237/239 - Pathology of the Prostate, Prostate Cancer Flashcards

1
Q

According to the AUA, who should be screened for prostate cancer?

What is the appropriate interval?

A

People of average risk 55-69 years old

People with increased risk 40-55 years old

Every 2+ years “may be preferred” over annual

(This is a shared-decision making process)

  • Don’t screen <40 years or average risk 40-55 years
  • Don’t screen 70+, unless life expectancy >10 years
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2
Q

How do we enhance the accuracy of PSA testing?

A

Do advanced imaging (MRI) after elevated PSA

Helps determine whether biopsy is needed, and increases accuracy

(we know what to aim for)

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3
Q

What is the most common type of prostate cancer?

A

Adenocarcinoma

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4
Q

What is the mainstay of therapy for patinets with metastatic, castrate-sensitive prostate cancer?

A

Androgen deprivation therapy

  • Anti-androgens
  • GnRH antagonist or continuous agonist
  • Tesosterone synthesis inhibitor
  • Surgical castration

Maybe add bone protective therapy or chermohormonal therapy

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5
Q

Which cell type will be notably absent from a prostate adenocarcinoma?

A

Basal cells

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6
Q

Where in the prostate do most prostate cancers arise?

A

Peripheral zone

(Close to the capsule)

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7
Q

List 4 non-adenocarcinoma types of prostate cancer

A
  • Basal cell carcinoma
  • Ductal adenocarcinoma
  • Small cell carcinoma
  • Primary urothelial carcinoma of the prostate
    • Derived from urothelium of the prosatatic urethra
    • This is technically not a type of prostate cancer
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8
Q

What are the management options for organ-confined prostate cancer?

A
  • Prostatectomy (robot-assisted or orpen)
  • External beam radiotherapy
  • Brachytherapy
  • Cryoablation
  • High-intensity focused ultrasound
  • MRI-guided laser ablation

Basically, do not need to do chemotherapy, may not need to take out the whole prostate

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9
Q

List 7 risk factors for prostate cancer

A
  • Old age
  • Family hx
  • African American ethnicity
  • Vitamin D deficiency
  • Obesity
  • Chronic inflammation - IBD

Prostate cancer= cancer most commonly associated with aging

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10
Q

What is the most common method of detection for prostate cancer?

A

Elevated serum PSA

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11
Q

How do we screen for prostate cancer?

A

PSA or digital rectal exam

PSA is not specific for prostate cancer

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12
Q

When prostate caner metastasizes to the bone, what changes will occur?

A

Increased osteoblastic activity

-> Thick trabecula

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13
Q

What is the most prevalent cancer diagnosis in men?

A

Prostate cancer

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14
Q

Is PSA a tumor marker?

A

No!

Will be elevated in prostate cancer

BUT can also be elevated in other conditions

Must confirm prostate cancer with tumor markers, pathologic microscipic features

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15
Q

What are the histologic features of prostate adenocarcinoma?

A

Small glands with an infiltrating pattern

Cells will have prominent nucleoli

No basal cells - they have been lost :(

Staining for basal cells will be negative

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16
Q

AMACR is a tumor marker that will be positive in which cancer cells?

A

Prostate

AMACR is an enzyme involved in beta-oxidation of branched-chain fatty acids

17
Q

What is the treatment for prostate cancer that is “interemediate risk” or higher?

A

Radical prostatectomy

18
Q

What is the frequency of hereditary prostate cancer?

A

15%

19
Q

What is the precursor lesion for prostate cancer?

A

High-grade prostatic intra-epithelial neoplasia

A non-invasive neoplastic lesion, but we don’t call it carcinoma in situ

20
Q

Name a transmembrane glycoprotein that is expressed in 95% of all prostate cancer specimens

A

PSMa

21
Q

Irritable bowel disease is associated with increased risk of which GU cancer?

A

Prostate cancer

22
Q

What system is used to grade prostate cancer?

A

Gleason score

I would recommend using sources outside of this deck if you want to get cozy with the Gleason grading system

23
Q

Which prostate cancer patients are candidates for surveillence?

A

Older men with low volume tumors that are Gleason 6 or less and low PSA