Unit 13 Flashcards
at what age does bph begin to dev
> 55
main risk factor for bph
aging
characteristic of prostatic growth with age
slow, gradual growth
how is growth of prostate characterized in bph
periurethral growth, originating in center of gland
what type of growth is bph and what cells areinvolved
hyperplasia and hypertrophy
m. and exocrine epith tissue
number one risk of bph
aging
what change does age cause in bph
change in androgen levels
et of bph
aging
genetic predisposition
race (inc in blacks, dec in asian)
diet (directly linked to genes and race)
what are the 2 male androgens
T
DHT
what percent of t is converted to dht
95
how is t converted to dht
via ez 5 alpha reductase
what is dht responsible for
str, fx, growth of prostate
what is the physiologic fx of E in men
facilitates action of DHT on cells by sensitizing them -> inc effect of DHT
what happens to the T:E ratio as men age
qualatative dec in T while E remains the same
what happens to E when T decreases
it makes E relatively more significant
what does the inc significance of E do to prostatic cells
makes them more sensitive, so DHT has more effect
why does urethral compression occur in BPH
inc in tissue size is space occupying -> urethral compression
when does urine accum occur
with inc urethral compression
what happens when urine accums
inc urge to urinate, inability to enter bladder,, residual badder volume
what 2 compensatory changes occur to prevent ballder rupture
- bladder wall thickens
2. diverticula/trabeculae in bladder expand to inc bladder size
why is thickening of the bladder wall worsening the problem
we can now retain urine longeer
why is increassing bladder size worsening the problem
promotes urine stasis
2 complications of urine stasis
UTI/infc
renal calculi
why may renal calculi occur with urine stasis
rt percipitable components in urine
what happens when the bladder is full of urine
backs up into urine and kidney
hydrouretur
distention of uretur to accomodate inc urine vol
fish hook uretur
occurs at point where uretur attatches to bladder. inc P on this points pulls uretur downwards making hook apperance
2 consequences of hydroeuretur
urine begins to accum in kidney
hydronephrosis
what happens when urine accums in kidney
inc p pushing out on glomerulus, inc P in capsule > P of filtrate entering capsule -> no filtration
what leads to hydronephrosis
no filtration rt to no P gradient to faciliate filtration
hydronephrosis
distention of renal pelvis/calculi
mfnts of bph
frequency with nocturia hesistancy weak stream rt compression terminal dribbling urine retention of obstr is complete
dx of bph
hx, mnfts, px digital rectal exam PSA kidney fx tests urinalysis
PSA
prostate spec androgen
how is psa measured
in blood or in prostatic fluid
what is total psa porprortional too
total size of prostate
PSAv and PSAd
psa velocity
psa dencity
how is psav and psad calculated
using total psa
what are issues with psa
may have false positives or negatives
mixed up in prostate ca
what is tx of bph dependent on
s and s, sev, complicatiosn
tx for bph
no tx often lifestyle mod alpha andregenic antagonist 5 a reductase inhibit sx
what lifestyle mod might be done in bph
no fluids 2-3 h prior HS
no caffiene or alcohol
fx of aplha andregent antagonist
relax m. in gland to improve voiding by acting on obstr to improve urination
when is an alpha adregenic antagonist used
short term
fx of 5 alpha reductase inhibitor
dec DHT by inhibiting conversion of t to Dht
when is 5 alpha reductase inhibitor used
long term
what drugs do we use if cases of bph are sev
both
what 2 sx are used as a last resort for bph tx
transurethral resec of prostate
laser prostectomy
which population has in inc risk for prostate ca
men >65 yo
risks for prostate ca
age diet ethinicity family hx androgens
what type of carcinoma is in prostate ca
adenocarcinoma
what is adenocarcinoma rt to in prostate ca
glandular epith
characteristics of prostate ca
subcapsular, peripheral, multisite
why is prostate ca have a delayed dx
no early mnfts dt peripheral origin of ca
normal prostate size
2-3cm
prostate size in ca
4cm
prostate size in bph
5-6cm
when do mnfts appear in prostate ca
if it is well established
where do mets occur in prostate ca
bone liver lung
where do bone mets in prostate ca usually mnfts
back, hip, spine
where does prostate ca extend regionally
seminal vesicles,
bladder
mnfts of prostate ca
prostatisis
late back/hip pain rt to mets
dx prostate ca
hx, px
DKE (inc in men >50yo)
PSA
biopsy sample
what is tx of prostate ca based on
stage, age, grade
tx for beningn prostate ca
inc in men with inc age, no tx, activley monitor
tx for prostate ca
prevent cell griwth via DHT
radical prostectomy/remove seminal vesicles
combo tx (radiation)
how do we prevent cell growth via dht in prostate ca
admin estrogen/antiandrogenic drugs
