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
