Large Group 7 Flashcards
What will BPH feel like? Cancer?
cancer=hard/nodular
BPH=squishy
What do pts with BPH tend to presen with?
LUTS (lower urinary tract symptoms):
Frequency Urgency Nighttime urination Weak Stream Pushing and Straining. Not emptying. Intermittency.
many of these pts do NOT have BPH
What things can cause urinary retention?
outflow obstruction
increased sympathetic response (physical/mental stress, EtOH, cold temp, drugs)
Where does prostate cancer typically start? Which direction does it spread?
starts peripherally and spreads outward
What are the management options in BPH? (4)
Watchful waiting.
Pharmacotherapy.
Minimally Invasive therapy.
Surgical Prostatectomy.
What kinds of medications are used in BPH?
- treat the size of the prostate (acinar-glandular volume): 5-alpha reductase inhibitors: Finasteride/ Dutasteride
- treat the opening of the urethra: Alpha Blockers, Relaxes Smooth Muscle of Prostate and Bladder Neck: Terazosin, Doxazosin, Tamsulosin, Alfuzosin:
- Dual drug regimen
What do placebo studies in BPH pharm treatment show?
a significant decrease (-5.7 compared to meds 8.3-8.5) in prostate symptoms and a slight increase in peak flow
What are the indications for surgery in BPH? (5)
Urinary Retention.
Recurrent Urinary Tract Infections.
Recurrent or Persistent Gross Hematuria.
Bladder Stones.
Renal Insufficiency.
What is the gold standard for prostate surgeries (BPH)?
Transurethral Resection (TURP)
Resected electrosurgically, creating cavity.
Prostate chips.
Hospitalization.
Complication: Bleeding, 0.8% transfusion. Fluid Absorption. Retrograde Ejaculation Erectile Dysfunction
How is BPH diagnosed?
diagnosis of exclusion***
What is the problem with PSA?
a lot of false positives–> over diagnosed
can be elevated by cancer, BPH, prostatitis, inflammation, infection, manipulation by biopsy, unknown
What is the best chance for a cure of prostate cancer?
early detection
metastases cannot be cured, only slowed
What are the symptoms of early stage prostate cancer?
none!
What screening tests should be done for men 55-70 yo?
BOTH digital rectal exam and PSA
How is PSA adjusted to reduce false positives?
PSA with DRE, age, ethnicity, comorbidities, prior bx history.
Age adjusted PSA.
PSA Density: PSA/Prostate volume. Bx if greater than 0.15.
PSA Velocity: Three Measurements over three years.
Free PSA percentage.
What are the treatment options for prostate cancer? What determines which treatment you should use?
treatment based on age, health of pt, and characteristics of cancer
- radiation
- surgery
- watchful waiting: gleason <10 year life expectancy
What are the treatments for non-localized prostate cancer? Is this curative?
Palliative NOT curative.
Prostate CA is hormone sensitive, responds favorably to androgen hormonal deprivation
LH-RH agonists: ↓ pituitary-testis axis -> ↓ testosterone production
Anti-androgens: testosterone receptor blockers
Adrenal gland testosterone blockers: block remaining 5% of testosterone made by adrenals
When is surgery generally preferred in prostate cancer?
younger pt with >10 year life expectancy and localized disease
When is radiation generally preferred in prostate cancer?
older pt (> 70 yo), localized disease.
What values of total PSA and free PSA are more worrisome?
total PSA higher
Free PSA low
What are the risk factors for bladder cancer?
cigarette smoking
occupational exposure (aniline dyes, acrolein, coal)
Chronic cystitis/infections (chronic folley, bladder stone, schistosoma haematobium)
pelvis irradiation
Cyclophosphamide (Cytoxan)
What is the most common bladder cancer?
Transitional cell carcinoma
What cancer is Schistosoma haematobium linked to?
squamous cell bladder cancer
What is the typical progression of bladder cancer?
inward!!
ureothelium–> lamina propria –> muscularis propria (detrussor)–> perivesical fat
can then get into lymphatic system or blood stream
