Prostate Disorders

Benign Prostatic Hyperplasia (BPH)

overgrowth of the epithelium and smooth muscle due to testosterone stimulation, obstructs bladder neck and urethra, causing urinary problems, increases w/ age

BPH s/s

-urine hesitancy, urgency, frequency

-urinary retention (can lead to infection or hydronephrosis)

-hard to differentiate symptoms w/ cancer or BPH

BPH diagnosis

-clinical signs and symptoms

-digital rectal exam (DRE) to feel enlarged prostate

-UA C+S (looking for infection)

-PSA (tumor for prostate cancer)

-post void residual (PVR) uses bladder scanner

BPH treatments

-medications (alpha blockers and 5-alpha reductase inhibitors)

-invasive treatments if meds are ineffective (TURP, laser)

transurethral resection of the prostate (TURP)

excision of benign prostatic hyperplasia using a resectoscope through the urethra

BPH education

-avoid bladder irritants (caffeine, alcohol, aspartame)

-decrease fluid intake before bed

-avoid anticholinergics (block acetylcholine and parasympathetic urination)

-avoid decongestants (causes smooth muscles to contract in bladder)

Dihydrotestosterone (DHT)

A primary androgen that is an androgenic steroid product of testosterone and binds strongly to androgen receptors.

5 alpha reductase inhibitors

-Finasteride (proscar) inhbits enzyme that turns testosterone to dihydrotestosterone

-takes 6-12 months to work

-adverse effects (decreased ejaculate, libido, gynecomastia, tetraogen)

-effects PSA (Declines 30-50 % from baseline, measure at onset and 6 months)

alpha blockers

-doxazosin (cardura) non-specific

-tamsulosin (flomax) more prostate specific

-both block alpha receptors to relax smooth muscle in bladder neck and prostatic capsule

-improve in 7 days

-adverse effects: hypotension, retrograde ejactulation, decreased ejaculate

acute urinary retention

abrupt inability to pass urine with bladder distention and lower abdominal pain

acute urinary retention assessment

-bladder distention

-post void residual

-labs (BUN, creatinine, UA)

-insert foley

-may need coude cath for prostate enlargement

prostate cancer

Most common non-skin cancer in men, risk factors are african or caribbean descent, over 50, family history, high fat diet

clincal presentation of prostate cancer

early: may be asymptomatic and found of screening, s/s similar to BPH

late: urinary obstruction and bone metastasis (back or leg pain, neuro symptoms)

The screening dilemma

-PSA (0-4 ng/ml)

-DRE (looks for irregularity on nodules)

-screening lacks sensitivity and specificity

-some prostate cancers are indolent

-treatment causes sexual dysfunction and incontinence

prostate cancer treatment

-Watchful waiting

-Radical prostatectomy (significant sexual dysfunction and urinary incontinence)

-Radiation (either external beam or brachytherapy)

-Androgen blockers (blocks testosterone)

Gleason Score

grading of prostate cancer, first number 1-5 rates the gland itself, second number (2-10) rates mutation)