Prostate

Question 1

Pathogenesis of BPH

Answer 1

DHT mediates hyperplasia
Stromal cells help with expression of 5 alpha reductase
Estradiol enhances DHT activity and increases sex hormone binding globulin

Question 2

Difference in the effect of DHT and estradiol formation

Answer 2

DHT – Increased growth via intracellular androgen

Estradiol - Accelerates prostatic growth (more DHT receptor)

Question 3

Clinical Manifestations of BPH

Answer 3

Incomplete bladder emptying
Urinary retention
Chronic Renal Insufficiency
Hematuria

Question 4

Obstructive symptoms of BPH

Answer 4

hesitancy
Weak stream
Straining to pass urine
Prolonged micturation
Incomplete Bladder Emptying
Urinary Retention

Question 5

Irritative Symptoms of BPH

Answer 5

Urgency
Frequency
Nocturia
Urge Incontinence

Question 6

Name the survey used to assess BPH

Answer 6

IPSS

Question 7

Important parts of a Focused Physical Exam in a BPH patient

Answer 7

Abs - kidney/bladder masses, hernias
External genital – look for stenosis, testes, epidid., lesions
DRE – Size, consistency, nodularity, seminal vesicles
Neurologic – Sensation, sphincter tone, bulbocav. reflex

Question 8

Lab tests typically ordered in BPH work up

Answer 8

Urinalysis
Urine Culture
Creatinine
PSA
Cytology if indicated

Question 9

Relative indications for BPH intervention

Answer 9

Moderate post void residual
Symptoms of LUTS
Urodynamic evidence of obstruction

Question 10

Absolute Indications for BPH Intervention

Answer 10

Urinary Retention
Frequent UTIs
Renal Insufficiency
Gross Hematuria
Bladder Stones
Hydronephrosis

Question 11

Christmas Tree Bladder is typically considered a sign of…

Answer 11

Neurogenic bladder dysfxn

Question 12

Types of Medical therapy used for BPH

Answer 12

Alpha Blockers and 5-alpha reductase inhibitors

Question 13

Nmae important alpha blockers for BPH

Answer 13

Doxazosin, Terazosin (Hytrin)
Tamsulosin (Flomax)
Alfusosin, Silidosin

Question 14

Name important 5-alpha reductase inhibitors

Answer 14

Finasteride (Proscar)

Dutasteride (Avodart)

Question 15

Of the two types of medical treatment for BPH, which is better at what?

Answer 15

5 alpha reductase – Glandular hyperplasia

Alpha blocker – Stromal hyperplasia

Question 16

IMportant details to keep in mind with Finasteride and Dutasteride treatment

Answer 16

Will take 6-12 months to see maximum benefit
PSA should drop by 50%
Side Effects – Impotence and Decreased Ejaculate Volume

Question 17

What is the debate about the relationship of Finasteride and Dutasteride to treatment

Answer 17

They decrease the likelihood to cancer, but increase the likelihood of cancers being higher grade

Question 18

Important details to keep in mind with alpha blockers

Answer 18

Work in days-weeks
Doesn’t effect disease progression
Relaxes the prostate with minimal/no effect on bladder fxn

Question 19

Most common side effects of alpha blockers

Answer 19

Retrograde Ejaculation with Flomax

Asthenia
Dizziness
Flu like symptoms
Headache

Question 20

Minimally Invasive Treatments for BPHs

Answer 20

Microwave Thermotherapy
HoLAP/PVP (Greenlight laser)
TUNA
TURP

Question 21

Important details on TURP

Answer 21

Transurethral Resection of the Prostate
Therapeutic effect more than twice as good as meds
Can have post op UTI

Question 22

Who should be screened for prostate cancer

Answer 22

Patients with life expectancy above 10 years
Detectable abnormality
Age 50+ (40 w/ family history)
Only every 2 yrs if PSA under 1

Question 23

Causative factors of Prostate Cancer

Answer 23

Sex Hormones
Familial Pattern
Dietary Fat
Urbanization/Environmant
Longevity

Question 24

How do symptoms of prostate cancer develop

Answer 24

Early - none
Progressive – like BPH
Advanced – Persistent pain in back, hips, pelvis, ribs, or thighs

Question 25

Why do a TRUS?

Answer 25

Abnormal DRE or PSA

Staging a known cancer

Question 26

Why do a prostate biopsy?

Answer 26

Abnormal DRE, Prostate Nodule, or Elevated PSa/PSA Velocity

Question 27

How to prep for a prostate biopsy

Answer 27

Cleansing enema
Prebiopsy AB (Quinalone) (Pre-biopsy culture to check resistance)

Question 28

What part of prostate has the majority of cancers

Answer 28

peripheral zone has 70%

20% in transition zone

Question 29

Four sonographic characteristics of prostate lesions. What are they and which is most associated with cancer

Answer 29

Anechoic
Hypoechoic**
Hyperechoic
Mixed Echogenic

Question 30

Options for treatment of Late discovered prostate cancer

Answer 30

Orchiectomy
Palliative Radiation
Medical Management – Hormonal and Chemotherapy

Question 31

What type of hormonal therapy is used to control prostate symptoms

Answer 31

LR-RH Agonists/Antagonists to downregulate hormone production in the hypothalamus.

Anti-androgen