Male Reproductive Flashcards
Major cancer of 15-34Y
Testicular cancer
Big cause of male sterility
Testicular cancer
Risks for testicular cancer
Family hx, white, HIV esp in AIDS stage, cryptorchidism (testes not descended by 3M, and most not descended by 3Y, longer w/o descension, higher risk of cancer)
Can you get cancer in a teste if it descended with cryptorchidism?
YES (25%)
- if pt has corrected after 12Y or never, 2-6x higher chance of getting T cancer
What kind of tumor is most testicular cancer?
Germ cell tumors
Germ cells
Sperm forming
Seminomas
Rise from immature germ cells
- slow growing, non aggressive
- easy cure with radiation
Non-seminomas
From mature germ cells
- more aggressive, need surgery
CM of testicular cancer
Early - enlarge, painless mass, ache in groin or heaviness in scrotum
Late - frank pain, sx based on metastasis (cough, hemoptysis, swell, back pain, dizzy)
How deadly is testicular cancer?
Very curable if caught in early stage; not too deadly even in late stage
Prostate
Heart shaped gland around the urethra that makes seminal fluid
BPH
nonmalignant growth of epithelial (mechanical obs) and smooth muscle (dynamic obs) cells; both obstruct the urethra
Cause of BPH
unknown; sometimes from lower UTI
Risk for BPH
age, fam hx, race (higher in AfAm, lowest in Asian pop)
BPH theory of hormone imbalance
make T and little estrogen; T dec with time but est stays same of inc slightly, causing an imbalance from growth factors released
DHT accumulation theory of BPH
dihydrotestosterone increase and accumulates and activates growth factor and influences by presence of estrogen
DHT
dihydrotestosterone–made with T and 5-alpha-reductase
What does DHT do?
controls acne, growth of prostate, hair on chest, baldness
CM of BPH
frequency, urgency, delay in initation, dec force of urine, inc urine time, dribbling
Complication of BPH
obstructive neuropathy, bladder stones, recurring UTIs, renal problems
Tx of mild BPH
Mild - watchful wt and annual eval
Tx of moderate BPH
drug therapy
- 5-alpha reducatase inhibitor and alpha 1 adrenergic antagonist
Tx of severe BPH
invasive surgical procedures and microwave therapy to dec excessive tissue
Most common cancer in US men
prostate cancer
Risk factors for prostate cancer
Age over 50, family history, high fat diet
What is prostate cancer r/t?
altered sex hormone production
Tx for prostate cancer
removal, chemo, radiation
Prostate cancer CM
- mostly asymp when early
- bone pain with metastasis
- mets to lungs via lymph (cough and hemoptysis)
- pumonary symptoms
PSA screening
See paper notes
Prostate cancer severity decided by…
- Gleason score from tissue biopsy of 2 different spots (higher is worse)
- tumor volume - PSA level and # of cores (dx cancer earlier than digital rectal)
Erectile dysfunction
- impotence
- can’t maintain erection for satisfactory sex
ED is often assoc with…
Chronic illness
Primary ED
rare and lifelong; often early vascular trauma or severe psych prob
Secondary ED
history is normal then it develops
Psychogenic cause of ED
depression, dec libido, performance anxiety, strained relaxation
Organic cause of ED
peripheral vascular disease, meds (antideps and antiHTN), endocrine, trauma, surg, dec T levels, sedentary
Erection patho
arousal - inc ParaNS and nitric oxide - nitric oxide activates cGMP - relaxation of arteries and smooth muscles - inc inflow/dec outflow - engorgement and erection
Drugs for ED
PDE-5 inhibitors
When is chemo used for prostate cancer?
When late sx are occurring
BPH often causes…
lower urinary tract syndrom
T/F: bigger prostate causes worse symptoms
FALSE
Benefits of PSA
- small survival benefit
- associated with 50% dec in prostate cancer deaths in US
Harms of PSA screening
- takes 48 dx to prevent 1 death
- only 1/3 men with positive PSA have cancer
- unnecessary biopsies
- SE of unnecessary tx include ED, incontinence, bowel probs
Prostate cancer tx
- no meds
- surgical
- chemo or radiation
cGMP
cyclic guanosine monophosphate
What does PDE-5 do?
Remove cGMP
