Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GU > Prostate Disorders - Exam 2 > Flashcards

Prostate Disorders - Exam 2 Flashcards

1
Q

What is the primary function of the prostate? How do prostate diseases normally manifest?

A

production of fluid that mixes with sperm to form semen

often present as urinary symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does gross hematuria in the urine usually indicate?

A

cancer until proven otherwise!!

hematuria can be only at the beginning, end or throughout the stream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hesitancy, dribbling, decreased force or caliber of stream, interruption of stream are what type of voiding symptoms?

A

obstructive!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

overflow, urge, stress, total are what type of voiding symptom? Briefly describe each

A

incontinence

overflow: so full the bladder leaks
urge: strong urge to go
stress: when you sneeze, cough a little urine leaks out
total: urine comes out whenver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the MC route of pathogens in acute bacterial prostatitis? What are the risk factors for acute bacterial prostatitis? What is ABP likely to co-occur with?

A

ascent up the urethra

catheter, prostate biopsy, urethral stricture

likely to co-occur with UTI or bladder infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the MC pathogen for ABP? How common is it?

A

E. coli - 58-88%, Pseudomonas - 3-7%, Proteus - 3-6% (gram - rods)

relatively rare only 4% of all prostatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

fever, chills, malaise, suprapubic, perineal, low back pain, irritative or obstructive voiding symptoms

What am I?

A

Acute bacterial prostatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What will ABP DRE feel like? Should you give a prostatic massage?

A

DRE: hot, exquisitely tender prostate

DO NOT give prostate massage: CI due to risk of septicemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When would you want to order imaging in ABP? What imaging?

A

if no response to abx in 24-48 hrs

Pelvic CT or transrectal US to assess for prostatic abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the tx for acute bacterial prostatitis? When do you need to consider in-pt therapy?

A

Abx directed at the causative agent

in-pt: severe s/s, needing surgical drainage or suspected bacteremia

per Jensen: better to admit than to NOT admit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the empirical IV tx for ABP? What is the tx for nosocomial ABP?

A

empirically: fluoroquinolone +/- aminoglycoside , or ampicillin/gentamicin

nosocomial: IV carbapenem or IV broad-spectrum PCN/cephalosporin +/- aminoglycoside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the oral tx for ABP? Which one does Jensen prefer? What else do you need to consider? **How long do you continue therapy?

A

TMP-SMZ (Bactrim DS) 800-160 mg BID- Jensen prefers this one

Fluoroquinolone (ciprofloxacin 500 mg BID, levofloxacin 500 mg QD)

Consider G+C coverage if age <35 or high-risk sexual behavior

**continue therapy for 4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the MC cause of chronic bacterial prostatitis?

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the difference between ABP and chronic bacterial prostatitis PE?

A

acute: DRE with will be warm and tender

chronic: DRE is ofter NORMAL but can be boggy, tender, enlarged, or indurated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

during a DRE how much of the prostate should you be able to feel if normal? What is the texture of a normal prostate?

A

normal prostate: should be able to reach above prostate with finger

enlarged prostate: you will NOT be able to reach the top and feel the curve of prostate

normal texture should feel the same as the tip of your nose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is the UA normal in chronic bacterial prostatitis?

A

because bacteria are “locked away” in the prostate so they will not show up in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What will the prostatic secretions of chronic bacterial prostatitis show?

A

Increased WBCs (>10 per hpf) with + culture

lipid-laden macrophages

urine culture will be positive for organisms after the prostatic massage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the tx for chronic bacterial prostatitis? How long do they need to continue taking?

A

Fluoroquinolones or TMP-SMZ are preferred
2nd line - doxycycline, macrolides
Possible alternatives - prolonged cephalosporins, fosfomycin

for a LEAST 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What do you need to counsel your patient on when prescribing the appropriate tx for chronic bacterial prostatitis?

A

counsel on the long-term effect of abx use: quinolones - C. difficile diarrhea, CNS toxicity, tendinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are some supportive care measures for bacterial prostatitis? How common are relapses?

A

anti-inflammatory agents, alpha blockers, sitz baths

very common and require repeat abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

______ is characterized by pelvic pain/discomfort in men that is accompanied by urologic symptoms +/- sexual dysfunction. What are the two variations?

A

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

inflammatory and non-inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

inflammatory prostatitis is also known as ________

non-inflammatory prostatitis is also known as ______

Which one is the MC? What age does it peak?

A

inflammatory: Nonbacterial Prostatitis, aka Chronic Prostatitis)

non-inflammatory: CPPS, aka Prostatodynia

Nonbacterial prostatitis/CPPS is the MC form (vs. CBP or ABP)- peaks in the 50s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

irritative voiding or obstructive voiding, LBP that is often dull and poorly localized. May have hx of IBS or fibromyalgia. PE is unremarkable

What am I?
What will the urine culture show?

A

Chronic Prostatitis/Chronic Pelvic Pain Syndrome

urine culture is likely negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What will the prostate secretions show in a pt with Chronic Prostatitis/Chronic Pelvic Pain Syndrome?

A

increased WBC if inflammatory (chronic/nonbacterial prostatitis)
normal if noninflammatory
negative culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the tx for Chronic Prostatitis/Chronic Pelvic Pain Syndrome? How long do they need to continue treatment?
tx varies due to s/s and not fully knowing the underlying cause alpha-blockers : Tamsulosin/Silodosin/Alfuzosin aimed at treating urinary symptoms for alpha blockers: need to continue for longer than 6 weeks if some improvement 5-𝛼-reductase inhibitors - finasteride, dutasteride Anti-inflammatories - NSAIDs
26
What chronic prostatitis tx is NOT recommended in younger men? Why?
5-𝛼-reductase inhibitors - finasteride, dutasteride due to decreased semen volume
27
What are the main s/s difference between ABP, CBP, nonbacterial prostatitis (chronic prostatitis) and prostatodynia (chronic pelvic pain syndrome). Draw the chart from lecture
28
What is the MC benign tumor in men? MC as you _____
benign prostatic hyperplasia MC as you age
29
T/F: All men to have BPH have symptoms
FALSE! not everyone is symptomatic
30
What are some risk factors for benign prostatic hyperplasia?
higher free PSA levels prostatitis, heart disease beta-blocker use lack of exercise obesity
31
What four factors can decrease your risk of BPH?
NSAIDs, excessive ETOH use, smoking, exercise excessive ETOH use and smoking are due to decreased testosterone
32
What is the etiology of BPH?
multifactorial!! prostate becomes more sensitive to androgens and growth factor as you age aging prostate stops normal cell death testosterone, dihydrotestosterone and estrogen may be involved in development
33
What are the 2 ways BPH obstructs?
mechanical obstruction due to narrowing of the urethral lumen and bladder neck dynamic obstruction due to alpha-receptor stimulation which causes increased constriction to prostatic urethra
34
What type of voiding is associated with BPH?
both irritative voiding and obstructive voiding obstructive voiding: due to mechanical blockage irritative voiding: due to urgency, frequency and nocturia
35
Urine hesitancy Decreased force and caliber of stream Sensation of incomplete bladder emptying Double voiding (urinating within 2 hours) Straining to urinate Postvoid dribbling What am I?
Benign prostatic hyperplasia
36
What are the irritative voiding symptoms of BPH caused by?
Due to secondary response of bladder to increased outlet resistance Detrusor muscle hypertrophy and hyperplasia, collagen deposition
37
______ assesses the severity of BPH symptoms
AUA symptom score
38
What will the DRE of BPH feel like? If you find ____ or _____ need to think it could be possible cancer
smooth, firm, symmetric, elastic enlargement of prostate Induration or asymmetric enlargement → possible cancer
39
What are 2 lab finding that could correlate with a BPH dx?
UA- may see hematuria but not always PSA: may be elevated even when no cancer is present
40
When would imaging be needed in BPH? What would you possibly order?
US - may be indicated if high serum Cr or UTI
41
What is the tx for mild BPH? What is considered mild? _____ is also possible in 50% of patients
watchful waiting! mild symptoms with a score between 0-7 or pts who do NOT want tx spontaneous regression in 50% of patients
42
What are the 5 criteria that disqualify a person from "watchful waiting" as their BPH treatment?
Refractory urinary retention Large bladder diverticula Recurrent UTI or gross hematuria Bladder stones CKD
43
What are the symptom score categories according to the AUA symptom score questionnaire?
0-7: mild 8-19: moderate 20-35: severe
44
What are the 3 types of alpha receptors? What areas do each target specifically? Which ones are slightly more effective in relieving BPH symptoms but have more SEs?
𝞪1a - 70% of adrenoreceptors in prostate, bladder neck 𝞪1b - smooth muscle of vasculature 𝞪1d - prostate, bladder neck, detrusor, sacral spinal cord Doxazosin and terazosin may be slightly more effective than tamsulosin, but have more SE
45
Prazosin (Minipress) Doxazosin (Cardura) Terazosin (Hytrin) What drug class? What are the SE? What are the DDI?
𝞪1-blockade Agents orthostatic hypotension, dizziness and floppy iris syndrome anti-HTN, PDE-5 inhibitors (will drop BP)
46
Silodosin (Rapaflo) Tamsulosin (Flomax) Alfuzosin (Uroxatral) What drug class?
𝞪1a-blockade Agents
47
______ MOA converts testosterone to dihydrotestosterone. What is the end effect? How long does it take to reach therapeutic effects? What pt population is it more effective in?
5-𝞪-reductase inhibitors reduces the size of prostate gland takes ~6 months of treatment to see full benefit More effective in men with larger prostates
48
T/F: All 5-𝞪-reductase inhibitors reduce PSA by 50%. What are the 2 drugs in this class?
True! Finasteride Dutasteride-> may be slightly more efficacious
49
What is the first line pharm therapy for BPH? What is the goal?
alpha blocker + 5-alpha-reductase inhibitor is considered first-line and superior to either treatment alone goal is to shrink prostate
50
______ is the PDE-5 inhibitor that is used in BPH
Tadalafil (Cialis) Not superior to alpha-blockers, no extra benefit as adjunct
51
_______ is the herbal that is commonly used in BPH treatment. Is it FDA approved?
Saw Palmetto NOT FDA approved
52
**What is the gold standard of prostate surgeries? Do you need to be hospitalized?
TURP: Transurethral Resection of the Prostate yes, require spinal anesthesia and 1-2 day hospital stay
53
What are the risks with TURP? **What are the complications?
Risks - retrograde ejaculation (75%), ED (5-10%), urine incontinence (<1%) Complications - bleeding, urethral stricture, bladder neck contracture, perforation of prostate capsule, Transurethral Resection Syndrome
54
______ is the hypervolemic, hyponatremic state caused by absorption of hypotonic irrigation solution. What increases this risk?
Transurethral Resection Syndrome is procedure lasts greater than 90 minutes
55
What type of procedure?
TURP
56
______ is when resectoscope is inserted into urethra and 1-2 small grooves are cut into the bladder neck to open the channel and improve urine flow
Transurethral Incision of the Prostate (TUIP)
57
What type of procedure?
Transurethral Incision of the Prostate (TUIP)
58
____ is used when the prostate is too large to remove endoscopically. How large does the gland need to be? What is their risk of complication and duration of hospital stay?
Open/Robotic Simple Prostatectomy Glands >100 g usually require open prostatectomy Higher risk of complications and longer recovery but shorter hospital stay
59
What procedure?
open simple prostatectomy
60
What is happening in a Robotic Waterjet Therapy (Aquablation)? What size gland? How are the outcomes compared to TURP?
Prostate is mapped out pre-treatment to identify tissue to be destroyed without affecting nerves, ejaculatory ducts 30-150 mL lower risk of stricture, incontinence, and possibly less sexual dysfunction
61
What is a TULIP? What are the advantages? disadvantages?
Transurethral laser-induced prostatectomy (TULIP) laser destroys prostate tissue and done under transrectal US guidance Advantages - minimal blood loss, less transurethral resection syndrome, outpatient, can be used in pts on anticoagulants Disadvantages - cannot save tissue sample for pathology, longer post-op catheterization, increased irritative voiding s/s, higher cost
62
What type of procedure?
TULIP laser resection of the prostate
63
What is a TUNA? How do post-tx symptoms compare?
Transurethral Needle Ablation of Prostate (TUNA) Specially designed urethral catheter with radiofrequency needles that penetrate the prostatic urethra Radiofrequencies used to heat tissue causing necrosis of prostatic tissue and sloughing similar improvements in symptoms when compared to TURP
64
What procedure?
TUNA
65
What is UroLift? What are the risks? Do you have to be admitted? What size prostates?
Implant to Open Prostatic Urethra (UroLift) Uses special device to place implants that “hold open” prostatic lobes May be done outpatient/in clinic, under local anesthesia Approved for prostates <80 g
66
What procedure?
UroLift
67
What procedure?
Water Vapor Thermal Therapy (Rezum)
68
_____ uses special catheter device device to open up urethral lumen and improve urine flow. What medication is used? What is the purpose of the medication?
Catheter Balloon Dilation (Optilume) (paclitaxel) prevent regrowth or refusion of anterior prostatic lateral lobes
69
What procedure?
Optilume BPH Catheter System
70
_____ is the MC non-skin cancer in US men and 2nd leading cause of cancer-related death in men. What are the risk factors?
prostate cancer Increased Age-> MAJOR one! Black ethnicity + family hx of prostate cancer High dietary fat intake
71
**How will most cancers palpate on exam? Where is the MC site of prostatic metastasis?
Most cancers have palpably normal prostates Axial skeleton metastasi
72
Why would prostate cancer have an elevated BUN/Cr?
urinary retention or obstruction
73
How do you dx prostate cancer? What are the common places?
US-guided biopsy is standard method for detection either transrectal or transperineal
74
**What imaging would you want to order if lymph nodes are also involved?
MRI- can help determine if bx is needed
75
How is histology staged in prostate cancer? What types are confined to the prostate vs locally extensive or metastatic?
Histologically staged by Gleason system 1 (well-differentiated) to 5 (undifferentiated) Gleason grades 1-2 are usually confined to prostate Gleason grades 4-5 are usually locally extensive or metastatic
76
______ is now the preferred initial treatment recommendation for men with ______ prostate cancer and _____ clinical features
Active surveillance well-differentiated low-risk
77
What are the 4 parts of prostate cancer active surveillance?
Serial PSAs, serial DREs, periodic MRIs, biopsies as needed
78
What is the patient criteria should undergo tx for prostate cancer?
If life expectancy > 10-15 yrs and cancer shows concerning features - usually should undergo tx
79
____ is one tx for prostate cancer. What are the risks? Who is NOT a candidate for this type of tx?
Radical Prostatectomy erectile dysfunction, urinary incontinence, infection Rarely used if stage T4 or + lymph node metastasis
80
_____ form of prostate cancer tx is used for small, localized prostate cancer. How does it work?
Cryosurgery Liquid nitrogen placed in prostate with US guidance
81
______ is a LHRH that is given has injection or implant for prostate cancer
leuprolide
82
_____ is LHRH antagonist that is given as a monthly subq injection. What is an added benefit?
degarelix No initial “testosterone flare” seen with LHRH agonists
83
What are the 2 adrenal suppressants that are used in prostate cancer?
ketoconazole and corticosteroids
84
What type of cancer is MC in prostate cancer?
adenocarcinomas that usually arise in periphery of prostate
85
______ glycoprotein produced only by cells of the prostate gland. What does it correlate with?
Prostate Specific Antigen (PSA) volume of prostate tissue
86
T/F: PSA is only produced by malignant cells of the prostate.
FALSE!! Produced by benign or malignant cells
87
What are 4 uses for PSA?
detect cancer stage cancer monitor response to treatment detect cancer recurrence
88
T/F: Pts with prostate cancer will have an elevated PSA
FALSE!! Some pts will have a normal PSA with prostate cancer
89
What are the normal, intermediate and high PSA level ranges? What percent of patients that undergo prostate cancer screening will have an elevated PSA?
90
What can the PSA level tell you have the volume/stage of prostate cancer?
If no history of prostate cancer tx - PSA level usually correlates with volume and stage of disease Organ-confined - <10 mcg/L Advanced - >40 mcg/L
91
If your pt is on one of these 5 medications need to think that their PSA is actually higher than reflected by their lab value. **What is the major one?
**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
92
**If you pt is on _______, what do you need to do their PSA so it is accurate?
5-alpha-reductase inhibitors need to double the value on the lab report
93
What are the 3 non-cancer causes of elevated PSA?
Benign Prostatic Hyperplasia (BPH) Prostatic inflammation/infection Perineal trauma (Prostatic massage, biopsy, surgery all count but DRE does NOT impact PSA level)
94
When is free PSA commonly used? What does the results tell you?
PSA is intermediate (4.1-10 mcg/L) Lower % of free PSA = higher likelihood of cancer Free PSA <10% - 56% chance of cancer Free PSA >25% - 8% chance of cancer aka higher free PSA increases chances of it NOT being cancer
95
What does PSA velocity measure? _____ have a higher chance of cancer
measures amount of change in PSA level in serial measurements (aka need to compare it against previous results) > 0.35 mcg/L/yr increase - higher chance of cancer
96
What are the AUA guidelines for screening for prostate cancer?
Baseline PSA between ages 40-45 for high-risk, 45-50 otherwise Routinely screen every 2-4 years ages 50-69
97

GU (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions