B8.042 Pathology of Prostate Flashcards

1
Q

systemic symptoms of acute bacterial prostatitis

A

fever, chills, malaise, urinary irritative and obstructive symptoms

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2
Q

common causes of acute bacterial prostatitis

A

E. coli
other gram - rods
enterococci
staphylocci

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3
Q

routes of infection of prostate

A
  1. direct implantation
  2. lymphohematogenous spreading
  3. surgical manipulation (indwelling catheter, TURP, etc.)
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4
Q

acute prostatitis on histo

A

neutrophils in lumen of glands, stroma, and epithelium

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5
Q

other types of prostatitis

A

chronic bacterial
abacterial
granulomatous

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6
Q

DRE findings in prostatitis

A

hot, boggy, tender prostate

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7
Q

diagnosis of acute bacterial prostatitis

A

positive urine culture

clinical features

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8
Q

features of chronic bacterial prostatitis

A

similar to acute, but without fast onset
lacks fever and chills
can cause recurrent UTIs
positive urine culture

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9
Q

features of abacterial prostatitis

A

similar to chronic bacterial prostatitis, but with negative cultures

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10
Q

types of granulomatous prostatitis

A

infectious: fungal or mycobacterial granulomatous prostatitis
non-infectious: nonspecific granulomatous prostatitis

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11
Q

most common cause of granulomatous prostatitis

A

BCG treatment effect

-treatment of bladder cancer

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12
Q

chronic prostatitis on histo

A

lymphocytic infiltrate (instead of neutrophils like acute)

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13
Q

granulomatous inflammation on histo

A

epithelioid histiocytes
multinucleated giant cells
focis of granuloma formation

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14
Q

histo in BPH

A

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

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15
Q

symptoms of BPH

A

urethral obstruction
urine retention
increased incidence of urinary infection

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16
Q

pathogeneis of BPH

A

conversion of T to DHT in stromal cells via 5 a reductase stimulates growth factor receptors on both epithelial and stromal cells

17
Q

irritative symptoms of BPH

A

urgency
frequency
nocturia
dysuria

18
Q

obstructive symptoms of BPH

A

hesitancy
weakening of stream
terminal dribbling
incomplete evacuation

19
Q

potential complications of BPH

A
urinary retention
-cystitis
-urolithiasis
bladder hypertrophy and hyperplasia
-thick wall
-trabeculation
-diverticulosis
vesicoureteric reflex
-hydroureter/ hydronephrosis
-pyelonephritis
renal dysfunction
-postrenal renal failure
-hypertension
20
Q

treatment of BPH

A

lifestyle modification
a1 adrenergic receptor antagonists
5a reductase inhibitors
TURP

21
Q

epidemiology of prostatic adenocarcinoma

A

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

22
Q

pathogenesis of prostatic adenocarcinoma

A

multifactors: age, race, family history, hormone levels, and environmental influences
androgens
germline mutations in BRCA2

23
Q

tumor specific acquired somatic mutations in prostate cancer

A

gene fusion between ERG and TMPRSS2
MYC amplification
PTEN deletion
loss of TP53

24
Q

epigenetic alteration in prostate cancer

A

hypermethylation of GSTP1 gene

25
clinical presentation of prostate cancer
localized is asymptomatic LUTS hematuria in advanced disease back pain caused by vertebral metastases in rare patients (fatal outcome)
26
metastatic prostate cancer
osteoblastic lesions; high density tumor nodules | fragile despite high density > lack normal remodeling
27
detection of prostate cancer
DRE: low sens and spec multiparametric MRI serum PSA level: controversial
28
describe PSA
secreted by prostatic epithelium cutoff: 4 ng/mL organ specific, not cancer-specific
29
factors that can cause an elevated PSA
``` cancer prostatitis BPH infarct instrumentation of prostate ejaculation ```
30
limitations and potential harms of PSA screening
over diagnosis over treatment | false positive or false negative results
31
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
32
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
33
what is perineural invasion
glands wrapped around a nerve
34
people at higher risk for prostate cancer
african american | fam history of metastatic or lethal adenocarcinomas
35
histological grading of prostate cancer
Gleason grade: 1-5 | grading = predominant pattern + second most common pattern
36
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
37
prognostic factors of prostate cancer
level of PSA gleason grade pathologic stage
38
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