B8.042 Pathology of Prostate

Question 1

systemic symptoms of acute bacterial prostatitis

Answer 1

fever, chills, malaise, urinary irritative and obstructive symptoms

Question 2

common causes of acute bacterial prostatitis

Answer 2

E. coli
other gram - rods
enterococci
staphylocci

Question 3

routes of infection of prostate

Answer 3

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

Question 4

acute prostatitis on histo

Answer 4

neutrophils in lumen of glands, stroma, and epithelium

Question 5

other types of prostatitis

Answer 5

chronic bacterial
abacterial
granulomatous

Question 6

DRE findings in prostatitis

Answer 6

hot, boggy, tender prostate

Question 7

diagnosis of acute bacterial prostatitis

Answer 7

positive urine culture

clinical features

Question 8

features of chronic bacterial prostatitis

Answer 8

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

Question 9

features of abacterial prostatitis

Answer 9

similar to chronic bacterial prostatitis, but with negative cultures

Question 10

types of granulomatous prostatitis

Answer 10

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

Question 11

most common cause of granulomatous prostatitis

Answer 11

BCG treatment effect

-treatment of bladder cancer

Question 12

chronic prostatitis on histo

Answer 12

lymphocytic infiltrate (instead of neutrophils like acute)

Question 13

granulomatous inflammation on histo

Answer 13

epithelioid histiocytes
multinucleated giant cells
focis of granuloma formation

Question 14

histo in BPH

Answer 14

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

Question 15

symptoms of BPH

Answer 15

urethral obstruction
urine retention
increased incidence of urinary infection

Question 16

pathogeneis of BPH

Answer 16

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

Question 17

irritative symptoms of BPH

Answer 17

urgency
frequency
nocturia
dysuria

Question 18

obstructive symptoms of BPH

Answer 18

hesitancy
weakening of stream
terminal dribbling
incomplete evacuation

Question 19

potential complications of BPH

Answer 19

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

Question 20

treatment of BPH

Answer 20

lifestyle modification
a1 adrenergic receptor antagonists
5a reductase inhibitors
TURP

Question 21

epidemiology of prostatic adenocarcinoma

Answer 21

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

Question 22

pathogenesis of prostatic adenocarcinoma

Answer 22

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

Question 23

tumor specific acquired somatic mutations in prostate cancer

Answer 23

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

Question 24

epigenetic alteration in prostate cancer

Answer 24

hypermethylation of GSTP1 gene

Question 25

clinical presentation of prostate cancer

Answer 25

localized is asymptomatic
LUTS
hematuria in advanced disease
back pain caused by vertebral metastases in rare patients (fatal outcome)

Question 26

metastatic prostate cancer

Answer 26

osteoblastic lesions; high density tumor nodules

fragile despite high density > lack normal remodeling

Question 27

detection of prostate cancer

Answer 27

DRE: low sens and spec
multiparametric MRI
serum PSA level: controversial

Question 28

describe PSA

Answer 28

secreted by prostatic epithelium
cutoff: 4 ng/mL
organ specific, not cancer-specific

Question 29

factors that can cause an elevated PSA

Answer 29

cancer
prostatitis
BPH
infarct
instrumentation of prostate
ejaculation

Question 30

limitations and potential harms of PSA screening

Answer 30

over diagnosis over treatment

false positive or false negative results

Question 31

PSA screening guidelines

Answer 31

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

Question 32

histo features of prostatic adenocarcinoma

Answer 32

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

Question 33

what is perineural invasion

Answer 33

glands wrapped around a nerve

Question 34

people at higher risk for prostate cancer

Answer 34

african american

fam history of metastatic or lethal adenocarcinomas

Question 35

histological grading of prostate cancer

Answer 35

Gleason grade: 1-5

grading = predominant pattern + second most common pattern

Question 36

prostate tumor staging levels

Answer 36

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

Question 37

prognostic factors of prostate cancer

Answer 37

level of PSA
gleason grade
pathologic stage

Question 38

treatment options for prostate cancer

Answer 38

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