Prostate + UTI Flashcards
RF for prostate cancer
Urban african americans
Family history
High dietary fat
Smoking
Sx of prostate cancer
Asymptomatic
LUTS - storage, voiding, incontinence
LBP (mets)
Rx of prostate cancer (low, intermediate + high risk)
Low risk = active surveillance (PSA q6mo, DRE annually)
Intermediate risk = radical prostatectomy, brachytherapy, RT, PSA q6mo for 5 yrs
High risk = RT, androgen deprivation therapy, radical prostatectomy, radical RT, PSA q6mo
Complications of radical prostatectomy, radiation + mets
Radical prostatectomy: urinary incontinence
Radiation: bowel dysfunction, erectile dysfunction
Mets: adrenal gland, bone, liver, lung
Ix for prostate cancer
Order PSA if abnormal DRE, LUTS, FU of man w/ prostate cancer
Free PSA <10% suggestive of cancer
Don’t order if life expectancy <10 yrs
RF for BPH
Age
Obesity
Fam hx
Sx of BPH
LUTS - storage, frequency, incontinence, nocturia, hesitancy, weak stream, intermittance, straining, dribbling, incomplete void, retention
Erectile dysfunction
Ix for BPH
UA
PSA if life expectancy >10 yrs
Lifestyle management of BPH
Fluid restrict at bedtime
Avoid alcohol, caffeine, spicy food
Avoid irritating meds (TCAs, diuretics, antihistamines)
Bladder training
Pelvic floor exercises
Urethral milking
Medications for BPH
Alpha blocker (Tamsulosin)
5-alpha reductase inhibitors (Finasteride)
Combo best if symptomatic LUTS + enlarged prostate
DC alpha blocker after 6mo
Desmopressin
Alpha blocker (Tamsulosin) monitoring, effectiveness + SE
Monitor BP
Reduces LUTS but not dz progression
SE: HA, dizziness, somnolence, postural hypotension
5-alpha reductase inhibitors (Finasteride) uses, SE
Only if enlarged prostate on DRE
Shrinks prostate, reduces retention
Used best in conjunction with alpha blocker
SE: ED, reduced libido
Use of desmopressin
Good for nocturnal polyuria
Surgical options for BPH
Mono or bipolar transurethral resection of prostate
Bipolar plasma kinetic vaporization
Prostatectomy
Irritative vs obstructive sx of BPH
Irritative: frequency, urgency
Obstructive: weak stream, hesitancy, incomplete voiding