
- age
- family history
- race/ethnicity
BPH etiology - two theories
- hormone imbalance
- testosterone and estrogen - DHT accumulation
DHT accumulation
- dihydrotestosterone
- acts on skin: acne
- acts on hair follicles: hair on chest BUT off scalp
- stimulates growth of prostate cells
BPH clinical manifestations
- frequency and urgency
- delay in initiation
- reduction in force
- increased urination time
- dribbling
BPH complications
- obstruction
- UTI
- renal problems
where is DHT formed
- testosteron + 5 alpha-reductase
mild treatment of BPH
- watchful waiting
moderate treatment of BPH
- 5-alpha reductase inhibitors
- alpha1-adrenergic antagonists
severe treatment of BPH
- invasive options
5-a-reductase inhibitor drugs
- finasteride
- dutasteride
MOA of finasteride
- blocks conversion of testosterone to DHT (alpha 1 receptors)
- decreases epithelial tissue in prostate
indication of finasteride
- mechanical obstruction of urethra
does finasteride work on someone with a smaller prostate
it typically works best on someone with a large prostate
when will patients see results of finasteride
- 6-12 months
- take for rest of life
side effects of finasteride
- impotence
- decreased libido
- gynecomastia (great tissue)
side notes of finasteride
- decreases prostate specific antigen (PSA) levels
- used for male-pattern baldness
- men can’t donate blood on this
- pregnant women should not handle
dutasteride indication
- mechanical obstruction of urethra
MOA of dutasteride
- blocks conversation of testosterone to DHT (alpha 1 and 2 receptors)
- decreases epithelial tissue in prostate
alpha1-adrenergic antagonist drug
tamsulosin
MOA of tamsulosin
- relaxes smooth muscle cells
- selective for alpha receptors in the prostate
indication of tamsulosin
- dynamic obstruction of urethra
side effects of tamsulosin
- well tolerated
- abnormal ejaculation
combination therapy for BPH
- dutasteride + tamsulosin = jayln
- combining a 5-alpha-reducatse inhibitor with an alpha blocker is superior to either agent alone
what is the most common male cancer in US
prostate cancer
risk factors for prostate cancer
- age
- familial tendency
- high fat diet
- (African american most common)
what does severity of prostate cancer depend on
- Gleason score (higher = worse)
- tumor level
- how the cancer was detected
erectile dysfunction (ED) definition
- also known as impotence
- inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse
erectile dysfunction primary classification
- rare
- life-long inability to have a normal erection
- severe psychiatric problems
- early vascular trauma
erectile dysfunction secondary classification
- most common
- someone with a history of normal erections
PDE-5 inhibitor drug
sildenafil
MOA of sildenafil
- inhibits PDE5
- increases and preserves cGMP levels
- only enhances the normal response to sexual stimuli
indications of sildenafil
- relief of ED
- pulmonary arterial hypertension
- BPH
timing of sildenafil
- up to 4 hours before sexual activity
- onset: 30-60 minutes
side effects of sildenafil
- HA
- flushing
- dyspepsia
cautions of sildenafil
- preexisting CV disease, if on nitrate Rx
- hypotension
safety issues for a patient on sildenafil
- don’t take if you are on any nitrates
- if you have chest pain or other signs of a heart attack during sex, stop and call 911
- sudden loss of vision or hearing
- no more than once per day
- priapism
what is priapism
- erection that is painful or lasts more than 4 hours
- medical emergency
