Prostate Flashcards
Pathogenesis of BPH
DHT mediates hyperplasia
Stromal cells help with expression of 5 alpha reductase
Estradiol enhances DHT activity and increases sex hormone binding globulin
Difference in the effect of DHT and estradiol formation
DHT – Increased growth via intracellular androgen
Estradiol - Accelerates prostatic growth (more DHT receptor)
Clinical Manifestations of BPH
Incomplete bladder emptying
Urinary retention
Chronic Renal Insufficiency
Hematuria
Obstructive symptoms of BPH
hesitancy Weak stream Straining to pass urine Prolonged micturation Incomplete Bladder Emptying Urinary Retention
Irritative Symptoms of BPH
Urgency
Frequency
Nocturia
Urge Incontinence
Name the survey used to assess BPH
IPSS
Important parts of a Focused Physical Exam in a BPH patient
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
Lab tests typically ordered in BPH work up
Urinalysis Urine Culture Creatinine PSA Cytology if indicated
Relative indications for BPH intervention
Moderate post void residual
Symptoms of LUTS
Urodynamic evidence of obstruction
Absolute Indications for BPH Intervention
Urinary Retention Frequent UTIs Renal Insufficiency Gross Hematuria Bladder Stones Hydronephrosis
Christmas Tree Bladder is typically considered a sign of…
Neurogenic bladder dysfxn
Types of Medical therapy used for BPH
Alpha Blockers and 5-alpha reductase inhibitors
Nmae important alpha blockers for BPH
Doxazosin, Terazosin (Hytrin)
Tamsulosin (Flomax)
Alfusosin, Silidosin
Name important 5-alpha reductase inhibitors
Finasteride (Proscar)
Dutasteride (Avodart)
Of the two types of medical treatment for BPH, which is better at what?
5 alpha reductase – Glandular hyperplasia
Alpha blocker – Stromal hyperplasia
IMportant details to keep in mind with Finasteride and Dutasteride treatment
Will take 6-12 months to see maximum benefit
PSA should drop by 50%
Side Effects – Impotence and Decreased Ejaculate Volume
What is the debate about the relationship of Finasteride and Dutasteride to treatment
They decrease the likelihood to cancer, but increase the likelihood of cancers being higher grade
Important details to keep in mind with alpha blockers
Work in days-weeks
Doesn’t effect disease progression
Relaxes the prostate with minimal/no effect on bladder fxn
Most common side effects of alpha blockers
Retrograde Ejaculation with Flomax
Asthenia
Dizziness
Flu like symptoms
Headache
Minimally Invasive Treatments for BPHs
Microwave Thermotherapy
HoLAP/PVP (Greenlight laser)
TUNA
TURP
Important details on TURP
Transurethral Resection of the Prostate
Therapeutic effect more than twice as good as meds
Can have post op UTI
Who should be screened for prostate cancer
Patients with life expectancy above 10 years
Detectable abnormality
Age 50+ (40 w/ family history)
Only every 2 yrs if PSA under 1
Causative factors of Prostate Cancer
Sex Hormones Familial Pattern Dietary Fat Urbanization/Environmant Longevity
How do symptoms of prostate cancer develop
Early - none
Progressive – like BPH
Advanced – Persistent pain in back, hips, pelvis, ribs, or thighs
Why do a TRUS?
Abnormal DRE or PSA
Staging a known cancer
Why do a prostate biopsy?
Abnormal DRE, Prostate Nodule, or Elevated PSa/PSA Velocity
How to prep for a prostate biopsy
Cleansing enema Prebiopsy AB (Quinalone) (Pre-biopsy culture to check resistance)
What part of prostate has the majority of cancers
peripheral zone has 70%
20% in transition zone
Four sonographic characteristics of prostate lesions. What are they and which is most associated with cancer
Anechoic
Hypoechoic**
Hyperechoic
Mixed Echogenic
Options for treatment of Late discovered prostate cancer
Orchiectomy
Palliative Radiation
Medical Management – Hormonal and Chemotherapy
What type of hormonal therapy is used to control prostate symptoms
LR-RH Agonists/Antagonists to downregulate hormone production in the hypothalamus.
Anti-androgen
