Male Reproductive

Question 1

Testicular Cancer: Incidence / Significance

Answer 1

-1% of all male cancers

-Major cancer in men 15-34

Question 2

Testicular Cancer: Risk factors

Answer 2

Family history

Caucasian

Cryptorchidism (major) (10% of all cancers) (Testes do not descend) (Higher it is located –> higher chance for cancer)

HIV infection

Question 3

Teste Cancer: Germ cell tumors

Answer 3

Make up 95% of all teste cancers

Serminomas

Nonseminomas

Question 4

Serminomas

Answer 4

-arise from immature germ cells
-slow growing, non aggressive
-easily cured with radiations

Question 5

Nonseminomas

Answer 5

-Airse from mature germ cells
-More aggressive
-Usually treated with surgery

Question 6

Early Clinical Manifestations of Teste Cancers

Answer 6

-Enlargement of testicle with painless mass noted

-If discomfort is present usually ache in groin or sensation of heaviness

Question 7

Late clinical manifestations of testicle cancer

Answer 7

Frank pain

PAIN BASED ON METASTATIC SPREAD
Cough and hemoptysis

Swelling of lower extremities

Back pain

Dizziness

Question 8

BPH

Answer 8

Begning prostatic hyperplasia

Question 9

The Prostate

Answer 9

Gland surrounding the urethra

Produces seminal fluids

Weigh 4-20 gm

Question 10

BPH: Non malignant enlargement of prostate

Answer 10

Increase of epithelial cells

Increase smooth muscle cells

Stromal cells

Question 11

Risk factors for BPH

Answer 11

Age

Family history

Race/ethnicity

Question 12

BPH Symptoms

Answer 12

LUTS

Lower urinary tract symptoms

Question 13

BPH Etiology: Two Theories

Answer 13

1. Hormone imbalance
   -testosterone and estrogen (estradiol) (increase of estrogen levels)
2. DHT accumulation
   -What is DHT and where is it formed?
   -Testosterone + 5 alpha reductase –> DHT
   -Why is it important in development of BPH?

Question 14

DHT accumulation

Answer 14

High levels activities growth factors and influence by presence of estrogen

Acts on skin: acne

Acts on hair on chest but off scalp

Stimulate growth of prostate cells

Question 15

BPH: Clinical Manifestations

Answer 15

-Frequency and urgency

-Delay in initiation

-Reduction in force

-Increase urination time

-Dribbling

Question 16

BPH: complications

Answer 16

Obstruction (impair kidney fuction)

UTI

Renal problems

Question 17

Treatment of BPH

Answer 17

Mild symptoms = Watchful waiting

Moderate = drugs 5 alpha reductase inhibitors. Alpha 1 adrenergic antagonist

Severe Symptoms = invasive options

Question 18

Prostate Cancer

Answer 18

Most common know cancer in the US

2nd to lung cancer is cancer related deaths

Increases rapidly after age 50

Question 19

Prostate Cancer: RF’s

Answer 19

Age

Familial tendency (1st or 2nd degree increases risk 8 fold)

High fat diet

Question 20

Clinical Manifestations

Answer 20

Early: Asymptomatic

Late:
BHP type presentation
Metastasis-Bone and Lungs

Question 21

Prostate Cancer: Progonosis

Answer 21

-Stage dependent

-Early diagnosis

Question 22

The controversy with Prostate CA

Answer 22

-Most common cause of cancer death

-But many cases of cancer never become clinically relevant

-Prostate cancers grow slowly that men died of other causes

-PSA screening was widely adopted before we had evidence for supporting its use

Question 23

Benefits and Harms of using PSA

Answer 23

PP Slide

Even if cancer is detected it might not to be treated

Question 24

Prostate CA prognosis

Answer 24

Does not kill everyone

Low, intermediate, and high grade CA

Question 25

Severity of prostate cancer depends on

Answer 25

Gleason score: (higher = worse)

Tumor volume: PSA level and number of cores

How was the cancer detected? PSA vs DRE (digital rectal exam)

Question 26

Erectile Dysfunction

Answer 26

Impotence

Inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse

Question 27

ED: Significance

Answer 27

30 million men in the US

Associated with chronic illness

Question 28

Primary ED

Answer 28

Rare

Life long inability to have a normal erection

Severe psychiatric problems

Early vascular trauma

Question 29

Secondary ED

Answer 29

Most common

History of normal erections and then is unable

Question 30

Secondary ED: Organic Cause

Answer 30

PVD

Medications

Endocrine problems

Trauma - surgery (radical prostatectomy)

Question 31

Secondary ED: Psychogenic Cause

Answer 31

Depression

Low desire

Performance anxiety

Strained relationship

Question 32

Physiology of Normal Erection

Answer 32

Sexual arousal

Increase PNS and nitric oxide release

Activation of cGMP

Releaction of arteries and smooth muscles

Increase inflow and reduced outflow

Engorgement and erection

PDE -5 removes cGMP