Male Reproductive and Drugs Flashcards
testicular cancer
- 1% of all male cancers
- major cancer for men 15-34
risk factors testicular cancer
- fam hx
- caucasian
- crytochirdism (empty scrotum, testicles dont distend)
- HIV infection
germ cells tumors
- seminomas
- nonseminomas
seminomas
- arise from immature germ cells
- slow growing, non aggressive
- easily cured with radiation
nonseminomas
- arise from mature germ cells
- more aggressive
- usually treated w surgery
germ cell
sperm forming cells within the testicles
early clinical manifestations of testicular cancer
- enlargement of testicles
- painless mass noted
- if discomfort present, ache in groin, sensation of heaviness
late clinical manifestations of testicular cancer
- possible frank pain (rapid growth, hemorrhage)
manifestations based on where its spread - cough, hemoptysis, swelling of lower extremities, back pain, dizziness
benign prostatic hyperplasia
nonmalignant enlargement of prostate due to inc epithelial cells or inc smooth cells
prostate
gland that surrounds the urethra and produces seminal fluids
- weighs between 4-10 gms (walnut)
risk factors of BPH
- age
- fam hx
- race/ethnicity
symptoms of BPH
lower urinary tract symptoms
theories of cause of BPH
- hormone imbalance
- DHT accumulation
hormone imbalance of BPH etiology
- testosterone dec w aging
- estrogen can stimulate growth factors
DHT accumulation BPH etiology
DHT=dihydrotestosterone
- formed by testosterone + 5 alpha reductase
- inc levels inc growth factors
- DHT acts on skin, hair follicles (on chest, off scalp), stimulates growth of prostate cells
BPH clinical manifestations
- frequency and urgency
- delay in initiation
- reduction in force
- inc urination time
- dribbling
complications of BPH
- obstruction
- UTI
- renal problems
treatment of BPH
- mild symptoms: watchful waiting
- moderate: drug therapy
- severe: invasive options
finasteride class
5-α-reductase inhibitors
finasteride indications
mechanical obstruction of urethra
- also helps treat male pattern baldness
finasteride moa
blocks conversion of testosterone to DHT (alpha 1 receptors)
dec epithelia tissue in prostate
finasteride se
- impotence
- dec libido
- gynecomastia
finasteride nc
- dec PSA levels
- caution when handling bc teratogenic
- only works for someone w a large prostate
- see results w/in 6-12 mons
dutasteride class
5α reductase inhibitors
dutasteride indications
mechanical obstruction of urethra
dutasteride moa
blocks conversion of testosterone to DHT (alpha 1 and 2 receptors)
decreases epithelial tissue in prostate
dutasteride sd
similar to finasteride
- impotence
- dec libido
- gynecomastia
tamsulosin class
alpha 1 adrenergic antagonist
tamsulosin moa
- relaxes smooth muscle cells
- selective for alpha receptors in the prostate
tamsulosin indication
dynamic obstruction of urethra
tamsulosin nc
- immediate results
tamsulosin se
- well tolerated
- abnormal ejaculations
- doen’t dec levels of PCA
combination therapy
durasteride + tamsulosin
FDA approved
combining a 5-alpha- reductase inhibitor w alpha blocker is superior to either alone
prostate cancer
most common cancer in males
varies among race (highest in african american, asian and native american lowest)
incidence inc rapidly after 50
prostate cancer risk factors
- age
- familial tendency
- high fat diet
clinical manifestions of prostate cancer
- early: asymptomatic
- later: BPH type presentation, metastasis (bone, lungs)
- prognosis: stage dependent, early diagnosis
controversy w prostate cancer
most prostate cancer is clinically irrelevant bc it grows so slowly
- PSA screening was widely adopted before we had evidence for supporting use
- survival dec once the cancer has spread
benefits of screening PSA
- small survival benefit w PSA screening in randomized
- use of the PSA test was associated w 50% drop in prostate deaths
harms of screening
- would take 48 diagnosis of prostate cancer to prevent 1 death
- only 1 in 3 men w positive PSA will have prostate cancer
- many unnecessary biopsies
- unnecessary treatment include erectile disfunction, urinary incontinence, bowel problems
prognosis of prostate cancer
does not kill everyone
- low, intermediate, high grade
- severity depends on gleason score, tumor volume, PSA levels, number of cores positive, how cancer was detected
erectile dysfunction
inability to achieve or sustain an erection sufficient for satisfactory sexual intercourse
ED classification
- primary: life long inability to have a normal erection, severe psychiatric problems, early vascular trauma
- secondary: begins to be unable
organic causes of ED
- peripheral vascular disease (arterial insufficiency, excessive venous drainage, sedentary lifestyle)
- medication (antidepressants, antiHTN)
- endocrine problems
- trauma, surgery
psychogenic causes
- depression
- low desire
- performance
- strained relationship
physiology of a normal erection
- sexual arousal
- inc PNS and nitric oxide
- activation of cGMP
- relaxation of arteries and smooth muscles
- inc inflow and reduced outflow
- engorgement and erection
PDE-5 removes cGMP
sildenafil class
PDE-5 inhibitors
sildenafil moa
inhibits PDE5, inc and perserves cGMP levels
- only enhances the normal response to sexual stimuli
sildenafil indications
relief of ED
- pulmonary HTN
- BPH
sildenafil se
headache
flushing
dyspepsia
sildenafil nc
- use up to 4 hrs before sexual activity (onset30-60 mins)
- contraindicating if preexisiting CV disease if on nitrate or have hypotension
- if you have chest pain during sex stop and call 911
- sudden loss of vision or hearing
- no more than once per day
- priapism: painful erection or lasts more than 4 hrs = medical emergency
