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GU: Clin Med IIA > Prostate Disorders > Flashcards

Prostate Disorders Flashcards

1
Q

Gross hematuria is always ___ until proven otherwise

A

cancer

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2
Q

Irritative voiding symptoms

A

Urgency
Dysuria
Frequency
Nocturia

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3
Q

Obstructive voiding symptoms

A

Hesitancy
Dribbling
Decreased force or caliber of stream
Interruption of stream

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4
Q

s/s of Incontinence

A

Overflow
Urge
Stress
Total

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5
Q

Most common route for Acute Bacterial Prostatitis

A

ascent up urethra
Can occur in setting of cystitis, urethritis

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6
Q

risk factors for Acute Bacterial Prostatitis

A

factors predisposing to GU infections

  1. Catheter, prostate biopsy, urethral stricture
  2. Anecdotal risks - no strong evidence to support
    - Trauma (bike riding, horseback riding)
    - Dehydration
    - Sexual abstinence
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7
Q

MC pathogen for acute bacterial prostatitis

A

G- rods
E. coli - 58-88%, Pseudomonas - 3-7%, Proteus - 3-6%
Other pathogens - G+ bacteria, STDs, etc.

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8
Q

Fever, chills, malaise - common
Pain - perineal, sacral, or suprapubic
Irritative voiding s/s
Occasionally obstructive voiding s/s
DRE - Hot, exquisitely tender prostate

these s/s are indicative of what

A

acute bacterial prostatitis

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9
Q

what is contraindicated for a DRE?

A

Prostatic massage contraindicated - risk of septicemia

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10
Q

lab findings for acute bacterial prostatitis

A

CBC - leukocytosis and left shift
Urinalysis - pyuria, bacteriuria, hematuria
Urine culture - + for causative agent

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11
Q

imaging for acute bacterial prostatitis

A

if no response to abx in 24-48 hrs
Pelvic CT or transrectal US to assess for prostatic abscess

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12
Q

tx guidelines of acute bacterial prostatitis

A
  1. All patients should receive Gram stain + C/S
    - Adjust according to culture results!
  2. Outpatient - no major comorbidities, no s/s of sepsis, able to take PO abx
  3. Hospitalize - severe s/s, complicated case (e.g. surgical drainage), suspected bacteremia
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13
Q

tx for acute bacterial prostatitis

A
  1. IV - fluoroquinolone +/- aminoglycoside , or ampicillin/gentamicin
    - Nosocomial - IV carbapenem or IV broad-spectrum PCN/cephalosporin +/- aminoglycoside
  2. Oral - TMP-SMZ, Fluoroquinolone (ciprofloxacin, levofloxacin)
    - Consider G+ coverage if age <35 or high-risk sexual behavior
  3. Continue for 4 wks
    - Monitor UA/UC, rectal exam, inflammatory markers to ensure resolution
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14
Q

MC pathogen of chronic bacterial prostatitis? others?

A

G- rods
E. coli - 75-80%
Klebsiella, Enterococcus, Proteus, Pseudomonas

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15
Q

MC route of chronic bacterial prostatitis

A

ascent up urethra
May be complication of ABP
Many pts have no hx of acute prostatitis

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16
Q

irritative voiding symptoms; may see obstructive voiding s/s
Pain - dull, poorly located, in suprapubic, perineal or low back regions
History of recurrent bacteriuria or UTIs
DRE - often normal
May see boggy (spongy), tender, enlarged, and/or indurated prostate

these s/s are indicative of what dx?

A

chronic bacterial prostatitis
Some are asymptomatic

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17
Q

lab findings for chronic bacterial prostatitis

A
  1. UA - normal unless cystitis also present
  2. Prostatic secretions - Increased WBCs (>10 per hpf) with + culture
    - Lipid-laden macrophages
  3. Urine culture - negative
    - + for causative organism after prostatic massage
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18
Q

imaigng for chronic bacterial prostatitis

A

not needed
prostatic calculi possible

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19
Q

tx for chronic bacterial prostatitis

A
  1. Fluoroquinolones or TMP-SMZ
  2. for at least 6 wks
    - May continue up to 12 weeks
    - SE quinolones - C. diff diarrhea, CNS toxicity, tendinopathy
  3. Supportive - anti-inflammatories, sitz baths
  4. Difficult to cure - relapses are common
    - Require repeat courses of abx
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20
Q

Characterized by pelvic pain/discomfort in men, accompanied by urologic symptoms and/or sexual dysfunction

A

Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

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21
Q

types of Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

A
  1. Inflammatory (Nonbacterial Prostatitis - Chronic Prostatitis)
  2. Non-inflammatory (CPPS - Prostatodynia)
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22
Q

MC prostatitis form worldwide? when?

A

Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome
Incidence peaks in the 5th decade

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23
Q

cause of Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

A

unknown
Believed to likely be noninfectious cause

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24
Q
  1. Irritative voiding or obstructive voiding
  2. Pain - perineal, lower abdominal, or low back
    - Often dull and poorly localized as with CBP
    - May have hx of other pain syndromes (e.g. IBS, fibromyalgia)
  3. Less likely to have hx of UTI than in CBP
  4. DRE - tenderness in 50% of pts

these s/s are indicative of what dx?

A

Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

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25
Q

lab findings for Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

A

1.UA - unremarkable
2. Prostatic Secretions
- increased WBC if inflammatory (chronic/nonbacterial prostatitis)
- normal if noninflammatory
- negative culture
3. Urine culture - negative

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26
Q

imaging for Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

A

mainly to rule out other pathology
e.g., obstruction in pts with obstructive voiding s/s

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27
Q

tx for Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

A
  1. Difficult due to unknown cause - varies depending on s/s
  2. Newly diagnosed - abx if abx-naive
    - fluoroquinolones, erythromycin
    — Given for 6 wks
    — May consider d/c after 2 wks if no improvement
  3. Urinary sx - 𝛼-blocker
    - Tamsulosin/Silodosin/Alfuzosin - selective; less SE
    - Prazosin, terazosin, doxazosin can be used
    - May continue for > 6 weeks if benefit is seen
  4. Adjunct (Meds)
    - 5-𝛼-reductase inhibitors - finasteride, dutasteride
    - NSAIDs
    — Steroids may help but generally not used due to SE
  5. Adjunct (Nonpharm)
    - Sitz baths - for symptomatic relief
    - CAM - acupuncture, cernilton (pollen extract), quercetin (bioflavinoid) may offer some small benefit
    - PT - myofascial release, biofeedback
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28
Q

MOA of alpha-blockers

A

block 𝛼-1 receptors in the bladder neck and smooth muscle in the prostate, causing relaxation and increased urethral size

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29
Q

what medication is Not recommended for younger men d/t decreased semen volume to tx Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome?

A

5-𝛼-reductase inhibitors

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30
Q

what other sequelae may need to be addressed individually for Nonbacterial Prostatitis/Chronic Pelvic Pain Syndrome

A

Neuropathic pain
Psychosocial disorders
Pelvic floor muscle dysfunction
Sexual dysfunction

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31
Q

MC benign tumor in men
More common with increasing age

A

BPH

  • 8% of men 31-40
  • 50% of men 51-60
  • Over 80% of men 80+
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32
Q

Obstructive voiding s/s present in BPH is MC with

A

25% of 55-yr-old men
50% of 75-yr-old men

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33
Q

risk factors for BPH

A
  1. Some evidence for genetic component
    - Black men - more likely to have severe s/s and to need surgery
    - Asian men - less likely than black or white men to have BPH
  2. Increased risk - higher free PSA levels, prostatitis, heart disease, beta-blocker use, lack of exercise, obesity
  3. Decreased risk - NSAIDs, excessive ETOH use, smoking, exercise
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34
Q

cause of BPH

A

multifactorial

  • Aging prostate seems to become more sensitive to androgens and growth factors
  • Aging prostate may also stop normal cell death
  • Testosterone, dihydrotestosterone, and estrogen may be involved in development
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35
Q

2 mechanisms of obstruction of BPH

A
  1. Mechanical obstruction - d/t narrowing
    - Urethral lumen
    - Bladder neck
  2. Dynamic obstruction - due to alpha-receptor stimulation
    - Causes increased tone (constriction) to prostatic urethra

Prostate size does not always correlate with sx

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36
Q

s/s of BPH

A
  1. Obstructive voiding - mechanical blockage
    - Urine hesitancy
    - Decreased force and caliber of stream
    - Sensation of incomplete bladder emptying
    - Double voiding (urinating within 2 hours)
    - Straining to urinate
    - Postvoid dribbling
  2. Irritative voiding - urgency, frequency, nocturia
    - secondary response of bladder to increased outlet resistance
    - Detrusor muscle hypertrophy and hyperplasia, collagen deposition

Usually begin slowly, progress gradually

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37
Q

what assesses the severity of BPH sx?

A

AUA symptom score

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38
Q

during a DRE you feel a smooth, firm, symmetric, elastic enlargement of prostate

what could be the possible dx?

A

BPH

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39
Q

Induration or asymmetric enlargement prostate during a DRE is indicative of what

A

possible cancer

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40
Q

Besides a DRE what other physical exams should you do?

A

Neuro exam - to rule out neurogenic bladder
Lower abdominal exam - to evaluate for distended bladder

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41
Q

lab findings of BPH

A
  1. UA - often normal, possible hematuria
  2. PSA - may help screen for prostate cancer
    - Can be elevated in BPH even when no cancer is present
  3. Prostate Bx - usually only done if concern for cancer
    - Transrectal or transperineal
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42
Q

imaging for BPH?

A

often not needed

  1. US - may be indicated if high serum Cr or UTI
  2. Upper GU tract imaging - only if complications arise or comorbid GU disease present
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43
Q

pt with BPH has sx scoring a 6, what would be the best next step/management?

A

watchful waiting

  1. For mild sx (score 0-7) or pts who do not want tx
    - Not all pts will experience s/s progression!
    - Up to 50% have spontaneous regression
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44
Q

Observation for BPH is NOT ideal if:

A

Refractory urinary retention
Large bladder diverticula
Recurrent UTI or gross hematuria
Bladder stones
CKD

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45
Q

meds for BPH

A
  1. alpha blockers
    - 𝞪1-blockade Agents
    - 𝞪1a-blockade Agents
  2. 5-𝞪-reductase inhibitors
  3. Phosphodiesterase-5 inhibitors (PDE 5)
  4. Phytotherapy

alpha blocker + 5-alpha-reductase inhibitor - first-line and superior to either tx alone

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46
Q

3 types of alpha receptors
where are these receptors?

A
  1. 𝞪1a - 70% of adrenoreceptors in prostate, bladder neck
  2. 𝞪1b - smooth muscle of vasculature
  3. 𝞪1d - prostate, bladder neck, detrusor, sacral spinal cord
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47
Q

how selective are alpha blockers?

A

some are, some not

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48
Q

all alpha blockers have roughly the same equal efficacy, but what 2 may be slightly more effective than tamsulosin, but have more SE?

A

Doxazosin and terazosin

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49
Q

Prazosin

A

𝞪1-blockade Agents

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50
Q

Doxazosin

A

𝞪1-blockade Agents

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51
Q

Terazosin

A

𝞪1-blockade Agents

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52
Q

which 𝞪1-blockade Agent needs dose titration?

A

terazosin

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53
Q

Silodosin

A

𝞪1a-blockade Agents

54
Q

Tamsulosin

A

𝞪1a-blockade Agents

55
Q

Alfuzosin

A

𝞪1a-blockade Agents

56
Q

Typical 𝞪1 SE

A
  1. orthostatic hypotension, dizziness, tiredness, retrograde ejaculation, rhinitis, and HA
  2. Floppy Iris Syndrome - cataract surgery complication in pts taking 𝞪1-blockers
57
Q

DDI with 𝞪1

A
  1. antihypertensives
  2. PDE-5 inhibitors - significant hypotension if combined
58
Q

what enzyme converts testosterone to dihydrotestosterone

A

5-𝞪-reductase

59
Q

result of inhibiting 5-𝞪-reductase?
how long does this take?

A
  • reduces size of prostate gland
  • Takes ~6 months of treatment to see full benefit
  • Reduces prostate size by ~20% - may reduce need for surgery
60
Q

All 5-𝞪-reductase inhibitors reduce PSA by what %?

A

50%
Should double PSA value when comparing to pre-treatment PSA

61
Q

finasteride

A

5-𝞪-reductase inhibitors

62
Q

dutasteride

A

5-𝞪-reductase inhibitor

63
Q

which 5-𝞪-reductase inhibitor is more efficacious?

A

dutasteride

64
Q

what is the branded combo of dutasteride and tamsulosin

65
Q

SE of 5-𝞪-reductase inhibitors

A

Decreased libido, erectile or ejaculatory dysfunction

66
Q

what med is Approved for use in men with BPH + ED sx?

A

Tadalafil - PDE5
Not superior to alpha-blockers, no extra benefit as adjunct

67
Q

MC agent of phytotherapy

A

Saw Palmetto

Herbals are approved in Europe to treat BPH
FDA has not approved any phytotherapy for BPH
Conflicting evidence on data
Not recommended as first line treatment

68
Q

types of BPH conventional surgeries

A
  1. Transurethral Resection of the Prostate (TURP)
  2. Transurethral Incision of the Prostate (TUIP)
  3. Open/Robotic Simple Prostatectomy
69
Q
  • Usually require spinal anesthesia and 1-2 day hospital stay
  • Resectoscope is used to trim away excess prostate tissue around urethra

what type of surgery

A

Transurethral Resection of the Prostate (TURP)

  • Greater improvement in symptoms and flow rate than minimally invasive procedures
  • Longer hospital stay required than minimally invasive procedures
70
Q

risks with TURP

A

retrograde ejaculation (75%), ED (5-10%), urine incontinence (<1%)

71
Q

complications with TURP

A

bleeding
urethral stricture
bladder neck contracture
perforation of prostate capsule
Transurethral Resection Syndrome

72
Q

Hypervolemic, hyponatremic state caused by absorption of hypotonic irrigation solution
Not as common now due to newer surgical methods

what is this dx? s/s? tx?

A
  • Transurethral Resection Syndrome
  • N/V, confusion, HTN, bradycardia, visual disturbances, seizures, muscle weakness/spasms, coma
  • diuresis, hypertonic saline
73
Q
  • Pts with mod-severe sx and small prostates often have an “elevated bladder neck”
  • Resectoscope is inserted into urethra and 1-2 small grooves are cut into the bladder neck, opening the channel and improving urine flow

that is this surgical intervention

A
  • Transurethral Incision of the Prostate (TUIP)
  • More rapid and less complications than TURP - Lower rates of retrograde ejaculation (25%)
74
Q

When prostate is too large to remove endoscopically
Suprapubic or retropubic approach
what is this surgical intervention?

A

Open/Robotic Simple Prostatectomy

75
Q

Open/Robotic Simple Prostatectomy has higher risk of complications and longer recovery, what are the complications?

A
  • Bleeding, UTI, retrograde ejaculation, ED, urinary incontinence, urethral stricture
76
Q

what type of prostatectomy tends to have shorter hospital stays, less blood loss, less need for catheter

A

Robotic-assisted simple prostatectomies

77
Q

glands how large (g) usually require open prostatectomy?

78
Q

what are the minimally invasive surgery interventions?

A
  1. Laser Therapy - Transurethral laser-induced prostatectomy (TULIP)
  2. Transurethral Needle Ablation of the Prostate (TUNA)
  3. Transurethral Electrovaporization of the Prostate
  4. Hyperthermia
  5. Implant to Open Prostatic Urethra
79
Q

which minimal surgical intervention:

  • Done under transrectal US guidance
  • Visually directed laser surgery also an option
  • Prostate tissue is sloughed for up to 3 months
A

Laser Therapy

80
Q

advantages of Laser Therapy

A

minimal blood loss
less transurethral resection syndrome
outpatient
can be used in pts on anticoagulants

81
Q

disadvantages of laser therapy

A

cannot save tissue sample for pathology
longer post-op catheterization
increased irritative voiding s/s
higher cost

82
Q
  • Specially designed urethral catheter with radio-frequency needles that penetrate the prostatic urethra
  • Radio- frequencies used to heat tissue causing necrosis of prostatic tissue and sloughing

what type of surgical therapy?

A

Transurethral Needle Ablation of Prostate - TUNA
Similar improvement in symptoms when compared to TURP

83
Q

Resectoscope inserted through urethra
Heat vaporization of prostatic tissue
Usually requires longer to complete than a TURP

what BPH intervention?

A

Transurethral Electrovaporization of Prostate

84
Q

Transurethral catheter delivers microwaves to heat and damage prostatic tissue
No comparison data for outcomes

what BPH intervention?

A

hyperthermia

85
Q
  • Uses special device to place implants that “hold open” prostatic lobes
  • Less risk for morbidity or complications than prostate resection procedures
  • May be done outpatient/in clinic, under local anesthesia
  • Approved for prostates <80 g

what BPH intervention?

A

Implant to Open Prostatic Urethra (UroLift)

Minimal impact on erectile or ejaculatory function

86
Q
  • Uses special device to deliver steam into prostatic tissue to cause thermal destruction
  • Minimal impact on erectile or ejaculatory function
  • May be done outpatient/in clinic

what type of BPH intervention?

A

Water Vapor Thermal Therapy (Rezum)

87
Q

MC non-skin cancer in US men
2nd leading cause of cancer-related death in men

A

Prostate Cancer

88
Q

risk factors for Prostate Cancer

A

Black race/ethnicity
+ family hx of prostate cancer
High dietary fat intake

89
Q

when is prostate cancer more evident/MC than clinically evident?

A

on autopsy
Most of these are small and contained within the prostate

90
Q

most (40%) of 50 y/o US men have what type of prostate cancer?

A

risk of latent prostate cancer

16% - risk of clinically evident prostate cancer
2.9% - risk of death due to prostate cancer

91
Q

s/s of prostate cancer

A
  1. DRE - May manifest as focal nodules or areas of induration within prostate
    - Most cancers have palpably normal prostates
  2. Large or locally extensive cancer - obstructive voiding s/s
  3. LN metastasis - lower extremity lymphedema
  4. Axial skeleton metastasis - back pain, fractures
    - MC site of prostatic cancer metastasis
92
Q

lab findings of prostate cancer?

A
  • Elevated PSA - may be sign of cancer
  • Elevated BUN/Cr - if urinary retention or obstruction
  • Elevated Alk Phos/Hypercalcemia - if bony metastases
93
Q

what is the standard method for detection of prostate cancer

A

Transrectal US-guided biopsy
- May also do transperineal prostate biopsy

Multiple biopsies taken from prostate gland with spring-loaded 18-gauge biopsy needle under local anesthesia

94
Q

imaging for prostate cancer?

A
  1. Transrectal US - staging, guiding bx
  2. MRI - evaluation of prostate + LN
  3. CT - no used to identify or stage prostate cancer
    - Can help detect lymphatic metastases and intra-abdominal metastases
  4. Radionuclide Bone Scan - to detect bony metastases
95
Q

staging for prostate cancer?

A

T1-T4
T1 - Clinically inapparent (not seen on imaging or palpated) - elevated PSA only
T2 - confined within prostate, visible or palpable
T3 - extends through prostate capsule, may invade seminal vesicles
T4 - fixed or invades adjacent structures

96
Q

most prostate cancers are what type of carcinoma?

A

adenocarcinoma
Usually arise in periphery of prostate

97
Q

prostate cancers are histologically staged how

A

Gleason system
1 (well-differentiated) - 5 (undifferentiated)

98
Q

tx for a small, well-diff prostate cancer?

A

surveillance
If life expectancy > 10 yrs - usually should undergo tx

99
Q

what is removed in a Radical Prostatectomy?

A

prostate, seminal vesicles, ampullae of vas deferens

100
Q

if a pt has local recurrence after a radical prostatectomy, what are you suspicious of?

A

advanced cancer

101
Q

Radical Prostatectomy is rarely used in what tumor/cancer staging/severity?

A

stage T4 or (+)LN metastasis

102
Q

risk factors of radical prostatectomy

A

ED, urinary incontinence, infection

103
Q

f/u for radical prostatectomy pt?

A

with radiation may improve survival

104
Q

how can radiation therapy for prostate cancer be done?

A
  • by external beam radiotherapy or transperineal implantation of radioisotopes
  • +biopsy >18 months after radiation - 20-60%
105
Q

what tx is Primarily used in metastatic disease prostate cancer?

A

chemotherapy

106
Q

Liquid nitrogen placed in prostate with US guidance
Used for small, localized prostate cancers
+ biopsy rates - 7-23%

what type of prostate cancer intervention?

A

cryosurgery

107
Q

70-80% of metastatic pts will respond to what type of therapy?

A

Androgen Deprivation Therapy

108
Q

what are the tx used for Androgen Deprivation Therapy

A
  • LHRH agonists
  • LHRH antagonist
  • adrenal suppressants
  • orchiectomy
109
Q

leuprolide

A

LHRH agonists
leuprolide is the main one
goserelin, triptorelin, histrelin

110
Q

degarelix

A

LHRH antagonist

111
Q

which androgen deprivation therapy May be given as depot injection or implant

A

LHRH agonist

112
Q

SE of LHRH agonist

A

ED, hot flashes, gynecomastia, may see anemia

113
Q

which androgen deprivation therapy is Given as monthly subcutaneous injection

A

LHRH antagonist

114
Q

what is not initially seen with LHRH antagonists compared to the agonists

A

“testosterone flare”

115
Q

SE of LHRH antagonists

A

ED, hot flashes, weight gain, increased LFTs

116
Q

what are the adrenal suppressants for androgen deprivation therapy

A

ketoconazole, corticosteroids

117
Q

Survival from prostate cancer depends on differentiation and extent of spread:

A
  • Gleason 1-2 - confined to prostate
  • Gleason 4-5 - locally extensive/metastatic
  • T1-T2 - 80% of pts; 100% 5-yr survival rate
  • T3-T4 (no metastases) - 12% of pts; 100% 5-year survival rate
  • T4 with metastases - 4% of pts - 30% 5-year survival rate
    — (Remainder of patients are ungraded)
118
Q

glycoprotein produced only by cells of the prostate gland

A

Prostate Specific Antigen (PSA)

119
Q

Prostate Specific Antigen (PSA) is produced by what type of cells/

A

benign or malignant

Serum level is typically low
Correlates with the volume of prostate tissue

120
Q

what Can be used to help detect cancer, stage cancer, monitor response to treatment, and detect cancer recurrence

A

PSA

  • 20% of pts who undergo prostatectomy for localized cancer have normal PSA
  • Rising PSA after treatment for cancer - recurrence
  • 98% of pts with metastatic prostate cancer will have elevated PSA
121
Q

lab results with PSA from prostate cancer

A

In screening - 10-15% will have elevated PSA

  • Normal - 0-4 mcg/L (0-4 ng/mL)
  • Intermediate - 4.1-10 mcg/L (4.1-10 ng/mL)
    — 18-30% will have cancer
    — Usually signifies localized cancer
  • High - >10 mcg/L (>10 ng/mL)
    — 50-70% will have cancer
122
Q

a pt with no hx of prostate cancer has a PSA level of 9 mcg/L, what does this say about the volume and stage of disease?

A

organ-confined

  • <10 mcg/L
  • > 40 mcg/L = advanced
  • If no history of prostate cancer tx - PSA level correlates with volume and stage of disease
123
Q

Medications influencing PSA levels:

A
  • 5-alpha-reductase inhibitors - reduce by 50%
  • NSAIDs or acetaminophen - lower PSA levels
  • Statins - reduce PSA by 4.1% per year
  • Thiazides - ~26% reduction over 5 yrs
124
Q

Non-cancer causes of elevated PSA:

A
  1. BPH
  2. Prostatic inflammation/infection
  3. Perineal trauma
    - DRE not believed to have impact
    - Prostatic massage, biopsy, surgery do have impact
    — Recommended to avoid measuring PSA for ~6 weeks
    - Vigorous bicycle riding may cause elevations in PSA
    - Sexual activity can minimally elevate (0.4-0.5)
125
Q

what measures unbound (free) PSA vs. total PSA levels?
When is this used MC?

A

Free PSA
Used especially if PSA is intermediate (4.1-10 mcg/L)

126
Q

Lower % of free PSA = ?

A

higher likelihood of cancer

Free PSA <10% - 56% chance of cancer
Free PSA >25% - 8% chance of cancer

127
Q

what measures amount of change in PSA level in serial measurements? what measurement is indicative of cancer?

A

PSA velocity
> 0.35 mcg/L/yr increase - higher chance of cancer

128
Q

when to and not to screen for prostate cancer?

A
  1. USPSTF -
    - Intermediate (grade C) for 55-69
    - Against 70+
  2. NCCN & EAU - Recommend for 40 and 45, annual screening from ages 50-65 or 75
  3. AUA -
    - Only screen ages 40-55 if high risk
    - Screen ages 55-69 annually
    - Do not screen if:
    — 70+
    — life expectancy <10 years
  4. NCCN & EAU + AUA:
    - Optional baseline DRE and PSA at age 40 (if high-risk)
    - If <0.6 and normal DRE, repeat at age 45
129
Q

When to start annual DRE and PSA:

A
  • If abnormal DRE, PSA, + family hx, or black male taking a 5-alpha-reductase inhibitor
  • At age 50-55 if normal PSA/DRE findings at age 40 and 45 and no other areas of concern
130
Q

when to dc screening for prostate cancer/PSA

A

PSA <1.0 at age 65
PSA <3.0 at age 75
Life expectancy < 10 years

GU: Clin Med IIA (13 decks)

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