prostate cancer origins
70%-peripheral zone
15-20% Central zone
10-15% transitional zone
AIPC
Androgen independent prostate cancer
ADPC
Androgen dependent prostate cancer
prostate secretions are ____% of semen volume
30%
__% of prostate cancer cases are in men over __
90%,65
DRE by urologist has a ___% positive predictive value
39%
everyman should have his prostate examined DRE and PSA ___ times a year after the age of ___
1x
50 y/o
signs of Prostatitis
Fever, Chills, Malaise, Urinary frequency and urgency, dysuria, urethral discharge, dull, aching pain in perineal and rectal area
O of prostatitis
tender enlargment is acute inflammation of the prostate gland yielding a swollen asymmetric gland that is tender to palpate. Chronic inflammation
Signs of BPH
Urinary frequency, urgency, hesitancy, straining ot urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia
O of BPH
symmetric nontender enlargement, commonly occurs in middle years. median sulcus obliterated
Signs of Carcinoma
Frequency, nocturia, weak stream, hesitancy, pain or burning on urination, continuous LBP pelvis, thighs
O of Carcinoma
malignant neoplasm often starts as a singer hard nodule on the posterior surface, producing asymmetry and change in consistency. Entire gland feels stone hard and fixed.
BPH often begins in the ____ zone
transition:often strangles urethra
Prostate cancer often begins in the _____ zone and grows outward
peripheral
When PSA is greater than ___ng/cu.mm then__% of prostate biopsies reveal prostate cancer
10
66%
PSA is between ___ and ___ ng/cu.mm then ___ of prostate biopsies reveal cancer
4-10
22%
Free PSA increases more in ____
BPH
Protein bound PSA increases more in _____
prostate cancer
PSA ____ useful than just the PSA test
density
PSA density=
serum PSA lvl divided prostate volume
Prostate volume is determined by
transrectal ultrasonography (TRUS)
25-46% of men with BPH have elevated _____
serum PSA
surgical process to enlarge urethra in BPH
Transurethral resection TURP
Surgical procedure to enlarge BPH
TUIP- Transurethral incision
another possible test (enzyme) for prostate cancer
Prostate Acid Phosphatase
technique of freezing prostate sections as a therapy
Cryoablation
lowest PSA level achieved after cancer prostate treatment
Nadir
__ ng/ml is usually maximum PSA reading to be declared cancer free after cancer treatment
2
Clinically significant increase in PSA w/ in a year
.75 ng/ml this is with a PSA velocity test and is more useful than PSA test
PSA velocity test is recommended every
18 mo
some say every 3 years
radiotherapy treatment with ionizing radiation whose source is applied to the surface of the body or located a short distance from the body area being treated
brachytherapy
3 main stages of cancer development
initiation
promotion
proliferation
3 main stages of cancer development: initiation
DNA damage via ionizing radiation, viruses such as HPV, environmental carcinogens, artificial hormones, tobacco,free radicals etc
3 main stages of cancer development: Promotion
elevated IGF-1 levels, high consumption of animal fats, dietary deficiencies of protective factors such as vitamins C,D,E, essential fatty acids etc
3 main stages of cancer development: Proliferation
prolonged exposure to DHT, various estrogens, agent orange, obesity, high insulin resistance
5 alpha reductase does what?
converts TEST to DHT
test + 2 H atoms
DHT
average prostate cancer tumor doubles every
2-5 years
prostate cancer is known to spread to the ___ and ___
bones and lowerspine
causes of prostates
ascending from urethra
direct lymphatic spread from rectum
hematogenous spread
DRE prostatitis
Warm, boggy, tender palpation
urethra ends in an opening in the upper aspect (dorsum) of penis
epispadia
Penis does not return to flaccid state: can become a medical emergency
priapism
downward/ventral curve of the penis often associated with hypstadia/fibrosis, can be caused by urethral infection
chordee
Peyronie’s disease
upward/dorsal curvature of the penis fibrosing of connective tissue above the corpus cavarnosum on dorsal aspect of the penis associated with dupuytren’s contracture
foreskin cannot be fully retracted
phimosis