Prostate B&B Flashcards
what is the usual cause of acute prostatitis in older men vs younger sexually-active men?
in any case, usually bacterial
older men - E. coli most common, also proteus, pseudomonas
younger/sexually active - Neisseria gonorrhoeae or Chlamydia trachomatis
fever + dysuria + cloudy urine + “boggy” and tender prostate on digital rectal exam =
acute prostatitis - usually bacterial cause
presents like a UTI with a tender/edematous prostate
is benign prostatic hyperplasia pre-malignant?
NO
BPH: “nodular” hyperplasia of the stromal and epithelial cells in the transitional zone of the prostate, age-related
how can the prostate be divided into lobes and zones?
lobes: lateral (on both sides), anterior (in front of urethra), median (behind urethra), posterior lobe
zones: transitional (surrounds urethra - site of BPH), central, peripheral (outside of gland - site of most carcinoma)
how can finasteride be used to treat benign prostatic hyperplasia?
5-alpha reductase inhibitor
growth of prostate is driven by dihydrotestosterone (DHT), which is produced via conversion from testosterone using this enzyme!
slows onset, good for someone with mild-moderate symptoms (will not treat acute bladder obstruction)
what kind of drug is Finasteride?
5-alpha reductase inhibitors
can be used to slow onset of symptoms of benign prostatic hyperplasia (BPH)
what kind of drugs are Terazosin and Tamsulosin, and how are they used?
alpha1 blocker most commonly used for benign prostatic hyperplasia (BPH) - causes smooth muscle relaxation
uroselective - binds alpha1A receptors in prostate/bladder but not peripheral alpha1B (no hypotension)
what kind of drug is Tadalafil?
PDE-5 inhibitor - causes smooth muscle relaxation by preventing cGMP breakdown
Tadalafil is approved for benign prostatic hyperplasia (BPH), also used to treat erectile dysfunction
what is the most common cancer in men and where does it typically originate?
Prostate adenocarcinoma - 2nd most deadly (after lung), occurs in men 50+
occurs in peripheral zone / posterior lobe
explain why prostate adenocarcinoma does not usually cause dysuria?
occurs in peripheral zone / posterior lobe which is farthest from the urethra
how is a prostate biopsy performed?
transrectal biopsy with transrectal ultrasound (TRUS) guidance
recall the prostate is just anterior to the rectum
what is the problem with using prostate-specific antigen (PSA) for screening and diagnosis?
PSA is elevated in both benign prostatic hyperplasia (BPH) and prostate cancer, making it hard to differentiate for diagnosis (however there is less free PSA in cancer)
screening is controversial because these are cancers of older men and treating the tumor may not actually extend life
how can measurement of prostate-specific antigen (PSA) levels be adapted to more accurately diagnosis prostate cancer?
PSA rises in both BPH and prostate cancer
however, prostate cancer produces more bound PSA —> increased total PSA + decrease in free PSA
most PSA bound to protease inhibitors - antichymotrypsin and macroglobulin
how is stage vs grade of prostate cancer determined?
stage = extent of tumor growth/spread
grade = level of cell differentiation, determined using Gleason system
to where does prostate cancer classically metastasize? what is the consequence of this?
hematogenous spread to the spine —> back pain, increased alkaline phosphatase
causes osteoblastic lesions: deposition of new bone
