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Prostate Presentation

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fuckdaveliu's version from 2018-06-03 17:14

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Question Answer
Acute Prostatitis Acute Inflammation of the prostate; usually due to bacteria. Presents as dysuria with fever and chills. Prostate is tender and boggy on digital rectal exam. Prostatic secretions show WBCs, culture reveals bacteria
Chronic Prostatitis Chronic inflammation of prostate. Presents as dyuria with pelvic or low back pain. Prostatic secretions show WBCs, but cultures are negative.
Benign Prostatic Hyperplasia (BPH)Hyperplasia of prostatic stroma and glands. Age-related change (present in most men by the age of 60 years); no increased risk for cancer. Occurs in the central periurethral zone of the prostate. Problems starting and stopping urine stream. Impaired bladder emptying with increased risk for infection and hydronephrosis. Dribbling. Hypertrophy of bladder wall smooth muscle, increased risk for bladder diverticula. Microscopic hematuria may be present. Prostate-specific antigen (PSA) is often slightly elevated (usually less than 10 ng/mL) due to increased number of galnds. PSA is made by prostatic glands and liquefies semen.
Prostate AdenocarcinomaMalignant proliferation of prostatic glands. Most common cancer in men. 2nd most common cause of cancer-related death. Clinically silent. Arises in the peripheral, posterior region og the prostate and, hence, does not produce urinary symptoms early on. Normal serum PSA increases with age due to BPH(2.5 ng/ml for ages 40-49 years vs. 7.5 ng/mL for ages 70-79 years). PSA>10 ng/mL is highly worrisome at any age. Decreased % free- PSA is suggestive of cancer (cancer maes bound PSA). Biopsy shows small, invasive glands with prominent nucleoli. Gleason grading system is based in architecture alone (and not nuclear atypia). Multiple regions of the tumor are assessed because architecture varies from area to area. A score (1-5) is assigned for two distinct areas and then added to produce a final score (2-10). Higher score suggests worse prognosis. Might spread to lumbar spine or pelvis, result in a osteoblastic metastases that present as low back pain and increased serum alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)
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