Prostate clinical presentation

Rebbeck TR, Jaffe JM, Walker AH, Wein AJ, Malkowicz SB. Modification of clinical presentation of prostate tumours by a novel genetic variant in CYP3A4. J Natl Cancer Inst 1998 90 1225-1229. 

The clinical presentation of bacterial prostatitis is presented in Table 50-6. 

GC also may present in various ways, and the clinical presentations overlap those of CT. Males may have acute urethritis with discharge, epidid)Tnitis, prostatitis, and urethral strictures. In women, GC infection can produce cervicitis, which if left untreated can lead to PID, abscesses, or salpingitis. 

TABLE 114—6. Clinical Presentation of Bacterial Prostatitis Signs and Symptoms... 

In contrast, chronic bacterial prostatitis is more difficult to diagnose and treat. Chronic bacterial prostatitis typically is characterized by recurrent UTIs with the same pathogen and is the most common cause of recurrent UTI in males. The patient s clinical presentation can vary widely (see Table 114-6). Many adults, however, are asymptomatic. 

BPH is present as microscopic disease in many elderly males.1 The prevalence increases with advancing patient age. However, only about 50% and 25% of patients with microscopic BPH disease develop an enlarged prostate on palpation and clinical voiding symptoms, respectively.2 It is estimated that 25% of males 40 years of age or more have voiding symptoms consistent with BPH,3 and 20% to 30% of all male patients who live to the age of 80 years will require a prostatectomy for severe voiding symptoms of BPH. 

Presently it is under Phase 1 clinical trials for breast and prostate cancer. It has shown inhibitory activity for cancer cell growth and proliferation. The mechanism of anticancer activity is believed to be the... 

A history of urethritis and prostatitis in men or of cervicitis and cystitis in women is common in patients with ReA. The disease has been called HLA-B27 associated ReA and includes classical Reiter s disease with arthritis, urethritis and conjunctivitis. Presenting symptoms and signs are mostly asymmetrical axial and/or peripheral arthritis. Determining the B27 status of an individual patient with ReA is irrelevant to therapy. Diagnosis usually can be made by clinical examination and history. 

Cytokines have been under clinical investigation as adjuvants to vaccines, and IFNs and IL-2 have shown some positive effects in the response of human subjects to hepatitis vaccine. IL-12 and GM-CSF have also shown adjuvant effects with vaccines. GM-CSF is of particular interest because it promotes recruitment of professional antigen-presenting cells such as the dendritic cells required for priming naive antigen-specific T-lymphocyte responses. There are some claims that GM-CSF can itself stimulate an antitumor immune response, resulting in tumor regression in melanoma and prostate cancer. 

The management of lower urinary tract symptoms suggestive of clinical symptomatic BPH remains somewhat controversial. Treatment options range from watchful waiting, for those patients wishing to delay any active therapy, to minimally invasive treatment, such as transurethral needle ablation of the prostate and transurethral microwave therapy, to surgical interventions in the form of transurethral prostatectomy or open enucleation of the prostate. Most patients present with difficulties in urination for which a variety of medical therapies are available, including synthetic 5-a-reductase inhibitors, a-blockers, and plant extracts (Boyle et al., 2000). 

Finasteride was developed as the first orally active, specific inhibitor of 5a-reductase for clinical use. Clinical studies in men with BPH demonstrated that treatment with finasteride reduced prostate size, improved urinary symptoms, and reduced the risk of developing serious BPH-related outcomes, including acute urinary retention (AUR) and the need for surgery, confirming the effects of DHT on the prostate. Additional studies also demonstrated that finasteride is an effective treatment in men with AGA. Several small studies have also suggested it is moderately efficacious in women with hirsutism. A number of other inhibitors of 5a-reductase are also presently in development for the treatment of BPH and AGA. 

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