Male+Reproductive

= 1. Identify risk factors, patho mechanisms and pharm interventions for testicular cancer and prostate cancer = • = Testicular Cancer: = • Malignant tumors usually arise from germ cells—95%- two types; seminoma and nonseminoma – **Seminoma tumors**-arise from testicular epithelium • Occur most frequently in one’s forties • Type of germ cell tumor most likely to produce a uniform cell population – **Nonseminoma tumors**-arise fromprimitive, embryonic tissues • Therefore, they are multipotent (can differentiate into different tissue types). • Occur most commonly in the 20-30 year old age group • Alpha fetoprotein (normally found in fetal serum)-tumor marker for germ cell cancer of the testis • Human chorionic gonadotropin (normallly elevated in women during pregnancy)-tumor marker for germ cell cancer of the testis • Lactate dehydrogenase (normally found in muscle, liver, kidney and brain) ** Lactate dehydrogenase ** - The enzyme LDH is found in many body tissues, especially the heart, liver, kidney, skeletal muscle, brain, blood cells and lungs. It often becomes elevated in advanced cases of testicular cancer. Clinically, it is useful as [|marker] of advanced or bulky disease and, when elevated, as a marker for [|seminoma.] – Cryptorchidism (undescended testicle) & genetics. Patients with a history of cryptorchidism have a 10-40 times higher risk of testis cancer. The risk is higher for the abdominal versus the inguinal location of the undescended testis. – Didn’t find any pharm interventions listed in book or ppt. Book listed treatment of testicular CA as: – Orchiectomy, is the basic treatment of all testicular cancers, which is done at time of diagnostic exploration – Depending on the histologic characteristics of the tumor and the clinical stage of the disease, radiation or chemotherapy may be used after orchiectomy. – Rigorous follow-up in all men with testicular cancer is necessary to detect recurrence, which most often occurs within the first year.
 * Patho Mechanisms **
 * Detecting Testicular Cancer: **
 * Risk Factors: **
 * Pharm Interventions: **

=** Prostate Cancer: **= <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• Most prostate cancers are adenocarcinomas (95%). <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• Approximately 4% of cases of prostate cancer have transitional cell morphology and are thought to arise from the urothelial lining of the prostatic urethra <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• tumors spread to the bladder neck <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• PSA (prostrate-specific antigen) is a single-chain glycoprotein. The upper limit of normal for PSA is 4 ng/mL. Elevations in this blood antigen in combo with digital rectal exam are the two diagnostic tests for screening and diagnosing prostate Ca <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• BPH can also increase PSA slightly <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• PSA levels are slightly higher in older (not race specific) males and African American males <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• A recent development, the measurement of protein bound and free PSA can help discriminate between patients with mildly elevated PSA levels from cancer and those with benign prostatic hyperplasia. The higher the free PSA (PSA circulating unbound to plasma proteins) the higher the likelihood of cancer
 * Patho Mechanisms **
 * Detecting Prostate Cancer: (Also covers/ pertains to # 3. Explain the purpose of PSA testing)   **

<span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">– Unknown <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• family hx-both autosomal chromosomes and the X chromosome have genes that have been linked to the possible inheritance risk <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• race-African Americans > Caucasians > Asians; <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• diet-high fat, red meat consumption Japanese American men > risk than native Japanese men <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">• Other: heavy metal exposure, STDs, vasectomy <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">– Cancer of the prostate is treated by sx, radiation therapy, and hormonal manipulations <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">– Chemo has shown limited effectiveness in the tx of prostate ca <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">–  Tx decisions are based on tumor grade and stage and on the age and health of the man <span style="font-family: Verdana; font-size: 10pt; mso-bidi-font-family: Verdana; mso-fareast-font-family: Verdana; msobidifontfamily: Verdana; msofareastfontfamily: Verdana; msolist: Ignore;">– Most men with an anticipated survival greater than 10yrs are considered for sx or rad therapy Metastatic disease often is tx with androgen deprivation therapy (also covers/ pertains to # 4. Identify therapeutic uses of hormone therapy in treating prostate CA) <span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Androgen deprivation may be induced by orchiectomy (sx castration) or medical castration using different androgen blocking agents <span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· The GnRH analogs (e.g., leuprolide, buserelin, nafarelin) block LH release from the pit and reduce testosterone levels w/o orchiectomy <span style="font-family: 'Courier New'; font-size: 10pt; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o When given continuously and in therapeutic doses, these drugs desensitize GnRH receptors in the pit, thereby preventing the release of luteinizing hormone. <span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· The antiandrogens (e.g., flutamide) block the uptake and actions of androgens in the target tissues. <span style="font-family: Symbol; font-size: 10pt; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Complete androgen blockade can be achieved by combining an antiandrogen with a GnRH agent or orchiectomy
 * Etiology: **
 * Risk Factors: **
 * Pharm Interventions: **

= = = = = 2. Identify the mechanisms of action, indications for use, side effects and treatment decisions about when to use alpha reducatase inhibitors vs alpha adrenergic blockers = = = Alpha Reducatase Inhibitors Examples Mechanisms of action 5-alpha reductase inhibitors interfere with the effect of certain male hormones (androgens) on the prostate. This slows the growth of the prostate and can even cause it to become smaller, which may help improve the symptoms of [|benign prostatic hyperplasia (BPH)]. But since prostate size does not always correspond to the severity of a man's symptoms, these medicines will not give satisfactory results in every case. When you stop taking the medicine, symptoms usually return. Indications for use 5-alpha reductase inhibitors are not recommended for men with BPH symptoms without a noticeably enlarged prostate. 5-alpha reductase inhibitors may be prescribed for men who have bothersome, moderate symptoms of BPH. How Well It Works Most men who use 5-alpha reductase inhibitors report about a 3-point decrease in their [|American Urologic Association (AUA) symptom index]. This change represents a noticeable improvement in symptoms.[|1] 5-alpha reductase inhibitors also decrease the risk of complications, such as being unable to urinate (urinary retention), and make it less likely that you will need surgery.[|2] It may take up to 6 to 12 months before symptom improvement is noticeable. Early studies indicate that dutasteride is as effective as finasteride in reducing BPH symptoms.[|3] But no direct comparisons of treatment with dutasteride versus finasteride have yet been made. Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor may help your symptoms more than either medicine alone.[|4], [|5] Side Effects 5-alpha reductase inhibitors appear to be very safe and well tolerated. Side effects found in the first year of use included:[|2] <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Decreased sex drive. <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Increased ejaculatory dysfunction (such as a smaller amount of semen ejaculated). <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Difficulty getting an erection. <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Breast tenderness or enlargement. One large study reported that after 1 year of treatment, finasteride resulted in the same level of decreased sex drive and inability to get an erection as a placebo. In the same study, the risk for ejaculatory dysfunction was higher with finasteride.[|2] See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) What To Think About/ Treatment decisions 5-alpha reductase inhibitors reduce the size of the prostate. But since a reduction in size does not always bring about symptom relief, these medicines will not give satisfactory results in every case. When you stop taking the medicine, symptoms usually return. 5-alpha reductase inhibitors lower prostate-specific antigen (PSA) levels. Because PSA levels are used to detect early-stage prostate cancer, men interested in taking a 5-alpha reductase inhibitor might consider the following: <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Most experts suggest that men be checked for the presence of prostate cancer (using the PSA test and a digital rectal exam) before taking 5-alpha reductase inhibitors. <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Follow-up PSA levels that have not decreased by approximately 50% after 6 months of taking a 5-alpha reductase inhibitor may indicate a need for further testing for prostate cancer. <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ PSA levels above 2 ng/mL (nanograms per milliliter) during 5-alpha reductase inhibitor treatment may indicate a need for further testing for prostate cancer. 5-alpha reductase inhibitors may be less effective than alpha-blockers in relieving symptoms.[|2] 5-alpha reductase inhibitors are not recommended for treatment of BPH symptoms in men without an enlarged prostate.[|1] The medicine must be taken for the rest of your life to prevent the symptoms from returning. This medicine should not be used by men who plan to father a child because of the small chance that the medicine could cause a birth defect. Women who are pregnant or might become pregnant should not handle broken or crushed tablets of finasteride or dutasteride.
 * Brand Name || Chemical Name ||
 * Avodart || dutasteride ||
 * Proscar || finasteride ||

Brand Name || Chemical Name || Uroxatral || || Cardura  || || Rapaflo  || || Flomax  || || Hytrin  || || ** Mechanisms of action ** Alpha-blockers help treat [|benign prostatic hyperplasia (BPH)] by relaxing smooth muscle tissue found in the prostate and the bladder neck. This allows urine to flow out of the bladder more easily. These medicines usually are taken by mouth once or twice a day. ** Indications for use ** These medicines often are used by men who have moderate and bothersome symptoms of prostate enlargement and who want more than home treatment for their symptoms. ** How Well It Works ** Many men find a 4- to 6-point reduction in their [|American Urological Association (AUA) symptom index] scores. Most men find this a significant improvement in their symptoms.[|1] Symptoms generally improve in 2 to 3 weeks.[|2] Using a combination of an alpha-blocker with a 5-alpha reductase inhibitor may help your symptoms more than either medicine alone.[|3], [|4] ** Side Effects ** Side effects vary with the medicine and the individual. Common minor side effects of alpha-blockers include: <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Weakness or fatigue. <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Lightheadedness, dizziness, or fainting when you stand up suddenly after sitting or lying down. This may occur if your blood pressure becomes low when you stand up suddenly (postural or orthostatic hypotension). <span style="color: #333333; font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; mso-fareast-font-family: Wingdings; msobidifontfamily: Wingdings; msofareastfontfamily: Wingdings; msolist: Ignore;">§ Headaches and nasal congestion. Medicines used to treat [|erection problems], such as sildenafil (Viagra), vardenafil (Levitra), or tadalafil (Cialis), may make these side effects worse. Alpha-blockers may cause ejaculation of [|semen] into the bladder (retrograde ejaculation) instead of out through the penis. This is not harmful. These side effects go away when the medicine is stopped. See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.) ** What To Think About/ Tx Decisions ** Some evidence suggests that alpha-blockers are more effective than finasteride in relieving symptoms.[|5] Long-acting forms of these medicines can be taken once a day, which may make them more convenient to take than finasteride. Fewer side effects, especially low blood pressure when standing up suddenly, may occur if the drug is taken at bedtime. Alpha-blockers are sometimes used to treat high blood pressure, too. But for some people, an alpha-blocker does not help with their high blood pressure or is not a good choice for other reasons. So, even if you are taking an alpha-blocker for your BPH symptoms, you may have to take another medicine to control your high blood pressure.
 * Alpha Adrenergic Blockers **
 * Examples **