Reproductive: Diseases of Penis and Prostate

Question 1

define hydrospadias

Answer 1

urethra opens onto ventral surface of penis

Question 2

What is hydrospadias associated with?

Answer 2

poorly developed penis curving ventrally

Question 3

What is a ventral curving penis?

Answer 3

chordee

Question 4

define epispadias

Answer 4

urethra opens onto dorsal surface

Question 5

what is epispadias associated with?

Answer 5

exstrophy of bladder

Question 6

What is a common problem with hypospadias and epispadias?

Answer 6

infertility

Question 7

define phimosis

Answer 7

prepuce orifice that is too small to be retracted normally

Question 8

What is the problem associated mostly with phimosis?

Answer 8

generally leads to poor hygiene causing bacterial infections

Question 9

What is a paraphimosis?

Answer 9

foreskin retracted over the glans leading to urethral constriction

Question 10

What is the treatment for phimosis and paraphimosis?

Answer 10

circumcision

Question 11

What are the 2 types of penile carcinoma?

Answer 11

Bowen disease; Squamous cell carcinoma

Question 12

What is the epidemiology of squamous cell carcinoma of the penis?

Answer 12

usually age 40-70;

1% of cancer in men

Question 13

What is the etiology of squamous cell carcinoma of the penis?

Answer 13

uncircumcised penises increase incidence;
slow growing, non-painful;
patients often delay seeking medical attention

Question 14

What is closely associated with squamous cell carcinoma of penis?

Answer 14

HPV 16 and 18

Question 15

What does squamous cell carcinoma of penis look like grossly?

Answer 15

plaque progressing to ulcerated papule or fungating growth

Question 16

Where does squamous cell carcinoma of penis typically metastasize?

Answer 16

local lymph nodes

Question 17

What is Bowen disease typically associated with?

Answer 17

carcinoma in situ associated w/ visceral malignancy

Question 18

When and where does Bowen disease typically present?

Answer 18

Men > 35y/o;

involves shaft of penis and scrotum

Question 19

What does Bowen disease look like grossly?

Answer 19

thick ulcerated plaque

Question 20

How does Bowen disease look microscopically?

Answer 20

squamous cell carcinoma in situ

Question 21

Define Peyronie disease

Answer 21

curved penis due to fibrosis of tunica albuginea

Question 22

Where and how does the most common cancer in men metastasize?

Answer 22

prostate cancer metastasizes via lymph or hematogenously to bone

Question 23

Who is at highest risk for developing prostatic cancer?

Answer 23

after age 50 with AA> whites > asians

Question 24

What will a patient with prostatic cancer typically present with?

Answer 24

urinary problems and/or palpable mass on rectal exam

Question 25

What are clinical Sx associated with prostatic metastases?

Answer 25

pelvis and lower vertebrae pain associated with osteoblastic metastases

Question 26

How do labs and Dx tests help with prostatic cancer diagnosis?

Answer 26

elevated PSA and enlarged prostate =>highly suggestive of carcinoma

Question 27

Why is the 10yr survival rate for prostatic cancer only?

Answer 27

most patients present in advanced disease

Question 28

What are the prostatic carcinomas Tx?

Answer 28

surgery; radiation; hormonal modalities (orchiectomy/androgen block)

Question 29

Define benign prostatic hyperplasia (BPH)

Answer 29

large nodules in periurethral region (median lobe) of prostate may lead to narrowing of urethral canal

Question 30

Who and how will patients present with BPH?

Answer 30

men after age 45 with varying degrees of urinary obstruction and difficulty urinating

Question 31

Acute prostatitis results from what?

Answer 31

bacterial infection of prostate typically from E. coli

Question 32

How does bacteria cause acute prostatitis?

Answer 32

direct extension from posterior urethra or bladder via the lymph or hematogenously

Question 33

What is the common cause of chronic prostatitis?

Answer 33

recurrent UTI in men

Question 34

How may either form of chronic prostatitis present?

Answer 34

bacterial or non-bacterial may be asymptomatic or may present w/ lower back pain and urinary Sx

Question 35

What is an antiandrogen used specifically for prostate cancer? what is its MOA?

Answer 35

Flutamide => androgen receptor antagonist

Question 36

MOA of spironolactone?

Answer 36

androgen receptor antagonist but also K+ sparing diuretic

Question 37

When is spironolatone used?

Answer 37

Hirsuitism; | primary hyperaldosteronism, edema, HTN

Question 38

What drug is used in its depot form for prostate cancer? and MOA?

Answer 38

Leuprolide => GnRH analog

Question 39

What drug is used for BPH and male pattern baldness? and MOA?

Answer 39

Finasteride => 5a-reductase inhibitor (prevents conversion of T to DHT

Question 40

When is ketoconazole used?

Answer 40

androgen receptor positive prostate cancer

Question 41

What is the MOA for ketoconazole?

Answer 41

inhibits steroid synthesis (also antifungal agent)