Prostate Conditions Flashcards
What causes acute bacterial prostatitis?
MC gram negative: E.coli and pseudomonas
What is the presentation for acute bacterial prostatis?
Abrupt:
PERINEAL, SACRAL, suprapubic pan
High FEVER
Initiative voiding
+//- urinary retention
Exquisitely tender prostate
(GENTLE DRE) NO PROSTATIC MASSAGE could have bacteria leak out and cause septicemia
What are the labs for acute bacterial prostatis?
UA: pyuria, bacteriuria, hematuria
CBC: leukocytosis
Urine culture: + offending pathogen
What is the treatment for acute bacterial prostatitis?
You have to base your abx off of you cultures
IV: fluoroqunolone + aminoglycoside
(Ciprofloxacin/levofloxacin + gentamicin or tobramycin)
P.O.: fluoroquinolone: TMP-SMX after afebrile for 24 hours
When would you admit for acute bacterial prostatitis?
Septicemia, comorbidities, unlikely to f/u
Initiate parenteral broad spectrum: ampicillin + aminoglycoside
How long is treatment for acute bacterial prostatitis?
4-6 weeks
What happens if urinary retention develops as a result of acute bacterial prostatitis?
Percutaneous suprapubic tube indicated
URETHRAL CATH CI DUE TO RISK OF SEPTICEMIA
What is the f/u for acute bacterial prostatitis?
Urine and prostatic secretion culture to ensure eradication
Patient presents w/ irritating voiding symptoms, low back pain, perineal pain, HX OF UTIs w/ a prostatic calculi?
Chronic bacterial prostatis?
How do the labs for chronic and acute bacterial prostatitis differ?
In chronic the UA and culture are likely unremarkable and you WANT TO DO A POSTPROSTATIC MASSAGE W/ EXPRESSED PRSTATIC SECRECTIONS: indicates inflammation not necessarily infection
What is the treatment for chronic bacterial prostatitis?
TMP-sulfamethoxazole 6-12 weeks
Symptomatic relief
NSAIDS or sitz baths
What are your options for if treatment for chronic bacterial prostatitis fails?
Try again w/ longer course of abx
Consider possibility of infected prostate stone
What is the MC prostatitis?
Chronic non bacterial prostatitis
What is the difference between the clinical presentation of chronic bacterial and non bacterial prostatitis?
Nonbacterial prostatitis does not have a hx of UTIs
How are the labs for bacterial and non bacterial chronic prostatitis different?
They will both show increased leukocytes on prostatic secretions becuase that indicated inflammation not infection, but all cultures are negative
What is thee treatment for chronic nonbacterial prostatitis?
Trial of abx against atypical organisms
ERYTHROMYCIN: 14 DAYS
NSAIDs
Sitz baths
What is prostatodynia?
Voiding dysfunction or pelvic floor musculature dysfunction
Leads to similar symptoms as chronic prostatis, but everything is normal.
What is the treatment for prostatodynia?
Alpha-blockers: bladder neck and urethral spasms
Diazepam: pelvic floor dysfunction
Sitz baths
What 2 factors are essential for BPH development?
DHT, aging
What does 5-alpha-reductase do?
Converts testosterone to DHT
What does DHT do?
Promotes prostate cell proliferation, leading to BPH
What is the pathology of BPH?
Hyperplastic process increasing cell numbers leads to nodular growth pattern.
Growth occurs in the transition zone and includes stroma and epithelium
How do the treatments for BPH affect the different tissue types?
Alpha blockers decrease the tone of the prostatic stroma
5 alpha reductase inhibitor: works on the increased prostate epithelium
What are the two ways that symptoms can show for BPH?
Obstructive and irritating
What is the single most important tool for the evaluation of BPH?
American urological association symptom index (questionnaire)
How does the prostate feel in BPH?
Smooth, firm, elastic enlargement,
If there is induration further work up needed to rule out cancer (Transrectal U/S and biopsy)
If the AUA score is >=8 what are other studies you can consider for BPH?
Urodynamic studies or Post void residual
When should you get imaging for BPH?
Only if there are complications: hematuria, UTI, CKD, urinary stone disease
What lab do you need to get for BPH?
UA to rule out infection and PSA to r/o cancer
What is the treatment for mild BPH (AUA score 0-7)?
Watchful waiting , some men will undergo spontaneous resolution
What is the treament for moderate to severe symptoms of BPH?
Watchful waiting, surgery, medical therapy
What are absolute surgical indications for BPH?
+/-
Refractor urinary retention (failing at least 1 attempt at catheter removal)
Large bladder diverticula
BPH sequelae:
- Recurrent UTI
- Recurrent or persistent hematuria
- Bladder stones
- CKD (renal insufficiency/failure)
what does the 5-alpha-reducatase inhibitor do finasteride do?
reduces serum PSA by 50%
what if you have BPH and erectile dysfunction?
tadalafil
what are the essentials for diagnosis of prostate cancer?
PROSTATIC INDURATION on DRE or PSA elevation
what is the MC non cutaneous cancer in men in US?
prostate
what is the 2nd leading cause of cancer-related death
prostate cancer
if you have symptoms w/ prostate cancer what does that mean?
locally advanced or metastatic disease, think bone pain or lumbar spine pain, obstructive or irritative
what labs are important for indicating prostate cancer and what level means confined to the prostate and what level indicates advanced disease?
PSA
retention or obstruction: inc. BUN or creatinine
skeletal metastases: inc. alk phos or hypercalcemia
confined: <10ng/mL
advanced: PSA >40 ng/mL
what is important to remember about PSA and prostate cancer?
even if it’s negative you can still have cancer
what do you do if someone has an elevated PSA?
ultrasound and biopsy
what do you do if someone has an abnomral DRE, but a normal PSA>
refer for u/s and biopsy
if a patient is older and has a low cancer risk what is an option for prostate cancer treatment?
active surveilance
who is a poor candidate for radical prostectomy?
T4 advanced disease or lymph node mets (not good candidates)
what is a good treatment for cancer that has metastasized?
androgen suppression via hormonal therapy
what is used for prognosis of prostate cancer and what does a high score mean?
CAPRA nomogram
higher is worse
what’s prevention of prostate cancer?
antioxidants cruciferous veggies vit. D omega 3 lose weight dont smoke high fiber/low fat green tea (polyphenols) decreased ETOH intake
what is the screening criteria for prostate cancer according to american cancer society?
begin at 50 for average age white 45 at w/ high risk -black -BRCA-1 -FAm HX
stop when life expectancy <10years
what does the USPSTF recommend for prostate cancer screening?
against it
what rate for PSA change indicates cancer?
> .75 ng/mL/ year
what does free PSA indicate?
> 25% cancer unlikely
<10% = 50% chance of cancer
