B8.042 Pathology of Prostate Flashcards
systemic symptoms of acute bacterial prostatitis
fever, chills, malaise, urinary irritative and obstructive symptoms
common causes of acute bacterial prostatitis
E. coli
other gram - rods
enterococci
staphylocci
routes of infection of prostate
- direct implantation
- lymphohematogenous spreading
- surgical manipulation (indwelling catheter, TURP, etc.)
acute prostatitis on histo
neutrophils in lumen of glands, stroma, and epithelium
other types of prostatitis
chronic bacterial
abacterial
granulomatous
DRE findings in prostatitis
hot, boggy, tender prostate
diagnosis of acute bacterial prostatitis
positive urine culture
clinical features
features of chronic bacterial prostatitis
similar to acute, but without fast onset
lacks fever and chills
can cause recurrent UTIs
positive urine culture
features of abacterial prostatitis
similar to chronic bacterial prostatitis, but with negative cultures
types of granulomatous prostatitis
infectious: fungal or mycobacterial granulomatous prostatitis
non-infectious: nonspecific granulomatous prostatitis
most common cause of granulomatous prostatitis
BCG treatment effect
-treatment of bladder cancer
chronic prostatitis on histo
lymphocytic infiltrate (instead of neutrophils like acute)
granulomatous inflammation on histo
epithelioid histiocytes
multinucleated giant cells
focis of granuloma formation
histo in BPH
hyperplasia of prostatic stromal and epitheial cells, resulting in formation of large nodules
proliferative prostatic glands
nodules still only have 2 cell layers: basal and secretory THUS benign
symptoms of BPH
urethral obstruction
urine retention
increased incidence of urinary infection
pathogeneis of BPH
conversion of T to DHT in stromal cells via 5 a reductase stimulates growth factor receptors on both epithelial and stromal cells
irritative symptoms of BPH
urgency
frequency
nocturia
dysuria
obstructive symptoms of BPH
hesitancy
weakening of stream
terminal dribbling
incomplete evacuation
potential complications of BPH
urinary retention -cystitis -urolithiasis bladder hypertrophy and hyperplasia -thick wall -trabeculation -diverticulosis vesicoureteric reflex -hydroureter/ hydronephrosis -pyelonephritis renal dysfunction -postrenal renal failure -hypertension
treatment of BPH
lifestyle modification
a1 adrenergic receptor antagonists
5a reductase inhibitors
TURP
epidemiology of prostatic adenocarcinoma
most common form of cancer in men
19% of cancer, 8% of cancer death
incidence increases with age
less common in asians, more in africans
pathogenesis of prostatic adenocarcinoma
multifactors: age, race, family history, hormone levels, and environmental influences
androgens
germline mutations in BRCA2
tumor specific acquired somatic mutations in prostate cancer
gene fusion between ERG and TMPRSS2
MYC amplification
PTEN deletion
loss of TP53
epigenetic alteration in prostate cancer
hypermethylation of GSTP1 gene
clinical presentation of prostate cancer
localized is asymptomatic
LUTS
hematuria in advanced disease
back pain caused by vertebral metastases in rare patients (fatal outcome)
metastatic prostate cancer
osteoblastic lesions; high density tumor nodules
fragile despite high density > lack normal remodeling
detection of prostate cancer
DRE: low sens and spec
multiparametric MRI
serum PSA level: controversial
describe PSA
secreted by prostatic epithelium
cutoff: 4 ng/mL
organ specific, not cancer-specific
factors that can cause an elevated PSA
cancer prostatitis BPH infarct instrumentation of prostate ejaculation
limitations and potential harms of PSA screening
over diagnosis over treatment
false positive or false negative results
PSA screening guidelines
don’t screen men <40
do not screen 40-54 at average risk
individualized screening for men < 55 at high risk
individualized screening for men 55-69
2 year or greater interval
do not screen men 70+ or those with less than 10-15 year life expectancy
histo features of prostatic adenocarcinoma
small glands lined by a single layer of epithelium
loss of outer basal cell layer
large nuclei with one or more large nucleoli
perineural invasion
what is perineural invasion
glands wrapped around a nerve
people at higher risk for prostate cancer
african american
fam history of metastatic or lethal adenocarcinomas
histological grading of prostate cancer
Gleason grade: 1-5
grading = predominant pattern + second most common pattern
prostate tumor staging levels
pT2: organ confined
pT3: extraprostatic extension
pT3a: extraprostatic extension or microscopic invasion of bladder neck
pT3b: tumor invades seminal vesicles
pT4: tumor is fixed or invades adjacent structures other than seminal vesicles such as external sphincter
prognostic factors of prostate cancer
level of PSA
gleason grade
pathologic stage
treatment options for prostate cancer
active surveillance: low grade only
radical prostatectomy: localized disease
external beam or interstitial radiation therapy: localized disease
hormonal manipulations: orchiectomy or agonists of LHRH for advanced metastatic disease
