Male repro 2

Question 1

What is the structure located post to the prostate

Answer 1

Retroprastatic fascia (Denonvilliers fascia)
-seperates the prostate and urinary bladder from the rectum
-

Question 2

What is the venous drainage of the prostate

Answer 2

collects into the periprostatic venous plexus where it is returned to the internal iliac vein by inferior vesicle veins
-eventually drains into the common iliac vein

Question 3

Hypertrophy of what zones of the prostate may cause sig obstruction of the urethra

Answer 3

Hypertrophy of the pre prostatic shpinchter or transitional zone

Question 4

causes of transmisson of acute bacterial prostatis

Answer 4

• unprotected sex
• during surgucal intervention
• dematogenic spreas as a result of general inf

-can progress to chronic bacterial protatis

Question 5

inflammatory cronic pelvix pain syndrome- what is it / why does it happen

Answer 5

involves presence of active bacterial body or acute/subacute inflammation
-improper tx of chronic bac prostatis may cause inflammatory spread int the pelvis and surrounding tissue

Question 6

symptomatology of BPH

Answer 6

• Urinary frequency
• Urinary urgancy
• Hesistency (difficulty initiating stream)
• Urinary intermittecy- interrupted/weak stream
• Incomplete bladder emptying
• straining
• decreased force of stream
• dripply

Question 7

general pathogenesis of BPH/ where

Answer 7

Glandular epithelial cells, stromal cells undergo androgen dependent hyperplasia in transitional zone

Question 8

Horomonal pathogenesis of BPH

Answer 8

• Test converted to DHT
• DHT binds to nuclear androgen receptors
• DHT mediated transcription of genes leads to increased prod of growth factors from fibroblast growth factors fam

Question 9

complications of BPH

Answer 9

• acute urinary retention + UTI
• Detruser hyperatropy
• pyelonephrits
• hydronephritis

Question 10

Hallmark antomical and histopathology of BPH

Answer 10

Hallmark fx= nodular prostatic enlargement

histo- glands and stroma become hyperplastic

Question 11

Risk factors of protate cancer

Answer 11

Smoking
inflmamatory proceses
familial prostate cancer markers (BRCA2/1 gene mutation)

Question 12

pathogenesis of prostate cancer (androgens)

Answer 12

Androgen receptors can muatte causing perm androgen receptor activation (causing cell div)

Question 13

Hereditory pathogenesis of prostate cancer

Answer 13

• MYC oncogene on chromosome 8q24
• Environment
• aquired somatic mutations (TMPRSS2-ETS fusion genes, ETS transcription factors)

Question 14

What is the gleason score

Answer 14

based on the architectural features of prostate cancer cells

-higher score indicates a greater likelihood of having worse outcome

Question 15

Local invasion of prostate cancer

Answer 15

2st step- is thru capsul and commonly invade seminal glands

invasion of the bladder/rectum or penile bulb is less common (T4 disease

Question 16

lymphatic spread of prostte cancer

Answer 16

typically to internal iliac nodes (more advanced to lumbar nodes)

Question 17

Hematogenous spread of prostate

Answer 17

very likely to spread to the bones of the axial skeleton if it becomes metastatic beyond nodes
-vertebreal metastases are common pres

Question 18

What adoes a PSA velocity of >2ng/ml/year associated w

Answer 18

a higher risk of finding glaeson >7 prostate cancer on prostaectomy

Question 19

What PSA density makes it more likely to find prostate cancer on biopsy

Answer 19

PSA density >.15ng/ml/cm

Question 20

What % of free PSA makes it more likely for prostate cancer

Answer 20

a ratio of <7% of free PSA

Question 21

Recoendations for PSA screening

Answer 21

-US preventative service- recomend against

american cancer society- recoemnds beginning at 50

Question 22

surgical procedures for prostate cancer

Answer 22

• Radical prostactomy
• robot assisend
• Transurethral resection of the prostate