urology 2 Flashcards
what is single most important diagnostic test for male hypogonadism
testosterone
what can abnormal testosterone levels
obesity (decreases testosterone) male senescence (increase binding) (getting older)
primary hypogonadism
kleinfelter
secondary hypogonadism
type 2 DM
liver or kidney disease
aging
if testosterone comes back abnormal
check it again (if comes back abnormal again)
order FSH and LH
causes of elevated psa
BPH prostatic cancer prostatic inflammation or infection perineal truama (DRE, bike riding, sexual activity in last 48-72 hrs)
psa
indirect measurement of prostate glandular size in men w/out cancer
normal values increase w/ age (which means prostate increases in size with age)
vary by race (blacks have higher values)
decrease psa
obesity
meds ( 5 alpha reductase inhibitors, nsaids, statins, and thiazides)
pro psa
more strongly associated w/ prostate cancer then BPH
psa velocity and psa doubling time
velocity- rate of change of psa values over time
doubling- time it takes for psa to double
Free/ Total PSA (PSA II)
If the free PSA is elevated in respect to the bound PSA, then the PSA is probably being produced by BPH
If there is a high level of bound PSA, then it is likely to be manufactured by prostate cancer cells (Percentage of Free PSA decreases as Total PSA increases in serum of men with prostate cancer)
when to talk to men about prostate screening
at age 50 w/ no other risk factors who will live at least 10 years
at 45 for ppl w/ high risk factors (ppl w/ 1st degree relative diagnosed younger then 65)
at 40 for ppl w/ even higher risk (ppl w/ multiple 1st degree relatives diagnosed younger then 65)
best way to check male fertility
semen analysis
how long do you need to refrain from sex
2-3 days
how long after ejaculate does it need to be analyzed
1 hr
