Male reproductive Flashcards
Significance of testicular cancer
1% of all male cancers
Major cancer in men 25-34
Risk factors of testicular cancer
Family history
Caucasian
Cryptorchidism
HIV infection
2 types of germ cell tumors
seminomas
nonseminomas
what are seminomas
Arise from immature germ cells
Slow growing, nonaggressive
Easily cured with radiation
what are nonseminomas
Arise from mature germ cells
More aggressive
Usually treated with surgery
early clinical manifestations of testicular cancer
Enlargement of testicle
Painless mass noted
If discomfort present
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
location, weight, and production of the prostate
Gland surrounding the urethra
Produces seminal fluids
Weighs between 4-20 gm
what is benign prostate hyperplasia
Nonmalignant enlargement of prostate
↑ epithelial cells = average 11.9%
↑ smooth muscle cells = average 38.8%
Stromal cells = average 38.6%
Risk factors of BPH
Age
Family history
Race/Ethnicity
Symptoms of BPH mimic what
lower urinary tract symptoms
2 theories of BPH etiology
- Hormone Imbalance
Testosterone and estrogen (estradiol) - *DHT Accumulation
What is DHT and where is it formed?
Testosterone + 5 alpha-reductase -> DHT
why is it important in development of BPH?
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
Complications of BPH
Obstruction
UTI
Renal problems
treatment of BPH
Mild symptoms = watchful waiting
Moderate symptoms = drug therapy
5-alpha reductase inhibitors
Alpha1-adrenergic antagonists
Severe symptoms = invasive options
Finasteride (Proscar) CLASS
5--reductase inhibitors
Indication of Finasteride (Proscar)
Mechanical obstruction of urethra
Finasteride MOA
Blocks conversion of testosterone to DHT (alpha 1 receptors)
Decreases epithelial tissue in prostate
Finasteride adverse effects
Impotence
Decreased libido (5-10%)
Gynecomastia
SIDE NOTES for Finasteride
Decreases prostate specific antigen (PSA) levels
Used for male-pattern baldness
Caution in Handling
Dutasteride (Avodart)
5-α reductase inhibitors
Indication of Dutasteride (Avodart)
Mechanical obstruction of urethra
MOA of Dutasteride
Blocks conversion of testosterone to DHT (alpha 1 &2 receptors)
Decreases epithelial tissue in prostate
Adverse Effects of Dutasteride
Similar to finasteride
Tamsulosin (Flomax) class
Alpha1-Adrenergic Antagonists
MOA of Tamsulosin
Relaxes smooth muscle cells
Selective for alpha receptors in the prostate
indication of tamsulosin
Dynamic obstruction of urethra
Adverse effects of Tamsulosin
Well tolerated
Abnormal ejaculation
What is Jalyn
Prototype: dutasteride and tansulosin
FDA approved for BPH
how does Jalyn work
Combining a 5-alpha-reductase inhibitor with an alpha blocker is superior to either agent alone
Prostate Cancer characteristics
Most common male cancer in US
2nd to lung cancer in cancer related death
Varies among races
African-American men = highest
Asians and Native American men = lowest
Incidence increases rapidly after 50
> 80% of all cases in men > 65 yo
Risk factors of prostate cancer
Age
Familial tendency
High fat diet
Clinical manifestations of of prostate cancer
Early
Later
BPH type presentation
Metastasis
Bone
Lungs
Prognosis
Stage dependent
Early diagnosis
controversy topics with prostate cancer
Prostate cancer is a common cause of cancer death
BUT many cases of prostate cancer never become clinically relevant
Most prostate cancers grow so slowly that men die of other causes
PSA screening was widely adopted before we had evidence for supporting its use
Benefits of PSA screenings
Small survival benefit with PSA screening in randomized trials
Use of the PSA test was associated with a 50% drop in prostate cancer deaths in the U.S.
Harms of PSA screenings
Would take 48 diagnoses of prostate cancer to prevent 1 death
Only 1 in 3 men with a positive PSA will have prostate cancer
Many unnecessary biopsies
Side effects of unnecessary treatment include erectile dysfunction, urinary incontinence, bowel problems
Prognosis of prostate cancer
Low, intermediate, and high-grade CA
Severity depends on a couple things:
Gleason score (higher = worse)
Tumor volume
PSA Level (higher and rapid rise = worse)
Number of “cores” positive (more = worse)
what is erectile dysfunction
Inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse
erectile dysfunction is also known as
impotence
classes of ED
Primary (rare)
Secondary (most common)
what is primary ED
Life-long inability to have a normal erection:
Severe psychiatric problems
Early vascular trauma
what is secondary Ed
ED in someone with a history of normal erections
Organic causes of secondary ED
Peripheral vascular disease
•Arterial insufficiency
•Excessive venous drainage
•Sedentary lifestyle (risk factor)
Medications
•Antidepressants
•Antihypertensives
Endocrine problems
Trauma, Surgery (Radical prostatectomy)
Psychogenic causes of Secondary ED
Depression
Low desire
Performance anxiety
Strained relationship
physiology of normal erection
Sexual arousal
_PNS and nitric oxide release
Activation of cGMP
Relaxation of arteries and smooth muscles
Increased inflow and reduced outflow
Engorgement and erection
Class of Sildenafil (Viagra)
PDE-5 Inhibitors
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 ssexual activity (onset 30-60 minutes)
adverse effects of sildenafil
most common HA (16%)
flushing (10%)
dyspepsia (7%)
Cautions of sildenafil
preexisting CV disease if on nitrate Rx
hypotension
safety issues with sildenafil
Do not take if you are taking any nitrates
If you have chest pain or other signs of a heart attack during sex, stop and call 911
Sudden loss of vision in one or both eyes, sudden loss of hearing
No more than once per day
Priapism - erection is painful or lasts more than 4 hours - medical emergency
What cells make up about 95% of all testicular cancers
Germ cell tumors
