Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical Medicine 3 > Lecture 12 (GU part 2)-Exam 4 > Flashcards

Lecture 12 (GU part 2)-Exam 4 Flashcards

1
Q

Epididymitis/Epididymo-Orchitis
* What are the mc organism with men over 35 and under 35?
* What is the clinical presentation? (3)

A

Organisms:
* Men < 35: Chlamydia (& gonorrhoeae)
* Men > 35: E. coli

Clinical Presentation
* Retrograde spread of organisms through the vas deferens
* Painful acute onset of swelling of scrotum usually accompanied by dysuria
* Early, pain & swelling may be localized to epididymis, though involvement of testes is frequent, ultimately resulting in epididymo-orchitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Epididymitis/Epididymo-Orchitis
* What is the clinical presentation?

A
  • Painful acute onset of swelling of scrotum usually accompanied by dysuria
  • Tender swollen firm testicle (posterior and superior)
  • Testis and epididymis can become one mass
  • (+) prehn and cremasteric reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epididymitis
* Often associated with what?
* Epididymis is what?
* Must differentiate from what?

A
  • Often associated with UTI
  • Epididymis is exquisitely tender and the overlying scrotum may be markedly erythematous
  • Must differentiate from testicular torsion (can use scrotal US)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Epididymitis/Epididymo-orchitis
* What is the best initial test? What are some other tests you can do?
* What is empiric antimicrobial therapy?

A

Dx:
* Scrotal US: enlarged epididymis and increased testicular blood flow
* UA: Pyuria (increase WBCs), positive leukocyte esterase and/or bacteriuria
* NAAT: Gon and chlamydia

Empiric antimicrobial therapy covering both gram-negative rods & gram-positive cocci should be initiated pending culture results.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Epididymitis/Epididymo-orchitis txt:
* males over 35 and under 35?
* What is the supportive care?

A

Additionally, empiric therapy for C. trachomatis is indicated in any patient with possible sexually transmitted disease.
* Men < 35: ceftriaxone plus doxycycline
* Men > 35: ciprofloxacin (and confirm absence of GC on NAAT)

Bed rest, scrotal elevation, analgesics, & local ice packs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is scrotal fasiitis/fournier gangrene

A

Fournier gangrene, also known as scrotal fasciitis, is a rare but severe and potentially life-threatening bacterial infection that affects the genital, perineal, and perianal regions. It involves the necrotizing (tissue-destroying) infection of the fascia, the connective tissue layers that surround muscles, nerves, and blood vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Testicular cancer:
* What is the incidence and epidemiology?

A
  • Annual incidence is about 6900 cases with 300 deaths
  • Peak incidence is 20-40
  • Occurs 4-5 time more frequently in Caucasians
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Testicular Cancer
* What are the increased risks?

A
  • Cryptorchid testes 10- to 40-times increased risk of testis cancer (MCC) -> (surgery does not reduce incidence)
  • Testicular feminization syndromes
  • Klinefelter’s syndrome(47 XXY) is associated with mediastinal germ cell tumor
  • Other risks include trauma, mumps, and maternal exogenous estrogen exposure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Testicular Cancer
* Acute pain may be associated with what? Chronic pain?
* Gynecomastia is often associated with what?
* What is indicative of testicular cancer?

A
  • Acute pain may be associated with hemorrhage; chronic pain may be associated with the weight of larger lesions.
  • Gynecomastia is often associated with an elevation in serum beta-human chorionic gonadotropin (beta-HCG).
  • Positive bHCG in a male is indicative of testicular cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Testicular Cancer
* Presents how?
* Less frequent presentations includes what?
*

A
  • Presents as a painless mass that is discovered by the patient, who may report a history of trauma. Commonly, the trauma called attention to the mass, but the patient may think that the trauma caused the mass.
  • Less frequent presentations include acute testicular pain in ~10% of patients, symptoms related to metastases in ~10%, and asymptomatic (asymptomatic mass discovered during the physical examination) in ~10% .
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Testicular Tumor
* Tends to occur in who?
* Appears as what?
* Does not do what?
* Most are what? Associated with that?
* In presence of pain, differential diagnosis includes what?

A
  • Tends to occur in young men & is most common tumor in males aged 15-30
  • Appears as an irregular, nontender mass fixed on testis
  • Does not transilluminate
  • Most are malignant & may be associated with inguinal lymphadenopathy
  • In presence of pain, differential diagnosis includes epididymitis or orchitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Seminoma
* What is it?

A

Simple (lackstumor marker a-fetoprotein), sensitive (sensitive to radiation), Slower growing and asoociated with stepwise spread

The 4 Ss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

NonSeminoma
* What are the four main subtypes?

A
  • Embryonal carcinoma
  • Teratoma
  • Choriocarcinoma
  • Endodermal sinus (yolk sac) tumor:They often have several histologic components: seminoma, embryonal carcinoma, teratoma, choriocarcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Endodermal sinus (yolk sac) tumor
* What are the several histologic components?

A

seminoma, embryonal carcinoma, teratoma, choriocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pance pearl

Nonseminomas
* What are the types?

A
  • Embryonal cell carcinoma, teratoma, yolk sac (MC in boys 10y or younger), choriocarinoma (worst prognosis). Mixed tumors (semi + nonsem) are treated like nonseminomas
  • (+) increase serum a-feroprotein and b-hCG and resistance to radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mixed Embryonal Carcinoma plus Teratoma
* more aggressive than what?
* What is often elevated?

A
  • Embryonal carcinoma is more aggressive than seminoma.
  • Alpha fetoprotein is often elevated.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Approach to Diagnostics/Treatment of Testicular Cancer
* What is is both diagnostic and therapeutic?
* What are the markers?

A

US is inital test of choice: seminoma (hypoechoic mass) and nonseminoma (cystic, nonhomogenous mass)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Staging Evaluation
* Measurement of what?
* CXR to r/o what?
* CT scan of abdomen and pelvis for what?
* Lymph nodes are staged at what?

A
  • Measurement of serum tumor markers: Alphafetoprotein(AFP) & B-human chorionic gonadotropin (B-hCG)
  • CXR to r/o mets
  • CT scan of abdomen and pelvis for regional retroperitoneal and paraaortic metastases
  • Lymph nodes are staged at resection of primary tumor through an inguinal approach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Staging of Testicular Cancer
* What is stage 1,2,3

A
  • Stage I- disease is limited to testis, epididymis, or spermatic cord
  • Stage II-involves retroperitoneal nodes
  • Stage III-disease is outside retroperitoneum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Staging of Testicular Cancer
* What mc stages for seminoma? Nonsem?

A

Among seminoma pts at diagnosis
* 70% are stage I
* 20% are stage II
* 10% are stage III

Among nonseminoma germ cell tumors
* 33% are found in each stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment of test cancer
* What is txt for stage 1 and 2 seminoma?
* What is txt for stage 1 and 2 nonsem germ cell tumor

A

Stages I & II Seminoma
* Inguinal orchiectomy followed by retroperitoneal radiation therapy to 2500-3000 cGy is effective

Stages I & II Nonseminoma germ cell tumors
* Inguinal orchiectomy followed by retroperitoneal lymph node dissection is effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Treatment of test cancer
* What is the txt For pts of either histology with bulky nodes or stage III disease?
* Cure rate?

A

For pts of either histology with bulky nodes or stage III disease
* Cisplatin(20 mg/m2 days 1-5), etoposide(100 mg/m2 days 1-5), and bleomycin(30 U days 2, 9, 16) given every 21 d for four cycles standard therapy

95% of pts are cured if treated appropriately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lower Urinary Tract Symptoms(LUTS)
* What are Irritative sxs?
* What are obstructive sxs?

A

Irritative
* Frequency
* Nocturia
* Urgency
* Urge Incontinence

Obstructive
* Hesitancy
* Slow stream
* Stop-& start voiding
* Sensation of incomplete emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Acute Urinary Retention
* Causes include what?
* What are the sxs?

A
  • Causes include impaired bladder contractility, bladder outlet obstruction (urethral structures/BPH), detrusor-sphincter dyssynergia, neurogenic bladder, MS, fecal impaction, Parkinson’s to name a few.
  • Sxs: sense of incomplete emptying, frequency, pain, abdominal distention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Acute Urinary Retention
* How do you dx?
* How do you dx in those who cannot void?
* how do you dx in those that can void (chronic)?
* When does a foley go in?

A

Dx: Postvoid Residual Urine Volume (PVR): <100ml is normal
* Clinical in those that cannot void (acute)
* In those that can void (chronic): US showing postvoid volume of >300cc of urine (some studies show 200cc)
* Foley goes in at 300-400cc of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Acute Urinary Retention
* What is the work up and txt?

A
  • Work-up: Pelvic exam, electromyography or cystourethroscopy (based on presumed cause)
  • Tx: Cath/Foley in Acute, Self-Cath in chronic and treat underlying cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Acute Bacterial Prostatitis
* What is it?
* less often infection is from where?

A
  • Prostate becomes infected by the direct invasion through urethra
  • Less often infection is from bloodstream or lymphatic spreading
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Acute Bacterial Prostatitis
* What are the sxs?

A
  • 30-50 years of age
  • Onset of symptoms over days
  • Pain in rectal, perianal area, low back & abdomen
  • Chills & high fever
  • Urinary irritation symptoms similar to BPH
    * Varying degrees of symptoms of obstructed voiding including frequency, urgency, dysuria, or burning on urination, nutria, sometimes gross hematuria
  • Arthralgia & myalgia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Acute Bacterial Prostatitis: PE
* Pain with what?
* What is going with urethra?
* Prostate gland acutely what?
* Postmassage urine or prostatic secretions reveal what?
* What is often involved?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Acute Bacterial Prostatitis: labs
* UA?
* Urine cx?
* Occasionally what?
* C/S prostatic secretions usually yields what?
* Because acute cystitis can accompany acute prostatitis, bacterial pathogen often can be identified by what?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute Bacterial Prostatitis: txt:
* What is the supportive care?
* What anabiotics?
* If clinical response satisfactory, treatment is continued for how long?
* Because bacteremia may occur, an acutely inflamed prostate gland should not undergo what?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Acute Bacterial Prostatitis
* If sepsis is suspected, what do you give?

A

broad-spectrum antibiotics covering gram-positive and gram- negative organisms should be given IV until bacterial sensitivity is known If clinical response is adequate, patient continues IV therapy until afebrile for 24 to 48 h & then is switched to oral therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Acute Bacterial Prostatitis
* What are complications?

A
  • Complete urinary retention may occur & patient may require a suprapubic cystostomy(preferred over a urethral catheter which may lead to bacteremia)
  • Rarely prostate abscess develops & treated surgically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Prostatitis: Treatment
* Treat severely ill, hospitalized patients empirically with what?
* For patients with suspected acute prostatitis who are not acutely ill, treat with what?

A
  • Treat severely ill, hospitalized patients empirically with IV fluoroquinolones (ciprofloxacin, ofloxacin) or TMP-SMX or Tetracyclines
  • For patients with suspected acute prostatitis who are not acutely ill, treat with oral antibiotics, either empirically or after culture results are obtained (make sure to r/o GC NAAT).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Chronic Bacterial Prostatitis
* What are the sxs? (4)

A
  • Variable
  • Hallmark is relapsing UTI due to same pathogen found in prostatic secretions
  • Low back pain & perineal pain, urinary urgency & frequency, & painful urination
  • Some are asymptomatic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Chronic Bacterial Prostatitis
* What are the PE findings? (3)

A
  • Prostate may be moderately tender & irregularly indurated or boggy but there are no specific findings
  • Exam may be normal
  • Secretions may be copious
38
Q

Chronic Bacterial Prostatitis
* What are the causes?
* What is the treatment?

A

Etiologies
* Gram-negative bacilli most common cause, but enterococci & chlamydiae have also been associated with chronic prostatitis

Treatment
* A fluoroquinolone is treatment of choice & is given BID for 4 to 12 weeks
* Often recurs & is usually treated with a second course of antibiotics

39
Q

Chronic Nonbacterial Prostatitis
* What are the sxs? (5)

A
  • More common than bacterial prostatitis
  • Unknown cause
  • Symptoms simulate those of chronic bacterial prostatitis
  • WBCs & oval fat bodies are usually increased in prostatic secretions
  • History of UTIs is rare
40
Q

Chronic Nonbacterial Prostatitis: Txt
* Lower-tract localization cultures what? why?
* What is the txt for symptomatic relieve?
* What may be helpful?

A
  • Lower-tract localization cultures of urethral, bladder,& prostatic secretions required for diagnosis to R/O bacterial pathogen
  • Hot sitz baths, anticholinergic drugs, & periodic prostatic massage provide some symptomatic relieve
  • Antibiotics do not relieve symptoms, but NSAIDs may be helpful
41
Q

Prostatodynia:
* What is it?
* sxs mimic what?
* Usually no signs of what?
* What is the txt?

A
  • Noninfectious, noninflammatory condition of younger men
  • Symptoms mimic those of prostatitis
  • Usually, no signs of infection or inflammation are present on examination of urine or prostatic secretions
  • Treatment supportive
42
Q

Prostatic Hyperplasia
* What are other terms?
* What is the patho?

A

AKA
* Nodular prostatic hyperplasia
* Benign prostatic hyperplasia (BPH)

Pathophysiology
* Normal prostate weighs 20 to 30 gm, but most prostates with nodular hyperplasia can weigh from 50 to 100 gm.

43
Q

Prostatic Hyperplasia
* Common conditions as what?
* 25% of males have some degree of what?
* > 90% of males will have prostatic hyperplasia by when?
* In only a minority of cases (about 10%) will this hyperplasia be what?

A
  • Common condition as men age
  • 25% of males have some degree of hyperplasia by fifth decade of life
  • > 90% of males will have prostatic hyperplasia by eighth decade
  • In only a minority of cases (about 10%) will this hyperplasia be symptomatic & severe enough to require surgical or medical therapy.
44
Q

Prostatic Hyperplasia
* Enlargement impinges what?

A

Enlargement impinges upon the prostatic urethra, leading to difficulty on urination with hesitancy, weak stream, straining to pass urine, urge incontinence

45
Q

Prostatic Hyperplasia
* May be related to what?

A

May be related to accumulation of dihydrotestosterone in prostate, which binds to nuclear hormone receptors which then trigger growth

46
Q

Prostatic Hyperplasia
* What are the sxs? (4)

A
  • Progressive urinary frequency, urgency, & nocturia due to incomplete emptying of bladder
  • Decreased size & force of urinary stream produce hesitancy & intermittency
  • Sensations of incomplete emptying, terminal dribbling, almost continuous overflow incontinence or complete urinary retention may ensue
  • Straining to void can cause congestion of superficial veins of prostatic urethra & trigone, which may rupture & produce hematuria
47
Q

Prostatic Hyperplasia
* Acute complete urinary retention may be precipitated by what?

A

Acute complete urinary retention may be precipitated by prolonged attempts to retain urine, immobilization, exposure to cold, anesthetics, anticholinergics & sympathomimetic drugs, opiates or ingestion of alcohol

48
Q

Prostatic Hyperplasia
* How is the prostate exam?

A

On rectal examination, prostate usually is enlarged, has a rubbery consistency, & frequently has lost median furrow
* However, digital rectal examination of prostate size may be misleading
* A small prostate on rectal exam may be sufficiently large to cause obstruction

49
Q

Prostatic Hyperplasia
* What may be palpable or percussible on PE?
* What is moderately elevated?
* Men with mild or moderate BPH symptoms usually what?

A
  • Distended urinary bladder may be palpable or percussible on PE
  • Serum prostate-specific antigen (PSA) is moderately elevated in 30 to 50% of patients with BPH, depending on prostate size & degree of obstruction
  • Men with mild or moderate BPH symptoms usually do not need further testing
50
Q

Prostatic Hyperplasia
* More severe symptoms or the presence of hematuria or UTI warrants what?
* What imaging can be done?
* With prolonged obstruction, what happens?
* Urethral catheterization cystoscopy or ultrasonography after voiding measures what?

A
  • More severe symptoms or the presence of hematuria or UTI warrants further evaluation by a urologist
  • IV Pyelogram may disclose upward displacement of terminal portions of ureters (fishhooking) & detect at base of bladder compatible with prostatic enlargement
  • With prolonged obstruction, ureters dilate & hydronephrosis occurs
  • Urethral catheterization cystoscopy or ultrasonography after voiding measures residual urine, & catherization permits preliminary drainage to stabilize renal function & adequately control UTI
51
Q

Prostatic Hyperplasia: Transrectal Ultrasonography
* Permits what?
* May aid in selection of what?
* Differentiates what?
* Instrumentation should be avoided until when?

A
  • Permits estimation of gland size
  • May aid selection of appropriate surgical approach
  • Differentiates vesical neck contracture, chronic prostatitis,& other obstructive phenomena
  • Instrumentation should be avoided until definitive therapy has been decided, because it may increase obstruction, trauma,& infection
52
Q

Prostate Nodular Hyperplasia, gross
* Glands may be more what?
* Nodular hyperplasia is NOT a precursor of what?

A
  • Glands may be more variably sized, with larger glands have more prominent papillary infoldings.
  • Nodular hyperplasia is NOT a precursor to carcinoma
    * Unlike endometrial hyperplasia
53
Q

Prostatic Hyperplasia
* When BPH is associated with UTI or azotemia due to bladder outlet obstruction, initial therapy should be what?
* What may be necessary in advanced bladder outlet obstruction?
* Chronically obstructed, distended bladder should be what?

A
  • When BPH is associated with UTI or azotemia due to bladder outlet obstruction, initial therapy should be medical, directed toward stabilizing renal function, discontinuing anticholinergic & sympathomimetic drugs & eradicating infection
  • Urethral or suprapubic catheter drainage may be necessary in advanced bladder outlet obstruction
  • Chronically obstructed, distended bladder should be slowly decompressed to help avoid postobstructive diuresis
54
Q

Prostatic Hyperplasia
* What are the lifestyle interventions?

A

These should be tailored to symptoms but may include avoiding fluids prior to bedtime or before going out, reducing consumption of mild diuretics such as caffeine and alcohol, and double voiding to empty the bladder more completely.

55
Q

Prostatic Hyperplasia
* What is the medical txt?

A
  • Alpha adrenergic blockers such as terazosin may improve voiding.
  • Phosphodiesterase type 5 (PDE5) inhibitors with BPH and ED
  • 5 alpha reductase inhibitor finasteride may reduce prostate size, improving voiding over time (6 months), especially in patients with large(> 40 gram) glands
  • Avoidance of anticholinergic & narcotic drugs, which may induce obstruction
56
Q

Prostatic Hyperplasia
* What is the surgical txt?

A
  • Definitive therapy
  • Although sexual potency & continence are usually retained, about 5 to 19 % of patients will experience some postsurgical problems
  • Transurethral resection of the prostate (TURP) is preferred procedure
  • Transurethral Incision of Prostate (TIUP) is alternative
57
Q

Prostatic Hyperplasia
* What is a Suprapubic or Retropubic Prostatectomy

A
  • Permits enucleation of the adenomatous tissue from within surgical capsule
  • Procedure reserved for larger prostates (usually > 75 grams)
  • Incidence of ED & incontinence is much higher than after TURP
  • All surgical approaches require postoperative catheter drainage or 1 to 5 days
58
Q

Prostatic Hyperplasia
* What are the alternative surgical txt?

A
  • Roles of these procedures has not been established
  • Intraurethral stents
  • Microwave thermotherapy
  • High-intensity focused ultrasound thermotherapy
  • Laser ablation
  • Electrovaporization
59
Q

Prostate Cancer
* AKA what?
* MC what?
* Rare before what?

A
  • AKA Adenocarcinoma of the prostate
  • Most common non-skin malignancy in elderly men.
  • Rare before 50
60
Q

Possible Risk Factors for Prostate Cancer? (6)

A
  • Age (increasing incidence with advancing age)
  • Family history
  • Diet (possible link to high-fat diet)
  • Selenium deficiency
  • No demonstrated association with cigarette smoking, sexual activity, or prior history of prostatitis or BPH
  • Epidemiologic studies have shown that the risk of prostate cancer is higher in African Americans compared with other ethnic groups, and that it occurs at an earlier age.
61
Q

Vitamin D and Prostate Cancer
* The vitamin D receptor has been found where?
* Reports showed what?
* Low serum levels of 25-hydroxyvitamin D has been reported to what?

A
  • The vitamin D receptor has been found in normal prostate, benign prostatic hyperplasia, malignant prostate tissue and prostate cancer cell lines
  • Reports show an inverse relationship between prostate cancer mortality and UV light
  • Low serum levels of 25-hydroxyvitamin D has been reported to be a risk factor for prostate cancer
62
Q

Vitamin D and Prostate Cancer
* In vitro, 1,25-OH-vitamin D3 and its analogs inhibit what?
* 1,25-OH-vitamin D3 inhibits what?
* A study of 7 patients with recurrent prostate cancer showed what?

A
  • In vitro, 1,25-OH-vitamin D3 and its analogs inhibit the proliferation of prostate cancer
  • 1,25-OH-vitamin D3 inhibits the growth of androgen-dependent and androgen-independent prostate cancer cells
  • A study of 7 patients with recurrent prostate cancer showed that calcitriol administration inhibited PSA rise
63
Q

Prostate Cancer
* Autopsy studies have found prostatic adenocarcinoma in who?
* Many of these carcinomas are what?
* Most men die with what?
* However, some become aggressive, and prostatic adenocarcinoma is what?
* Affects who?
* main type is what?

A
64
Q

Prostate Cancer
* Most early disease is what

A

Most early disease is asymptomatic as prostate cancer generally is slowly progressive & may cause no symptoms

65
Q

Advanced Prostatic Adenocarcinomas
* Locally advanced disease causes what?
* What may cause bone pain?
* What can result in loss of bowel & bladder function.?

A
  • Locally advanced disease causes obstructive or irritative voiding symptoms and may exhibit extension of induration to seminal vesicles & fixation of gland laterally
  • Metastasize to regional (pelvic) lymph nodes & to pelvis, ribs, & vertebral bodies may cause bone pain causing blastic metastases in most cases.
  • Metastasis to spinal cord impingement from epidural spread can result in loss of bowel & bladder function.
66
Q

Advanced Prostatic Adenocarcinomas
* What can cause lymphedema and/or renal failure due to obstruction?
* What is seen in minority of cases?

A
  • Metastases to lymph nodes can cause lymphedema and/or renal failure due to obstruction
  • Metastases to lungs & liver are seen in a minority of cases.
67
Q

Screening for Prostate Cancer: DRE
* Most authorities agree on using DRE as part of what?
* What is not clear?
* Done in conjunction with what?

A
  • Most authorities agree on using DRE as part of periodic health screening for men over age 50,
  • Role in screening for prostate cancer is not clear
  • Done in conjunction with PSA testing as part of the periodic health examination in men > 50 who are at average risk and in > 40 who are at higher risk (race; family history of prostate cancer)
68
Q

Screening for Prostate Cancer: PSA
* What is it?
* Produced by what?
* Screening can detect what?
* No data indicating that PSA screening does what?
*

A
  • Glycoprotein that is specific to prostate but not to prostate cancer
  • Produced by all types of prostate tissue whether healthy, hyperplastic, or malignant
  • Screening can detect tumors at a more favorable stage
  • No data indicating that PSA screening decreases mortality from prostate cancer

Some authorities do not recommend use of PSA for routine screening

69
Q

Screening for Prostate Cancer: PSA
* Done in conjunction with what?
* PSA and DRE are both necessary to screen for what?
* In men with less than 10 years to live, prostate cancer screening may what?

A
  • Done in conjunction with DRE (digital rectal exam) as described previously (over age 50 for average-risk men; over age 40 for high-risk men)
  • PSA and DRE are both necessary to screen for prostate cancer & are most appropriate for men with more than 10 years to live(under 75 years of age)
  • In men with less than 10 years to live, prostate cancer screening may worsen quality of life
70
Q

Screening for Prostate Cancer
* What is normal?
* What is borderline?
* What is high?
* Higher PSA level the more likely presence what?

A
  • Results under 4 ng/ml are usually considered normal
  • Results between 4 and 10ng/ml are considered borderline
  • Results over 10ng/ml are considered high
  • Higher PSA level the more likely presence of prostate cancer
71
Q

Screening for Prostate Cancer: PSA
* men with prostate cancer can have what?
* A negative PSA and a negative DRE make what?
* Age-specific ranges may be useful as what?

A
  • However, men with prostate cancer can have a negative or borderline PSA level
  • A negative PSA and a negative DRE make the presence of cancer unlikely (negative predictive value)
  • Age-specific ranges may be useful as older men have higher PSA levels than younger men, even in the absence of cancer
72
Q

Clinical Presentation: prostate cancer
* On physical examination, digital rectal exam (DRE) may detect what?
* However, prostate cancer is often not detectable by DRE, because why?

A
  • On physical examination, digital rectal exam (DRE) may detect prostate nodules, induration, or asymmetry that can occur with prostate cancer.
  • However, prostate cancer is often not detectable by DRE, because DRE can only detect tumors in the posterior and lateral aspects of the prostate gland, which are the portions of the prostate that are palpable via the rectum.
73
Q

Clinical Presentation: prostate cancer
* Tumors not detected by DRE include the 25 to 35 percent that are not what?
* Lower urinary tract symptoms (LUTS) such as what?

A
  • Tumors not detected by DRE include the 25 to 35 percent that are not reachable because they occur in other parts of the gland and the small, stage T1 cancers that are not palpable
  • Lower urinary tract symptoms (LUTS) such as frequency, urgency, nocturia, and hesitancy occur commonly among men and are usually related to a benign etiology such as benign prostate hyperplasia (BPH) rather than to prostate cancer.
74
Q

Advanced Prostate Cancer
* What sxs may appear?

A

In late disease, symptoms of bladder outlet obstruction, ureteral obstruction & hematuria may appear

75
Q

Prostate Cancer:
* What are the different ways to detect? (3)
* None of these methods can reliably detect all what?
* Metastatic lesions in lumbar spine of a male should raise what?

A

Detection
* Digital examination
* Ultrasonography (transrectal ultrasound)
* Prostate specific antigen (PSA)
* None of these methods can reliably detect all prostate cancers, particularly the small cancers.
* Metastatic lesions in lumbar spine of a male should raise suspicion of prostate as primary origin

76
Q

Factors used for Staging: Prostate cancer ?(5)

A
  • Size and location of the cancer
  • Has it invaded the prostatic capsule or seminal vesicle?
  • Distant metastasis
  • Grade & stage correlate well with each other & with prognosis.
  • Varies widely with tumor stage & grade.
77
Q

Diagnosis Prostate Cancer
* Suspected on basis of what?
* What on transrectal ultrasound (TRUS)?
* Elevated levels of what?
* Requires histologic confirmation most commonly by what?

A
  • Suspected on basis of abnormal digital rectal findings
  • Hypoechoic lesions on transrectal ultrasound (TRUS)
  • Elevated levels of serum prostate-specific antigen(PSA)
  • Requires histologic confirmation most commonly by TRUS-guided transrectal needle biopsy, which can be done in an outpatient setting without anesthesia
78
Q

Diagnosis Prostate Cancer
* What is is diagnostic?
* May be diagnosed incidentally when ?
* What is usually diagnostic ?

A
  • Involvement of perineural lymphatics, if present, is diagnostic
  • May be diagnosed incidentally when malignant changes are found in tissue removed during surgery for suspected benign prostatic hypertrophy
  • Detection on bone scan or x-ray in presence of a stony hard prostate is usually diagnostic (still need biopsy)
    * Prostatic cancer frequently produces osteoblastic bony metastasis
79
Q

Diagnosing Prostate Cancer
* What is normal PSA?
* What is mildly increased PSA?
* What is rising PSA suspicious for?

A
  • Normally less than 4 µg/L
  • Mildly increased PSA (4 to 10 µg/L) in a patient with a very large prostate can be due to nodular hyperplasia, or to prostatitis, rather than carcinoma.
  • Rising PSA (more than 0.75 µg/L per year) is suspicious for prostatic carcinoma, even if PSA is in normal range.
80
Q

Diagnosing Prostate Cancer: Transrectal Ultrasonography (TRUS)
* used when?
* May be able to indicate what?
* It can also be used to determine what?

A
  • Used when the PSA is borderline & DRE is normal
  • May be able to indicate areas of prostate that require biopsy
  • It can also be used to determine prostate volume, which can be used in calculation of PSA density
81
Q

Diagnosing Prostate Cancer: Transrectal Ultrasound Guided (TUG) needle biopsy
* Useful for what?

A

Useful to confirm diagnosis, although incidental carcinomas can be found in transurethral resections for nodular hyperplasia

82
Q

Biopsy of the Prostate
* Recommended when?
* Results in what?
* Biopsy also may be useful when?

A
  • Recommended when PSA level is high
  • Results in borderline range may be an indication for biopsy if DRE is abnormal
  • Biopsy also may be useful when the Free PSA ratio is low, in presence of borderline PSA results
83
Q

Pathologic Grading of prostate cancer:
* Graded based on what?
* What are the grades?
* Adenocarcinomas of prostate are given what?
* Two grades are added to get a final grade of what?

A
  • Graded according to the Gleason grading system based on pattern of growth and likelihood of spread.
  • 5 grades (from 1 to 5) based upon architectural patterns.
  • Adenocarcinomas of prostate are given two grades based on most common & second most common architectural patterns.
  • Two grades are added to get a final grade of 2 to 10.
84
Q
A
85
Q

Differential Diagnosis of prostate cancer
* What suggest malignancy ?
* Must be differentiated from what?

A
  • Stony hard induration or a nodule of the prostate on digital rectal examination suggest malignancy
  • Must be differentiated from granulomatous prostatitis, prostatic calculi, & other more unusual prostatic diseases
86
Q

American Urological Society Clinical Staging

A
87
Q

Prognosis of prostate cancer
* What is possible in many patients?
* Outcomes are dependent on factors such as what?
* For patients with low-grade, organ-confined tumors survival is what?

A
88
Q

Treatment Options: prostate cancer
* When do you do no treatment?
* When do you do radical prostatectomy?
* When do you do radiotherapy?

A
89
Q

Treatment Options of prostate cancer: hormonal
* When do you do it?
* What decreases serum testosterone equivalently?
* Some patients may benefit from what?
* Exogenous estrogens rarely used as they pose a risk of what?

A
  • For an asymptomatic patient with a locally advanced tumor or metastasis with or without adjunct radiotherapy
  • Bilateral orchiectomy or medical castration with luteinizing hormone- releasing hormone agonists decreases serum testosterone equivalently
  • Some patients may benefit from the addition of antiandrogens for total androgen blockade
  • Exogenous estrogens rarely used as they pose a risk of cardiovascular and thromboembolic complications
90
Q

Treatment Options of prostate cancer: Local Radiotherapy & other Treatment
* When do you do this?
* No standard therapy for what?
* What is being investigated and may offer palliation and prolonged survival?

A
  • Usually palliative in patients with symptomatic bone metastasis
  • No standard therapy for hormone refractory prostate cancer
  • Cytoxic & biological agents are being investigated and may offer palliation and prolonged surviv

Clinical Medicine 3 (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions