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22 Cards in this Set
- Front
- Back
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What is the anatomy of the prostate?
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*Peripheral zone which is the primary site for prostate cancer; palpated on DRE
*Periurethral zone which is the primary site for the component of BPH |
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What hormone is directly responsible for prostate development?
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Dihydrotestosterone = DHT
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What is prostatitis? What are the characteristics?
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Inflammation of the prostate; presents with fever, dysuria and painful/swollen gland on DRE
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How do you work up prostatitis?
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Urine culture and examine for WBC's; more than 20 WBC's/HPF (high power field) suggests acute prostatitis
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What is BPH? What are the risk factors?
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Enlargement of the prostate gland that normally occur to men in their mid to late 40's; all men get this as they age but it is more common in blacks > whites > asians, family history
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What is the pathogenesis of BPH?
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DHT promotes hyperplasia of the prostate
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What are the clinical findings of BPH?
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1) Trouble initiating and stopping the urinary stream
2) Dribbling, incomplete emptying 3) Nocturia, dysuria 4) Hematuria 5) Urgency, frequency |
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What are the typical sizes of prostate glands in different age groups?
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Birth - size of a pea
by age 25 - size of a walnut |
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How do you work up BPH?
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Detailed history, DRE, PSA, and TRUS (transrectal ultrasound)
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What are the complications of BPH?
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Mainly due to obstructive uropathy
*Acute urinary retention - sudden inability to urinate, catheter must be inserted to empty the bladder 1) Postrenal azotemia 2) Bilateral hydronephrosis 3) Bladder diverticula 4) Bladder infections, UTI's |
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How do you treat BPH?
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1) Alpha blockers such as tamsulosin and and terazosin; take 1-2 days to work
2) 5-alpha reductase inhibitors such as finasteride; take months to work 3) Combination 4) Transurethral resection of the prostate |
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Are there any complications with alpha blockers for BPH?
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If taken with drugs for impotence, they may interact and cause low blood pressure; take at least 4 hours apart
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Are there any complications with 5-alpha reductase inhibitors?
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They lower your PSA's so doctors need to know that to interpret your PSA test results properly
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What are lifestyle changes that should be made for BPH?
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Limit beverages in the evening, limit caffeine and alcohol, limit diuretics
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What are alternative therapies for BPH?
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Saw palmetto
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What is the epidemiology of prostate cancer?
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It is the most common cancer in adult males
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What are the risk factors for prostate cancer?
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Age, African-American, high-fat diet, positive family history
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What is the clinical presentation of prostate cancer?
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1) Early on it is asymptomatic, develops in the peripheral zone
2) Late, symptoms occur due to obstruction of the urethra 3) Much later, low back/pelvic pain due to metastasis |
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How do you interpret PSA and DRE in regards to TRUS?
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1) If PSA > 10, TRUS with biopsy regardless of DRE findings
2) If DRE is abnormal, TRUS with biopsy regardless of PSA 3) If PSA < 4.0 and DRE negative, annual follow up 4) If PSA is 4.1-10 and DRE negative, controversy on what to do next |
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What will you find on DRE in prostate cancer?
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Cancer feels like a knuckle, normal prostate feels like thenar eminence
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What are the stages of prostate cancer?
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Stage A - nonpalpable, confined to prostate
State B - palpable nodule, but confined to the prostate State C - extends beyond capsule w/o metastasis Stage D - metastatic disease |
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How do you treat prostate cancer?
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1) If localized, radical prostatectomy except in older men who have < 10 years to live and are asymptomatic
2) If invasive, radiation plus androgen deprivation 3) If metastatic, orchiectomy, antiandrogens or Leuprolide *Beam radiation therapy *Radioactive seeds *Hormone therapy |
