Prostate Flashcards
Is screening for prostate cancer recommended ?
NO
BPH risk factors
Age, obesity, diabetes, family history
BPH complications
UTI, bladder stone, urinary retention, hydronephrosis, renal failure
DDx Urinary Retention (8)
BPH
Prostate CA
Urethral stricture
Urethral diverticulum (women)
Medication
Infection
Trauma
Neurological (Spinal cord injury)
Voiding sx
predominant in bladder outlet obstruction (BOO) secondary to BPH (4)
Hesitancy, Weak Stream, Intermittence, Straining
storage sx (4)
r/o overactive bladder (OAB)
Urgency, Frequency, Urgency Incontinence, Nocturia
nocturnal polyuria
how many pees to be significant
2+
investigations for Lower Urinary Tract Symptoms (LUTS)
Urinalysis +/- culture (r/o infection)
PSA
PVR if considering anticholinergics (eg. storage symptoms suggesting OAB)
aka post voiding residual = bladder scan
Urinary retention - medication that can precipitate
decongestants
antihistamines
antidepressants
Decongestants (e.g., Pseudoephedrine, Phenylephrine) mechanism of action in urinary retention
Stimulate alpha receptors, tightening the bladder neck and urethral sphincter.
Antihistamines (e.g., Diphenhydramine, Loratadine, Cetirizine) mechanism of action in urinary retention
Anticholinergic effects reduce bladder muscle contraction.
Tricyclic Antidepressants (TCAs) (e.g., Amitriptyline, Nortriptyline) mechanism of action in urinary retention
Strong anticholinergic effects slow bladder contraction.
Selective Serotonin Reuptake Inhibitors (SSRIs) mechanism of action in urinary sx
Affect serotonin regulation, which influences bladder control.
✅ Increased urinary frequency or urgency
✅ Possible incontinence
Rx for BPH
- Tamsulosin (Flomax) CR 0.4mg PO daily = alpha blocker
For larger prostates combination therapy more effective with
5-alpha reductase inhibitors (onhibit conversion of testosterone to DHT, onset 4-6 months)
- Dutasteride (Avodart) 0.5mg PO daily
- or Finasteride (Proscar)
when to stop combination therapy
After 6-9 months of combination therapy, consider stopping alpha blocker
5-alpha reductase inhibitors take 4-6 months to work fully
anticholinergics when to prescribe
if storage sx :
overactive bladder (OAB)
Urgency, Frequency, Urgency Incontinence, Nocturia
ex of anticholinergics
Tolterodine, Oxybutynin, Mirabegron)
bacteril prostatitis tx
Septra DS 1 tab q12h x 6 weeks (or 12 weeks for chronic)
or Ciprofloxacin 500mg PO q12h x 6 weeks (for both acute and chronic)
Prostatie non infx ddx
Target UPOINTS
Urinary (storage/voiding symptoms)
Tamsulosin 0.4mg PO daily (a-blocker), antimuscarinics
Psychosocial
CBT, counselling, antidepressants, anxiolytics
Organ specific (prostate tenderness, hematospermia)
Quercetin, pollen extract
Infection (positive cultures in prostate sample, previous UTI)
Fluoroquinolone x 6 weeks
Neurologic / Pain
Acetaminophen, NSAIDs
Gabapentinoids, TCA, acupuncture
Tenderness (pelvic floor spasm, trigger points)
Physiotherapy (pelvic floor relaxation), exercise, heat therapy
Sexual dysfunction
PDE-5 inhibitors
