(Should be in PJ1310) BPH and Erectile Dysfunction

Question 1

some differences between BPH and ED

Answer 1

BPH;
does not affect sexual function
it’s symptoms are linked to urination
main issue is a constricted urethra

while for ED;
it affects sexual function
symptoms are linked to sexual arousal
main issue is the inability to get and maintain an erection

Question 2

describe the prostate gland(in terms of appearance, size..etc)

Answer 2

a walnut shaped gland that sits below the bladder

Weighs ~20g

Wraps around the urethra

It is composed of both
muscular tissues (30%) and
glandular tissue (70%)

Question 3

function of the prostate gland

Answer 3

an exocrine gland that stores and secretes slightly alkaline solutions that nourish and protect the sperm

the smooth muscle of the prostate gland contracts to help propel semen into the urethra and out of the body during ejaculation

it produces 25% of the volume of semen

rest of semen produced by seminal vesicles

Question 4

some of the components of the solution produced or secreted by the prostate gland

Answer 4

Proteolytic enzymes
Prostatic acid phosphorylase
Prostate specific antigen
Citric acid

Question 5

what regulates the secretions of the prostate gland

Answer 5

hormones, mainly testosterone levels

Question 6

describe BPH

Answer 6

it is a non cancerous increase in prostate size, due to an increase in prostate cell numbers (hyperplasia)

note it is a hyperplasia, not a hypertrophy(increase in cell size)

not always symptomatic initially, so it diagnosis might be prolonged

only affects males, and is more prevalent with increase in age

Question 7

some symptoms of BPH

Answer 7

compression of the urethra, leading to urinary flow inhibition, which leads to BOO(bladder outlet obstruction)

Dribbling or incontinence- caused by an overfull bladder
Dysuria- pain while urinating
Hesitancy- difficulty in initiating micturition
Poor stream/weak urine flow
An ‘overactive bladder

Question 8

if symptoms of BPH left untreated, what happens

Answer 8

it can cause recurrent urinary tract infections, bladder
stones, and retention.

can also cause more serious complications like renal failure or CKD

Question 9

causes of BPH

Answer 9

main cause unclear
but
Hormonal involvement thought to be a cause of BPH

Question 10

which class of hormones are thought too be involved in the development of BPH

name the hormones that fall under this class of hormones

Answer 10

androgens. they play a permissive role in BPH development. This means they do not directly cause it but they are necessary for it to occur

testosterone and dihydrotestosterone (DHT)

androgens are the group of sex hormones that give men their ‘male’ characteristics (collectively called virilisation). The major sex hormone in men is testosterone, which is produced mainly in the testes.

Question 11

testosterone release is split between?

Answer 11

the testis (95%) and the adrenal gland (5%)

Question 12

name of enzyme that converts testosterone to DHT

Answer 12

5a-Reductase enzyme

both androgens but DHT more potent as it binds more strongly to the androgen receptors

Question 13

testosterone and DHT (androgens) bind to what? and what does this lead to

Answer 13

androgen receptors and leads to cell growth in sex organs, bones, muscles…etc

the cell growth causes BPH

DHT levels elevated in BPH, even though serum testosterone levels may sometimes be low

Question 14

state some androgen functions

Answer 14

They are essential for spermatogenesis, the production and maturation of sperm in the testes.

Androgens also promote muscle growth by increasing protein synthesis and help maintain bone density, supporting bone growth during puberty.

They influence libido and sexual behavior

stimulate red blood cell production in the bone marrow, and impact fat distribution and metabolism.

play a role in mood, cognitive function, and overall well-being.

Question 15

the primary androgen that stimulates growth of
benign and malignant prostate tissue

Answer 15

DHT

Question 16

oestrogen is aka? is it present in males

Answer 16

oestradiol and yes it is

levels in males increase with age, leading to an increase in androgen receptors(AR)

note DHT ad testosterone main organs in increasing AR expression

Question 17

name some tests for BPH and what their collective purpose is

Answer 17

Digital rectal exam
Prostate-specific antigen (PSA)
Uroflow test/cystoscopy
Biopsy

they are carried out to rule out BPH, instead of “rule in” or confirming it’s presence

note that a physical examination of the prostate can also be done by palpating the prostate

Question 18

what happens when palpating the prostate, and how do we tell if the person has BPH through

Answer 18

a doctor or nurse feels the prostate through the rectum to check for prostate problems or cancer

if positive for BPH, the prostate will feel enlarged, and smooth

note if malignant or prostate is cancerous, the prostate will feel enlarged, hard and lumpy

Question 19

what is the prostate specific antigen (PSA) test

Answer 19

a protein produced by the prostate gland that can be measured in the blood to help diagnose prostate problems

helps determine PSA density

note that this is a test to rule out BPH BUT PSA levels do increase with BPH

note that it can be used to estimate prostate size

Question 20

some limitations of the PSA test

Answer 20

lots of false positives
there can be false negatives as well
cannot have sex or ejaculate an hour before the test, else results may be affected

sex, ejaculation and exercise can increase PSA levels