prostate problems and GU cancers Flashcards
what is the most common prostate condition?
benign prostatic hyperplasia (BPH)
BPH is a major cause of _______ in older men
LUTS (lower urinary tract symptoms)
what are the symptoms of BPH? (4)
weak urinary stream, post-void dribble, frequent urination, nocturia
prevalence of BPH increases sharply with ____
age
for BPH, you can expect prostate volume (PV) to _____ in ___years
double in 15 years
BPH tends to progress
what is the AUA -SI ?
american urological association symptom index : calculates the chance of Dx being BPH based on cardinal signs, all of which are obstructive signs.
what are the signs that the AUA-SI uses?
frequency, incomplete emptying, intermittency, urgency, weak stream, straining, nocturia
there is an increased risk for _____ with BPH. why is this?
UTI
why? increased PVR (post-voidal residual volume)/incomplete emptying
txt for BPH? (3)
- 5-alpha reductase inhibitors (finasteride or dutasteride)
- alpha 1–andrenergic blocking drugs: (tamsulosin/Flomax®, terazosin, prazosin)
- combo
*Prazosin will lower BP more; other HTN alpha blockers can be used for dual effect (e.g. doxazosin/Cardura®)
how do the 5alpha reductase work?
reduce prostate volume:
improve symptoms AND slow disease process
how do the alpha blockers work?
relax smooth muscle: improve symptoms
what will lower PSA? making PSA tests harder to interpret (prostate specific antigen)
the use of 5 Alpha reductase inhibitor (finasteride, dutasteride)
what is the surgical txt for BPH?
TURP: transurethral resection of the prostate
- grinds a tunnel through the prostate
when is surgical txt appropriate for BPH?
mostly if there is acute obstruction
what is acute bacterial prostatitis? is it worrisome?
Ascending urethral infx or reflux of infected urine– can be severe and life-threatening
what does a rectal exam show for acute bacterial prostatitis? what else is a symptom?
- reveals swollen, “boggy”, very tender, warm prostate
- pelvic pain
txt for acute bacterial prostatitis?
4wks abx then maybe TURP or other surgery
how does chronic bacterial prostatitis present?
- Frequent and urgent urination, dysuria
- low back pain, dull aching pain present in the perineum, rectum, or sacrococcygeal region (“like sitting on a golf ball”
is acute or chronic bacterial prostatitis more common?
chronic
PE of chronic bacterial prostatitis?
large boggy prostate, less tender than in acute
chronic bacterial prostatitis presents with what other infection? what are the organisms?
recurrent UTIs
-same strain of pathogenic bacteria in the prostatic fluid and urine; Gram neg enterobacteria (E. coli, Proteus, or Klebsiella) or Pseudomonas
Dx of chronic bacterial prostatitis?
urine Cx (best after prostatic massage), with Tx based on culture results
txt of chronic bacterial prostatitis?
Empiric Tx: at least 4-6 wk of FQ or TMP/SMX
nonbacterial prostatitis, chronic pelvic pain syndrome (CPPS): what is it?
Similar to chronic prostatitis in presentation, but negative cultures, or not responsive to antibiotics
txt for CPPS
Treatments not highly effective
Alpha blockers, NSAIDs, benzos (muscle relaxer), warm baths, prostatic massage, frequent ejaculation may help
what are important considerations for those with CPPS?
Psychological considerations: take Pt seriously, validate symptoms, consider pain management, psych
what is the most important risk factor for prostate cancer?
age
BRCA link in ___ % of prostate cancer cases
15
prostate cancer 2014 review summary: __________ and _____________ are always valuable to use, and to document
“Screening Discussion” and “Shared Decision Making” are always valuable to use, and to document
prostate cancer 2014 review summary: Screening has the most benefit in ___________ and those with _____________
younger men, those with 15+yr life expectancy
Much prostate CA is ___________ _______, especially in older men with short life expectancy. “far more men die ___ prostate cancer than ___ prostate cancer”
clinically insignificant
-Far more men die with prostate cancer than die of prostate cancer”
prostate cancer: Consider what options are acceptable to the patient when? why is this important?
BEFORE you do testing!
- often more harm than good is done with screening, prostate size increases with age.. and so does the risk for prostate cancer.
The analysis of family medicine recommend what in regards to screening for prostate cancer?
against routine performance DRE to screen for prostate cancer in the primary care setting.
what is the standard txt for metastatic prostate cancer? what is it often combined with?
Androgen Deprivation Therapy (ADT): since prostate CA is extremely androgen-dependent; often combined with radiation therapy
painless hematuria and smoking history: what do you think the Dx likely is?
bladder cancer
unexplained hematuria…
MUST be followed up
Bladder cancer:______ matters – _____________ is ___%, and low risk. why is this significant?
- depth
- non-muscle invasive bladder CA (NMIBC) is 75%
- this cancer recurs often but does not kill
txt for bladder cancer
intravesicular chemo and BCG for low grade
how does BCG work for bladder cancer? (weeds)
activates the immune system (for superficial tumors)
what is the most common cause of renal cell carcinoma (RCC)?
from renal parenchyma
symptoms of RCC?
Sx: palpable flank mass, pain, hematuria, or incidentally
txt for RCC?
Tx: nephrectomy, nephron-sparing ablation
