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Men’s Health Part 2
Now, we'll start our Men's Health Part 2.
This lecture will cover acute bacterial prostatitis, benign prostatic hyperplasia, prostate cancer, testicular
cancer, and erectile dysfunction. We'll start with BPH.
BPH
BPH is a progressive benign hyperplasia of the prostate. The etiology is really unknown, but by the age
of 80, about 80% of men will acquire this disorder. And this is the most common cause of bladder
obstruction in men over the age of 50.
The signs and symptoms are urinary frequency, nocturia, dribbling, retention. On physical exam, the
bladder may be distended. The prostate is non-tender with either asymmetrical or symmetrical
enlargement. And the prostate will have a smooth rubber consistency with possible nodules.
For diagnosis of BPH, you need a UA to rule out UTI, uroflowmetry, an abdominal ultrasound to rule out
upper tract pathology. You would need to obtain a serum creatine and BUN which should be normal.
You need to do a prostate specific antigen or PSA and anything greater than four nanograms per
milliliter indicates disease. You also need to do a digital rectal exam.
For management of BPH, you can observe the condition and consult or refer to urology as needed. You
should use lifestyle modifications for additive therapy. There are two main classes of medications. And
this is alpha-adrenergic antagonists in 5-alpha reductase inhibitors. The combination of these two
medication classes is effective for long-term management of BPH and with demonstrated large
prostates. The alpha-adrenergic antagonists are first line option for moderate to severe, and
bothersome urinary tract symptoms. These drugs affect the contraction of the smooth muscle in the
prostatic, urethra and bladder neck. They show benefit over placebo. They typically take two to four
weeks to show improvement. They may affect blood pressure, require dose titration and blood pressure
monitoring. The American urology association recommends Alfuzosin, Doxazosin and Tamsulosin,
because they're thought to be more effective and have less effect on blood pressure. Prazosin and
Phenoxybenzamine have insufficient evidence and are not recommended.
Most common adverse effects are orthostatic hypotension. And then I've listed the dosages down here
as well.
Treatment with 5a-Reductase inhibitors: These work by blocking the conversion of testosterone to
dihydrotestosterone gradually reducing the prostatic volume. Most benefit is when the prostate volume
exceeds 40 milliliters. This requires six months to show clinical benefit, and there are two equally
effective options. This is Finasteride and Dutasteride. These should not be used in patients without
evidence of enlarge prostates, and they show reduced risk of urinary retention, less need for surgical
intervention and less overall incidents of prostate cancer when these medications are used. These are
used in patients with refractory hematuria after other causes have been ruled out. Side effects include
decreased libido and erectile dysfunction.
Prostatitis
Now we'll talk about acute prostatitus. Prostatitus is an inflammatory infection of the prostate. It is
usually caused by gram-negative bacteria, especially E. coli. With non bacterial prostatitis, this can occur
in younger men, and it is typically caused from Chlamydia, Mycoplasma or Gardnerella. On physical
