Prostate Flashcards
Describe the location of the prostate.
What is near it and what runs through it?
- Prostate lies inferior and around the neck of bladder.
- Encapsulated
- Posterior surface in contact with rectum (can be palpated)
Urethra runs through it. (prostatic urethra)
What runs from the kidney to Bladder
Ureter
What is the role of the prostate?
Fibromuscular and glandular accessory organ that provides then, milky, alkaline fluid as a bulking agent to semen and contracting during ejaculation. Ejaculatory duct meets urethra within prostate.
What is Benign Prostatic Hyperplasia?
How would CA differ in location and MNFTS?
• Nodular Periurethral enlargement of prostate (both muscle and glands
(CA is peripheral and multi centric, not necessarily urinary complications)
Incidence in Men by age?
• Very common as men age
o >40 years ~20% have BPH
o >60 years ~50%
o >80yrs ~90%
What is the Etiology of BPH
• Unclear
• Ageing the major risk
o Age related changes in androgen levels??
• Altered Testoterone : Estrogern Balance?
• Genetic, race and diet (higher likelihood)
o Japanese men low/ African high
o Role of yellow vegetables??
What is the relationship between testosterone and DHT?
Testes produce testosterone (converted to DHT which impacts accessory oragns)
o T -> 5alpha reductase-> DHT
o DHT acts on prostate cell and supports growth and Fx
What is the relationship of Estrogen to DHT
Sensitizes prostate to DHT
How does aging lead to prostate enlargement?
Aging leads to T quantitative dec and relative inc estrogen. This Increases significance of estrogen impacts (i.e relative inc) (Androgens have opposing actions) In this case a further sensitization of cells to DHT due to Alteration T:E ratio
o Relative inc in E -> sensitizes prostate to DHT -> enlargement
Is growth of BPH in the prostate hypertrophy or hyperplasia?
Where does growth take place?
o Hyperplasia in periurethral tissue -> compresses urethra
o Also hypertrophy of smooth muscle
Note: There is peripheral growth as well (not just periurethral)
What is the complication with prostate enlargement?
Impedes urine flow
bladder wall thickens ( normally thin walled, overfill can cause rupture… it’s a compensatory response)
o Trabeculations and diverticula develop in bladder
o Urine stasis (complications- stones, UTI’s, calculi)
NOTE (R/t future kidney notes)
What is a further complication once bladder back ups with urine?
o Ureter distention with urine -> hydroureter
o Ureter loop distends downward and creates “fishhook”
o Urine backs up in the kidney causing hydronephrosis
• Distention of renal pelvis and calicies with urine
Common MNFTS of BPH
- Frequency (inc)
- Hesitancy (difficulty starting urine flow)
- Weak urine stream (r/t constriction)
- Terminal dribblings (post void dribbling)
- Complete obstruction?
What is the major complications from complete urethral obstruction
Eventually pressure prevents filtration of Nitrogenous compounds and kidney failure
Dx of BPH
•Hx, MNFTS, Px
• Digital rectum exam (palpation of prostate through rectum)
• PSA (Prostate–specific antigen)
(Normally secreted by prostate in fluid, Inc should be proportional to Prostatic mass
o PSAD and PSAV (density and velocity) (requires size and PSA measure)
• Measure for benign and malignant growth
• BUN and Creatinine (No ischemic damage occurring here)
• Urinalysis (UTI’s?, stones?, hematuria)
