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Testicular Cancer
Testicular cancer is the most common cancer in young men aged 15 to 35 years. Despite its prevalence in this age group, it is highly treatable, especially when detected early. The disease primarily originates from germ cells within the testes and is categorized into two main types: seminomas and non-seminomas.
Etiology and Risk Factors
Genetics: Family history of testicular cancer increases the risk.
Cryptorchidism: Undescended testes are a significant risk factor.
Demographics: Caucasian men have a higher incidence than African American or Asian men.
Age: Most commonly affects young men, particularly those between 15 and 35 years.
Pathophysiology
Testicular cancer originates from the germ cells of the testes. The cells undergo malignant transformation, leading to uncontrolled proliferation. Depending on the type, the cancer may grow slowly or rapidly, with varying tendencies to spread:
Seminomas: Typically grow slowly and are sensitive to radiation therapy.
Non-seminomas: More aggressive and may require a combination of surgery, chemotherapy, and radiation.
Clinical Manifestations
Painless Testicular Mass: The most common symptom, often discovered by the patient during self-examination.
Testicular Discomfort: Some men may experience a dull ache or heaviness in the scrotum.
Gynecomastia: Hormone-producing tumors can lead to breast enlargement or tenderness.
Symptoms of Metastasis: If the cancer has spread, patients may present with back pain, chest pain, or respiratory symptoms.
Diagnostic Approach
Physical Examination: A thorough testicular examination to detect masses or irregularities.
Ultrasound: The primary imaging tool to distinguish between solid and cystic masses.
Tumor Markers: Blood tests measuring levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH).
CT Scan: Used to assess for metastatic disease.
Treatment
Orchiectomy: Surgical removal of the affected testicle is the standard treatment.
Radiation Therapy: Often used for seminomas, particularly in early-stage disease.
Chemotherapy: Commonly used for non-seminomas or advanced cases.
Surveillance: Regular monitoring with imaging and blood tests to detect recurrence.
Prognosis
Generally Excellent: The overall 5-year survival rate for testicular cancer is over 95%, even for cases that have spread beyond the testicle. Early-stage testicular cancer has an even higher survival rate, close to 99%, with effective treatments like surgery and chemotherapy.
Benign Prostatic Hyperplasia (BPH)
BPH is a non-cancerous enlargement of the prostate gland, most commonly seen in aging men. While it is not life-threatening, BPH can cause significant urinary symptoms and affect a man’s quality of life.
Etiology and Risk Factors
Age: BPH is strongly associated with aging, with prevalence increasing significantly after the age of 50.
Hormonal Changes: Dihydrotestosterone (DHT) plays a key role in prostate growth.
Genetics: Family history may contribute to an increased risk.
Lifestyle: Obesity, lack of physical activity, and diet are associated risk factors.
Pathophysiology
BPH results from the hyperplasia of stromal and epithelial cells in the prostate, primarily in the transition zone. As the prostate enlarges, it compresses the urethra, leading to obstruction of urinary flow.
Clinical Manifestations
Urinary Frequency: Increased need to urinate, often more pronounced at night.
Urgency: A sudden, strong urge to urinate.
Weak Urine Stream: Reduced force of the urine stream.
Incomplete Bladder Emptying: Sensation of residual urine after urination.
Straining: Difficulty initiating urination.
Diagnostic Approach
Digital Rectal Exam (DRE): Assesses the size and texture of the prostate.
Prostate-Specific Antigen (PSA) Test: Elevated PSA levels can suggest BPH, though PSA is not specific to this condition.
Urinalysis: Rules out infection or hematuria.
Uroflowmetry: Measures urine flow rate to assess the severity of obstruction.
Transurethral Resection of the Prostate (TURP): The most common surgical procedure, involving the removal of prostate tissue via the urethra.
Laser Therapy: A less invasive option that uses laser energy to remove excess tissue.
Prognosis
Generally Good: BPH is not life-threatening, and about 50% of men experience symptom improvement with medication. Minimally invasive procedures have a success rate of 80-90% for long-term symptom relief. However, 30% of patients may experience progression or require further treatment to manage complications such as urinary retention or bladder damage.
Prostatitis
Prostatitis is an inflammation of the prostate gland that can be acute or chronic. It significantly affects a man’s quality of life due to pain, urinary symptoms, and sexual dysfunction. The condition is classified into four main types: acute bacterial prostatitis, chronic bacterial prostatitis, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), and asymptomatic inflammatory prostatitis.
Etiology and Risk Factors
Bacterial Infection: Commonly caused by gram-negative bacteria, such as E. coli, particularly in acute and chronic bacterial prostatitis.
Urinary Tract Infections: Previous UTIs can lead to bacterial prostatitis.
Pelvic Floor Dysfunction: Often implicated in CP/CPPS.
Prostate Procedures: Increases the risk of bacterial prostatitis.
Pathophysiology
Condition
Pathophysiology
Acute Bacterial Prostatitis
Caused by a bacterial infection that leads to acute inflammation, swelling, and localized pain.
Chronic Bacterial Prostatitis
Involves a persistent bacterial infection, typically with a biofilm formation that causes chronic inflammation and can lead to recurrent flare-ups.
Chronic Pelvic Pain Syndrome (CP/CPPS)
Associated with a multifactorial mechanism, including pelvic floor muscle dysfunction, immune response, and neural mechanisms, though the precise etiology remains unclear.
Asymptomatic Inflammatory Prostatitis
Characterized by histological evidence of inflammation in the prostate tissue without clinical symptoms, often detected incidentally.
Clinical Manifestations
Condition
Clinical Manifestations
Acute Bacterial Prostatitis
– High fever, chills – Severe pelvic or perineal pain – Dysuria (painful urination) and urinary retention – Painful ejaculation
Chronic Bacterial Prostatitis
– Recurrent urinary tract infections (UTIs) – Persistent pelvic or perineal discomfort – Dysuria – Discomfort during ejaculation
Chronic Pelvic Pain Syndrome (CP/CPPS)
– Chronic pelvic pain lasting for at least three months – Urinary symptoms such as frequency and urgency – Erectile dysfunction
Asymptomatic Inflammatory Prostatitis
– No symptoms; typically discovered during investigations for elevated PSA levels or infertility
Diagnostic Approach
Physical Examination: DRE may reveal a tender, swollen, or firm prostate.
Urinalysis and Urine Culture: Essential to detect bacteria and white blood cells, particularly in bacterial prostatitis.
Prostate Fluid Analysis: Obtained after prostatic massage, useful in chronic prostatitis to identify bacteria.
PSA Test: Often elevated in prostatitis, though not specific to this condition.
Imaging: Ultrasound or MRI may be used in complex cases to evaluate abscesses or other complications.
Treatment
Condition
Treatment
Acute Bacterial Prostatitis
– Antibiotics: Broad-spectrum antibiotics, typically fluoroquinolones or trimethoprim-sulfamethoxazole, are the mainstay of treatment. – Pain Management: NSAIDs and alpha-blockers to relieve pain and urinary symptoms. – Hospitalization: Required in severe cases for intravenous antibiotics and supportive care.
Chronic Bacterial Prostatitis
– Long-term Antibiotics: Often required for several weeks to eliminate the infection. – Alpha-Blockers: To reduce urinary symptoms.
Chronic Pelvic Pain Syndrome (CP/CPPS)
– Multimodal Therapy: May include antibiotics, anti-inflammatory medications, alpha-blockers, physical therapy, and psychological support.
Asymptomatic Inflammatory Prostatitis
– Typically does not require treatment unless associated with other conditions, such as infertility.
Prognosis
Acute Bacterial Prostatitis: Generally good with prompt antibiotic treatment. Most patients recover fully within a few weeks, but delayed treatment can lead to complications, such as abscess formation or progression to chronic prostatitis.
Chronic Bacterial Prostatitis: Variable prognosis, with symptoms often persisting despite prolonged antibiotic therapy. Approximately 50% of patients may experience recurrent flare-ups, though symptom control is achievable with a combination of treatments.
Chronic Pelvic Pain Syndrome (CP/CPPS): Prognosis is difficult to predict, and complete symptom relief is often challenging. However, many patients experience symptom reduction through multimodal therapy, including pain management and lifestyle modifications.
Asymptomatic Inflammatory Prostatitis: Generally good prognosis, as it does not cause symptoms or affect quality of life. It is often discovered incidentally, and treatment is typically unnecessary unless linked to other conditions.