Term
|
Definition
| benign prostate hyperplasia |
|
|
Term
| What is the size of the prostate below age of 30? |
|
Definition
|
|
Term
| What is the prevalence of BPH in men age 40-49? by age 50? by age 80? |
|
Definition
|
|
Term
| What is normal prostate physiology? |
|
Definition
| no indurations, no growths, and no tenderness to palpation |
|
|
Term
|
Definition
| testosterone activates androgen receptors in the stromal cells of the prostate causing the synthesis and secretion of growth factors that regulate the growth of epithelial cells |
|
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Term
|
Definition
| in the transition zone of the prostate |
|
|
Term
| What can be caused by urinary outflow resistance as a result of BPH? |
|
Definition
| detrusor dysfunction and bladder trabeculation |
|
|
Term
| What are 5 complications of BPH? |
|
Definition
1. acute urinary retention
2. hypotonic bladder
3. bladder calculi
4. increased frequency of UTI
5. obstructive nephropathy - renal failure |
|
|
Term
| What are obstructive symptoms of BPH (static factors)? |
|
Definition
straining to void
hesitancy
weak urinary stream
intermittancy
stopping and starting of urinary stream
sense of incomplete bladder emptying |
|
|
Term
| What are the irritate symptoms of BPH (dynamic factors)? |
|
Definition
|
|
Term
T/F
Prostate size correlates with lower urinary tract symptoms. |
|
Definition
| False - correlates poorly |
|
|
Term
| When is BPH likely with lower urinary tract symptoms? |
|
Definition
|
|
Term
|
Definition
Digital rectal exam, BUN, Cr, urine - bacteriuria or hematuria, STD testing
if unlikely/uncertain: uroflow studies, urodynamic studies - post voiding volume |
|
|
Term
| What is the normal PSA between the ages of 40-49? After age 50? Above age 65? |
|
Definition
|
|
Term
| At what PSA is cancer diagnosed? |
|
Definition
|
|
Term
| What PSA velocity is suspicious? |
|
Definition
|
|
Term
T/F
A low ratio of Free PSA/Total PSA is consistent with cancer. |
|
Definition
|
|
Term
| What % of prostate cancers were detected with DRE? |
|
Definition
|
|
Term
| What % of prostate cancers are detected by PSA? |
|
Definition
|
|
Term
| What is the rate of detection of prostate cancer using both DRE and PSA? |
|
Definition
|
|
Term
| How many prostate biopsies are there annually because of PSA? |
|
Definition
|
|
Term
| What % of biopsies come back + for prostate cancer? |
|
Definition
|
|
Term
T/F
As the PSA values go up, they become less sensitive but more specific for prostate cancer. |
|
Definition
|
|
Term
T/F
Because of PSA testing, primary cancers are smaller in size than those in the past |
|
Definition
True
2.4 cc as opposed to 5.3 cc |
|
|
Term
| How many men die each year from prostate cancer? |
|
Definition
|
|
Term
| What % of cancers in men are prostate cancer? |
|
Definition
|
|
Term
| What % of cancer deaths are due to prostate cancer? |
|
Definition
|
|
Term
| At autopsy, what % of men have prostate cancer? |
|
Definition
|
|
Term
| At autopsy, what % of men over 50 have prostate cancer? |
|
Definition
|
|
Term
| At autopsy, what % of men over 80 have prostate cancer? |
|
Definition
|
|
Term
| How many men have prostate cancer? 1 in __? |
|
Definition
|
|
Term
| What % of the time is prostate cancer overdiagnosed? |
|
Definition
|
|
Term
| How many men do we have to treat for prostate cancer to save one? |
|
Definition
| We have to treat 20 or more men to save 1. |
|
|
Term
| Name the 10 weaknesses of PSA testing. |
|
Definition
1. age - affects level
2. variable epithelial tissue - varies by man and therefore PSA levels vary by man
3. Variable tissue secretions of PSA
4. Prostate volume
5. BPH tissue has higher levels of PSA than PC tissue
6. PSA changes due to drug therapy
7. PSA changes due to surgical therapy
8. PSA/% free PSA changes with inflammation
9. Consistency of test results
10. Normal PSA levels in men with PC |
|
|
Term
T/F
BPH tissue secretes more PSA than PC tissue. |
|
Definition
|
|
Term
T/F
Infection increases the total PSA. |
|
Definition
|
|
Term
T/F
Infection decreases the amount of free PSA. |
|
Definition
|
|
Term
T/F
You should re-test PSA before ordering a biopsy. |
|
Definition
|
|
Term
| What % of prostate cancers are found in men with normal PSA levels below 4.0? |
|
Definition
|
|
Term
| What are the surgical treatments for prostate cancer? |
|
Definition
prostatectomy
laproscopic radical prostatectomy
radiation therapy - external beam or brachytherapy
cryotherapy
orchiectomy |
|
|
Term
| What does an orchiectomy do? |
|
Definition
| reduces circulating androgens |
|
|
Term
| What are the drug therapies for prostate cancer? |
|
Definition
hormone therapy - antiandrogens
long-acting lutenizing hormone-releasing hormone agonist
gonadotropin-releasing hormone receptor antagonist |
|
|
Term
|
Definition
flutamide
nilutamide
bicalutamide*** |
|
|
Term
| What is the action of antiandrogens? |
|
Definition
| they block the activity of dihydrotestosterone |
|
|
Term
| Name 2 long-acting luteinizing hormone-releasing hormone agonists. |
|
Definition
| leuprolide acetate and goserelin acetate |
|
|
Term
| What is the action of gonadotropin-releasing hormone receptor antagonists? |
|
Definition
| they block the formation of testosterone |
|
|
Term
| Name 1 gonadotropin-releasing hormone receptor antagonist. |
|
Definition
|
|
Term
| Which drug is used to treat advanced prostate cancer? What type of drug is it? |
|
Definition
| degarelix - gonadotropin-releasing hormone receptor antagonist |
|
|
Term
|
Definition
by symptoms
It is given a symptom score |
|
|
Term
| What are the BPH symptom scores and what do they mean? |
|
Definition
Score 0-7 - mild; behavioral modifications
Score 8-19 - moderate; drug therapy, surgery
Score 20+ - severe; surgery, drug therapy |
|
|
Term
| What are some behavior modifications to reduce mild BPH symptoms? |
|
Definition
1. fluid restriction before bedtime
2. reducing caffeine intake
3. reducing alcohol use
4. frequent emptying of the bladder - set times
5. avoiding OTC meds that exacerbate symptoms |
|
|
Term
| What is the first line drug treatment for BPH dynamic effects (irritative symptoms)? |
|
Definition
| alpha-1 adrenergic antagonists |
|
|
Term
| What is the DOC and the second DOC for treating dynamic effects of BPH (irritative symptoms)? |
|
Definition
tamsulosin DOC
doxazosin DOC2 |
|
|
Term
| Name 5 alpha-1 adrenergic antagonists. |
|
Definition
1. tamsulosin
2. doxazosin
3. terazosin
4. alfuzosin
5. prazosin |
|
|
Term
T/F
Tamsulosin has minimal cardiac effects. |
|
Definition
|
|
Term
| How much of a reduction in the symptom score is to be expected from alpha-1 blockers? |
|
Definition
|
|
Term
| How do alpha-1 blockers work? (alpha-1 adrenergic antagonists) |
|
Definition
1. selectively bind reversibly to receptor in the peripheral vascular and in smooth muscle to block the effects of catecholamines
2. decrease smooth muscle tone which leads to arterial and venous dilation
3. decrease in smooth muscle tone surrounding the prostate and bladder outlet - which reduces the effects of BPH (voiding problems) |
|
|
Term
| What are the possible side effects of alpha-1 blockers? |
|
Definition
| dizziness, headache, nasal congestion, orthostatic hypotension, edema, palpitations, erectile dysfunction, and fatigue |
|
|
Term
| What type of drugs are used to treat static factors of BPH (obstructive symptoms)? |
|
Definition
| 5-alpha-reductase inhibitors |
|
|
Term
| How long does it take for 5-alpha-reductase inhibitors to work? |
|
Definition
|
|
Term
| How do 5-alpha-reductase inhibitors work? |
|
Definition
| they prevent testosterose from being converted into the active form (DHT) which is then prevented from promoting cell growth |
|
|
Term
| What are the 2 indications for 5-alpha-reductase inhibitors? |
|
Definition
|
|
Term
| What is the maximum dose for 5-alpha-reductase inhibitors? |
|
Definition
| same as the starting dose |
|
|
Term
| Name 2 5-alpha-reductase inhibitors. |
|
Definition
| finasteride and dutasteride |
|
|
Term
| What is the dosing for finasteride? |
|
Definition
|
|
Term
| What is the dosing for dutasteride? |
|
Definition
|
|
Term
| How much of a reduction in the symptom score is to be expected from 5-alpha-reductase inhibitors? |
|
Definition
|
|
Term
T/F
5-alpha-reductase inhibitors can reduce the size of the prostate. |
|
Definition
|
|
Term
| By what % can 5-alpha-reductase inhibitors reduce the size of the prostate? |
|
Definition
|
|
Term
| How do you manage a patient on 5-alpha-reductase inhibitors? |
|
Definition
- hepatic dysfunction
- no blood donations - dutasteride
- monitor PSA levels at 3 months
- monitor for relief of obstructive uropathy |
|
|
Term
| What are the possible side effects of 5-alpha-reductase inhibitors? |
|
Definition
| impotence, decreased libido, ejaculation disorder, gynecomastica |
|
|
Term
| Which drug should not be handled by women who are or may become pregnant? Why? |
|
Definition
finasteride (5-alpha-reductase inhibitor)
Can be absorbed through skin if crushed or broken and it is known to cause birth defects in developing MALE baby |
|
|
Term
|
Definition
flutamide
nilutamide
bicalutamide |
|
|
Term
| What do antiandrogens do? |
|
Definition
| they block the activity of dihydrotestosterone (DHT) and thereby blocks the promotion of cell growth |
|
|
Term
T/F
Antiandrogens have very limited use in treating BPH. |
|
Definition
| True - surgery is usually a better option. Antiandrogens are very $$$ and have lots of side effects. |
|
|
Term
| How do we use combination therapy to treat BPH? |
|
Definition
| begin with an alpha-1 blocker, then add a 5-alpha-reductase inhibitor |
|
|
Term
| What % of reduction in symptom progression is there from using combination therapy? |
|
Definition
|
|
Term
| How much is the risk of acute urinary retention decreased in BPH by using combination therapy? |
|
Definition
|
|
Term
| What % reduction in the need for surgery results from using combination therapy to treat BPH? |
|
Definition
|
|
Term
| What drug was used in a prostate cancer prevention trial? |
|
Definition
|
|
Term
| What reduction in prostate cancer was found in a clinical trial using 5 mg of finasteride as prophylaxis? |
|
Definition
|
|
Term
T/F
When finasteride was used as prophylaxis in a prevention trial, in the cancer that was found, Gleason scores were lower. |
|
Definition
| False - Gleason scores of 7 to 10 were more common |
|
|
Term
| What is the incidence of erectile dysfunction and retrograde ejaculation in combination therapy to treat BPH? |
|
Definition
|
|
Term
T/F
Combination therapy increased the incidence of erectile dysfunction and retrograde ejaculation as compared to monotherapy in a trial with dutasteride and tamsulosin. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Name some different phytotherapies for BPH. |
|
Definition
Serenoa repens - saw palmento extracts
beta-sitosterols - South African star grass
cernilton - ryegrass pollens
Pygeum africanum - bark of African prune tree |
|
|
Term
| How should phytotherapy be used? |
|
Definition
| in moderation - 1-2 capsules a day |
|
|
Term
T/F
Saw palmento contains finasteride. |
|
Definition
|
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