Exam 1- Concerns Found during the Proctological Exam

What is the normal size of the prostate?

Chestnut/walnut

What is the normal contour of the prostate?

Smooth

What is the normal consistency of the prostate?

Pencil eraser/ thenar pad with clenched fist

What is the normal mobility of the prostate?

Fairly mobile

Is there protrusion into the rectum with a normal prostate?

No

Is there a sulcus present in a normal prostate?

Yes

Is there pain with palpation on a normal prostate?

No

What is a non-cancerous enlargement of the prostate gland?

Benign Prostatic Hypertrophy (BPH)

With BPH normal tissue is replaced by?

Collagen

What is the result of BPH

Expansion of capsule, leading to pressure on urethra

BPH is common in?

Men over 50

Symptoms of BPH are rare before?

Age 40

50% with BPH have symptoms after age?

60

70-90% of men over age _______ have some BPH

70

Where does Benign Prostatic Hypertrophy occur?

Transition zone around urethra

What are the urinary issues with BPH?

Frequent urination (night especially)

Urgency (sudden, strong urge)

Weak stream

Incomplete emptying feeling

Straining (difficulty urinating)

What are some other symptoms of BPH?

Dribbling (after urination)

Interrupted stream

Acute urinary retention

What can result from acute urinary retention from BPH?

Recurrent/chronic urinary tract infections

What are some hormonal causes of BPH?

Increased sensitivity to DHT (dihydroestosterone)

Elevated levels of estrogen in aging men contribute to prostate growth

What are genetic factors of BPH?

Family history of it increases the risk of it

How do you diagnose BPH?

Digital rectal exam (DRE)

What tests are used to find BPH?

Prostate-specific antigen (PSA) test

Urinalysis

Ultrasound

What is the size of a prostate with BPH

Enlarged

What is the contour of a prostate with BPH

Smooth

What is the consistency of a prostate with BPH

Boggy, squishy

What is the mobility of a prostate with BPH

Fairly mobile

Is there protrusion into the rectum with BPH

Depends on stage/growth

Is there a sulcus present with BPH

Yes but may be less

Is there pain with palpation with BPH

No

What is prostate-specific antigen (PSA)

Protein produced by cells of the prostate gland

What is the function of Prostate-specific antigen (PSA)

Helps liquify the semen, allowing sperm to swim freely

What is the normal prostate-specific antigen level for men under 50?

Less than 2.5 ng/mL

What is the normal prostate-specific antigen level for men aged 50-59?

Less than 3.5 ng/mL

What is the normal prostate-specific antigen level for men aged 60-69?

Less than 4.5 ng/mL

What is the normal prostate-specific antigen level for men 70 and above?

Less than 6.5 ng/ML

What are some possible causes of a mildly elevated PSA level?

BPH

Prostatitis

Recent ejaculation

Minor infections

What is the actions when having mildly elevated PSA levels?

May require further monitoring or additional test

What is considered mildly elevated PSA level?

4-10 ng/Ml

What is considered moderately elevated PSA levels?

10-20 ng/ML

What are the possible causes of moderately elevated PSA levels?

Higher likelihood of prostate cancer

Significant BPH or prostatitis

What is the action for moderately elevated PSA levels?

Usually prompts more definitive testing, such as biopsy

What is considered highly elevated PSA levels?

Above 20 ng/mL

What are some possible causes for highly elevated PSA levels?

Strong indication of prostate cancer or advanced BPH

What is the action for highly elevated PSA levels?

Immediate further diagnostic tests, including imaging and biopsy

What is PSA velocity?

Irate of increase in PSA levels over time

What is the significance of PSA velocity?

Rapid increase can be more indicative of prostate cancer

What is the action when it comes to PSA velocity?

Frequent monitoring and potentially more aggressive testing

Generally the higher the PSA the ___________ likely a pathology (cancer BPH) is present

More likely

An increase of __________________ of PSA is an indication of cancer. Even if the number is low

Increase of 25% in one year

What visualizes the are needed for biopsy and helps determine the prostate volume?

Transrectal ultrasound

What is a cancer that originates in the prostate gland?

Prostate cancer

Prostate cancer is almost always?

adenocarcinoma

What is one of the most common cancers in men, particularly in older adults?

Prostate cancer

What is the ratio of men that will have prostate cancer?

1 in 6 men

Prostate cancer is the _______ leading cause of cancer death in males over 65

2nd

Early stages of prostate cancer are typically _________and detected through?

Asymptomatic

Routine screening

What are urinary symptoms of advanced prostate cancer

Frequent urination

Difficulty starting or stopping urine flow

Weak urine stream

Where is the pain with advanced prostate cancer?

Pelvic area, lower back or hips

What is it when there is blood in the urine or semen with advanced stages of prostate cancer?

Hematuria

Hematospermia

What is the sexual issue with advanced prostate cancer?

Erectile dysfunction

What are the 2 screening tests for prostate cancer?

Prostate-specific antigen (PSA) test

Digital Rectal Exam (DRE)

What are the diagnostic tests for prostate cancer

Biopsy

Imaging

What is the size of prostate cancer?

Early=normal

Late=enlarged

What is the contour of prostate cancer

Asymmetrical

What is the consistency of prostate cancer

Hard nodules

What is the mobility of prostate cancer

Not very mobile or not mobile at all

Is there protrusion into the rectum with prostate cancer

Depends on stage/growth

Is there a sulcus present with prostate cancer?

Obliterated in advanced cancer

Is there pain with palpation of prostate cancer?

NO

-how we tell the difference between cancer and prostatitis, cause prostatitis is painful

What stage of prostate cancer is when the cancer is confined to the prostate and not detectable on imaging?

stage 1

What stage of prostate cancer is when the cancer is more advanced but still confined to the prostate

Stage II

What stage of prostate cancer is when the cancer has spread beyond the prostate to nearby tissues?

Stage III

What stage of prostate cancer is when the cancer has spread to distant organs (e.g. bones, lymph nodes)?

Stage IV

If prostate cancer is found early and localized or regional (Stage 1, 2, or 3) what is the 5 year survival?

Nearly 100%

If prostate cancer is found with distant metastasis (Stage 4) what is the 5 year survival rate?

Around 34%

What is a Gleason score?

Number assigned to quantify prostate cancer, deterred from prostate biopsy

Prostate cancer is responsible for what percentage of all skeletal metastasis?

60%

Lung cancer is responsible for what percentage of skeletal metastasis?

Around 25%

What are the prostate hard nodules differentials?

Prostate cancer

Prostatic calculi

Prostatic TB (tuberculosis)

Prostatic granulomas

What are the 2 common ways to treat prostate cancer?

Active surveillance (wait and see)= for lower Gleason scores

Radiation therapy (one of most common)= need empty bowels

What type of diet is important for the prevention of prostate cancer recurrence?

Balanced diet

Reduced red meat

Healthy fats

Antioxidant-rich foods

What type of physical activity is important for prevention of prostate cancer recurrence?

Regular exercise (at least 30 mins most days)

Maintain healthy weight

What type of hormone is given for hormone therapy for prevention of prostate cancer recurrence?

Estrogen to limit growth of the prostate

What is prostatitis?

Inflammation of prostate gland which can be acute or chronic

What prostatitis is a sudden bacterial infection?

Acute bacterial prostatitis

What prostatitis is from recurrent bacterial infections?

Chronic bacterial prostatitis

What prostatitis is persistent pelvic pain without bacterial infection?

Chronic Prostatitis/chronic pelvic pain syndrome (CP/CPPS)

What is prostatitis inflammation without symptoms and often found during tests for other conditions?

Asymptomatic inflammatory prostatitis

Prostatitis is most common in men?

Under 50

Frequent ______ can increase the risk of prostatitis

UTIs

What are some other risk factors for prostatitis

Prostate surgery or biopsy

Sexual activity (unprotected sex)

Catheter use (in dwelling catheters)

Acute bacterial prostatitis has fever and chills that?

Sudden onset

Urinary symptoms of acute bacterial prostatitis

Frequent, urgent urination, painful urination

Pelvic pain of acute bacterial prostatitis

Lower abdominal pain, perineal or lower back pain

General discomfort of acute bacterial prostatitis

Malaise, muscle aches

Chronic bacterial prostatitis is from?

Recurrent UTIs

-persistent bacterial infections

Fever with chronic bacterial prostatitis

Mild fever (low grade fever)

Urinary symptoms of chronic bacterial prostatitis?

Discomfort during urination

Pain with chronic bacterial prostatitis

Persistent pain in the pelvic region

Chronic pelvic pain with chronic prostatitis/CPPS

Persistent pain in the pelvic area that expands from just the prostate