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FCP III: disorders of the prostate (exam 6)

Terms in this set (56)

hallmark of prostatitis
prostate pain

(no shit sherlock)
MC etiology of prostatitis
E. coli
What diagnostic study should you order for a pt with prostatitis who is persistently febrile
CT pelvis to r/o prostatic abscess
Is acute prostatitis more common in young or older men? What about chronic?
acute → young
chronic → older (due to recurrent prostate infections!)
most likely diagnosis
- warm boggy tender prostate (gross..)
acute bacterial prostatitis
Diagnose and treat this pt
21 yr old male presents to ED with dysuria and frequency. His temp is 104.2F. At your dismay, your preceptor makes you perform a DRE and on exam, the prostate feels "spongy". CBC shows highly elevated leukocytosis.
acute bacterial prostatitis → admit for IV abx → at discharge, continue PO abx x 4-6 wks

if urinary retention, insert suprapubic catheter
If pt has urinary retention secondary to acute bacterial prostatitis, what type of catheter is preferred
suprapubic cath (over a urethral cath)
clinical presentation of chronic prostatitis
- pain in genitals, urinary tract, perineum, lower back
- dysuria, urgency, frequency
- pain with ejaculation
What studies are utilized in the diagnosis of chronic prostatitis
- expressed prostatic secretion
- post prostate massage urine cx
meares stamey 4 glass test (rarely used)
most likely diagnosis
56 yr old male presents with frequency and pain in genitals. He states pain sometimes radiates to his low back and perineum. He has a hx of recurrent UTIs. On DRE, he has a tender, boggy prostate.
chronic bacterial prostatitis
abx therapy for chronic bacterial prostatitis
empiric bactrim DS or fluoroquinolone, then adjust pending cx results
What medications other than abx can be used for chronic bacterial prostatitis?
NSAIDs, alpha-1 blockers (tamsulosin), and anticholinergics (oxybutynin)
most likely diagnosis
65 yr old male presents with c/o low back pain and frequency. He has a hx of recurrent UTIs that have all came back with negative cultures. Prostate is TTP on DRE. Culture comes back with leukocytes but no bacteria are present.
inflammatory chronic pelvic pain syndrome (CPPS)
conservative treatment options for inflammatory CPPS
- symptomatic tx (analgesics, alpha-1 blockers, anticholinergics, etc.)
- sitz baths
- stress reduction
- diet changes
- prostate massage
What abx can be used for inflammatory CPPS
bactrim DS and if not responsive, doxy

(but consider referring to urology first)
What is one H&P finding that can help you differentiate chronic bacterial prostatitis from Inflammatory Chronic Pelvic Pain Syndrome (CPPS)?
CPPS will also have hx of recurrent UTIs but with negative cultures

(bc it's inflammatory! and not infectious)
prostadynia
non inflammatory chronic pelvic pain syndrome
most likely diagnosis
63 yr old male presents with pain in genitalia x 2 mo. He states he will also experience intermittent frequency and dysuria. Prostate is firm, normal size, and TTP on DRE. Fluid cx is negative.
prostadynia
Prostate fluid cx that is c/w prostadynia
no bacteria or leukocytes present (aka normal)
prostadynia treatment
Same as conservative tx for inflammatory CPPS
What two mechanisms of BPH impede passage of urine leaving the bladder?
- glandular obstruction due to growth of prostate tissue
- increased smooth muscle tone at bladder neck
What Sx of BPH usually brings the pt in for evaluation?
nocturia
if you read... think...
indurated or nodular prostate
cancer
what medications can make BPH worse
- pseudoephedrine (and other alpha agonists)
- anticholinergics can cause/worsen retention
medications used to treat BPH
alpha blockers
5 alpha reductase inhibitors
phytotherapy (sal palmetto)
alpha blocker MOA
block alpha 1 receptor and relax smooth muscle that restricts urine flow
What is the difference between Alpha-1 A blockers and alpha blockers?
alpha-1 A are uroselective → tamsulosin, silodosin, and alfuzosin
Pt has BPH and is treating with tamsulosin. He lets you know that he is about to undergo cataract surgery. What do you do next?
advise pt to stop tamsulosin prior to surgery or let surgeon know pt is taking alpha 1 blocker
Which BPH medication can cause retrograde ejaculation
alpha-1 blockers
which BPH treatment reduces risk of BPH progression
5 alpha reductase inhibitors
what does dutasteride do to a PSA?
decreases PSA reading by 50%
What BPH med is preferred in prostates that are over 40g
dutasteride or finasteride
PDE-5 inhibitor approved for BPH
tadalafil
What is Rezum
in office BPH treatment that involves thermotherapy using steam, which is delivered transurethrally
After effects of Rezum for BPH
post procedure irritative urinary sx
Pros of transurethral microwave thermotherapy for BPH
- minimally invasive
- outpatient
- pt is awake
What treatment is this describing?
- microwave device heats up prostate and causes necrosis
- prostatic tissue sloughs and passes per urethra when pt voids
transurethral microwave thermotherapy
What is similar to TURP but is less invasive?
transurethral incision of prostate (TUIP) → also less chance of retrograde ejactulation post procedure
urolift
permanent sutures compress prostatic tissue and widens urethral lumen
gold standard treatment for BPH
TURP (transurethral resection of the prostate)
TUR syndrome
rare but serious complication from TURP → continuous bladder irrigation leads to hyponatremia, AMS, HTN, and visual changes
TURP side effects/complications
- retrograde ejaculation
- TUR syndrome
- hematuria
BPH surgical option for anticoagulated pt
photoselective vaporization of prostate (PVP)
surgical treatment for prostates > 80g
open simple prostatectomy or Holmium Laser Enucleation of Prostate (HoLEP)
Biggest risk factor for prostate cancer
family hx
diagnostic for any hard prostate nodule felt on DRE
biopsy (and PSA)
Pt's most recent PSA comes back significantly elevated. You look in his chart and see a note stating he was recently catheterized. What do you do?
repeat PSA in about a week
T/F You should not perform a DRE if the pt is going to get his PSA levels drawn right after
false
How do you calculate PSA density and when is it clinically significant?
serum PSA concentration/prostate volume

may be significant if >0.15
treatment options for prostate cancer
surgery
radiation
hormonal manipulation
observe/active surveillance
radical prostatectomy indications
lesions clinically confined to prostate
complications of radical prostatectomy
impotence
bladder neck contractures
incontinence
seed implantation for prostate cancer
little radioactive iodine seeds implanted into prostate and stay there for the rest of eternity
How is hormonal manipulation utilized for prostate cancer treatment
tumor regression (does not remove tumor, just stops its growth)
hormonal manipulation for prostate cancer can include...
bilateral orchiectomy
LH-RH analogs
antiandrogens
leuprolide and goserelin
LH-RH analogs used in hormonal manipulation for prostate cancer
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