Quiz 5 -Prostate Flashcards
Acute Bacterial Prostatitis
pathogens from colorectal flora (E coli—most common)
urologic emergency
Acute Bacterial Prostatitis RFs
Young men (20-30 yo), sexually active; prior antibiotic exposure; dehydration
Phimosis; unprotected anal intercourse
Trauma (bicycle riding, horseback riding, catheterization)
HIV/DM
Prostate biopsy
Acute Bacterial Prostatitis Ssxs
fever, chills, malaise, arthralgia, myalgia
LUTS
low back pain
prostate acutely tender, warm, swollen
Acute Bacterial Prostatitis Labs
MSCC: hematuria, bacteriuria, pyuria, cloudy
elevated PSA
Acute Bacterial Prostatitis Tx
toxic pts: IV abx
non-toxic: oral abx
Acute Bacterial Prostatitis Complications
bacteremia, epididymitis, chronic prostatitis, prostatic abscess (=clinical and lab findings persist, order a TRUS, drainage)
Chronic Bacterial Prostatitis SSxs
Recurrent UTIs Fatigue Chronic GU pain Sexual dysfunction, ejaculatory pain Milky urethral d/c PE-- DRE – moderate tenderness, boggy, enlarged, soft prostate
Chronic Bacterial Prostatitis Dx
post-massage urine culture and sensitivity, EPS culture, semen culture
>10 leukocytes/HPF in EPS
Chronic Bacterial Prostatitis Tx
oral abx
quercitin
saw palmetto
prostatic massage
CP/CPPS
Prostadynia/ Chronic nonbacterial prostatitis
No objective cause is found
Sxs relate to prostate
Refractory to Tx
CP/CPPS
Prostadynia/ Chronic nonbacterial prostatitis Ssxs
LUTS pain sense of rectal fullness sexual dysfxn, post-ejaculation pain PE: tender (variable), boggy, enlarged (rarely)
BPH RFs
Genetic predisposition, Age, Race, Meds –antihistamines, diuretics, opiates, TCAs, anticholinergics
BPH Pathophys
dec T levels and inc E levels, inc SHBG and in turn an inc amount and activity of intraprostatic DHT (potent form of testosterone), which inhibits prostatic stem cell death and promotes transition zone growth.
mechanical obstruction
bladder –> irritative voiding sxs
BPH Ssxs
Symptom Score Questionnaire
hesitancy, dribbling, weak stream
irritative sxs (urg, freq, nocturia)
BPH Labs
UA
BUN, creatinine
PSA (>2 weeks after DRE)
BPH Tx
alpha blockers 5 alpha reductase inhibitors (Proscar) PDE5 inhibitors Avoid bladder irritants Serenoa repens prostatic massage kegels
BPH prognosis
<60 cm3 in size, watchful waiting combined with naturopathic therapies
When prostate is >60cm3, may need to use Proscar in addition
Complications: acute urinary retention*, recurrent infections, intestinal herniation and hemorrhoids (due to straining to urinate)
USPFTF Screening Recommendations for Prostate CA
No longer screen men >75 years
Screen every 4 years
Screening age with average risk: 50yo
Earlier screening (age 40-45) highly encouraged in populations with a higher disease prevalence & higher mortality rates:
- African American men
- Men with significant FHx (CaP in relatives younger than age 65)
- Men with BRCA1 or 2 mutations
Risks from [Excess] Screening/Tx
Risk from prostate biopsy: infection, discomfort, anxiety
Over-diagnosis
Risks of therapy: erectile dysfunction, urinary infections/retention
Prostate CA mets
lumbar spine
pelvic lymph/veins –> IVC
local LNs
bone
Prostate CA ssxs
early= asx
Obstructive or irritative sx
low back or flank pain
hematuria
wt loss (>10 lbs suggest locally advanced)
Sexual dysfunction: difficulty achieving ejaculation, painful ejaculation
Mets to bones causes pain and/or cord compressions paresthesia, weakness, urinary or fecal incontinence
Prostate CA PEs
DRE: induration of prostate (F/U with PSA, TRUS, Bx)
Single, discrete firm/hard nodule suggests CaP (ONLY POST. PALPABLE)
Things that raise PSA
DRE
Ejaculation, Recent sexual activity
BPH
Cystitis
Acute & Chronic bacterial prostatitis (falls
when treated)
Prostate biopsy
Exercise involving perineal pressure
Urethral instrumentationThings that lower PSA
Finasteride (Proscar) Saw palmetto Radical prostatectomy Withdrawal of anti-androgen drugs (Yarnell 249) Regular prostatic massage Green tea
Free: total PSA
Done in pts with normal DRE and a total PSA level between 4 -10 ng/mL
Ratio >25% is normal
Between 10-25% is intermediate
<10% is low
Nat Tx for Pts with Prostate CA
low fat diet fish minimize animal green tea Serenoa repens modified citrus pectin (to prevent mets for surgery) Constitutional hydro Sitz bath
ANGIOKERATOMAS
Benign vascular ectasias (dilated capillaries and venules)
Hydrocele RFs
Torsion, epididymitis. LA, intrascrotal infx; inguinal surgery; trauma; neoplasm
Clinical Findings
1. non-tender fluid-filled sac located on the anterior/inferior surface of the testicle, enlarges
2. A very large hydrocele may not always transilluminate
Hydrocele Signs
non-tender fluid-filled sac located on the anterior/inferior surface of the testicle, enlarges
(large hydrocele may not always transilluminate)
Spermatocele
painless mass on the superior, posterior pole of the testicle (on vas deferens)
Varicocele seq
infertility
Epididymitis
ascending LUT infection, E.coli, GC or chlamydia
Must R/O testicular torsion with scrotal U/S
elevating the testicle eases the pain (Prehn’s sign)
Testicular Torsion
Imaging: US
TX:
ED for surgery
oral enzymes and flavoinoids
ginkgo, curcumin, salvia miltiorrhiza
