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CPR EXAM 2 > Chapter 21: Prostate > Flashcards

Chapter 21: Prostate Flashcards

1
Q

Hematoceles of the the tunica vaginalis are uncommon but may be seen in what 2 conditions?

A
  1. Following testicular torsions
  2. Pts w/ systemic bleeding disorders
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2
Q

Accumulation of lymph in the tunica vaginalis that is almost always found in pts w/ elephantitis

A

Chylocele

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3
Q

Varioceles (aka dilated vein in speramtic cord) is often times asymptomatic but have been implicated as contributing factor to what?

A

Infertility

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4
Q

In which anatomic zone of the prostate do most hyperplasias arise?

Where do most carcinomas arise?

A
  • Hyperplasias in the transitional zone (TZ)
  • Carcinomas in the peripheral zone (PZ)
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5
Q

4 most common organisms implicated in acute bacterial prostatits?

A

1) E. coli
2) Gram (-) rods
3) Enterococcus spp.
4) Staphylococci

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6
Q

How does acute bacterial prostatitis present clinically (sx’s)?

Diagnosed how?

A
  • Fever + chills + dysuria
  • Dx: urine culure
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7
Q

Chronic bacterial prostatitis may present with what sx’s?

Pts often have a hx of what?

A
  • Low back pain + Dysuria + Suprapubic/perineal discomfort
  • May also be asymptomatic
  • Often have a hx of recurrent UTI’s (cystitis, urethritis)
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8
Q

Diagnosis of chronic bacterial prostatitis is made how?

A
  • (+) leukocytosis in prostatic secretions
  • (+) bacterial cultures
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9
Q

What is the most common type of prostatitis?

A

Chronic abacterial prostatitis

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10
Q

How does chronic abacterial prostatitis differ from chronic bacterial prostatitis based off of history and cultures?

A
  • No hx of recurrent UTI’s
  • (+) leukocytosis of prostatic secretions w/ negative bacterial cultures
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11
Q

What is the most common cause of Granulomatous Prostatitis seen in the US?

Fungal granulomatous prostatitis seen in whom?

A
  • Instillation of BCG for tx of superficial bladder cancer = attenuated mycobacterial strain
  • Fungal causes is typically only seen in immunocompromised pts
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12
Q

Which method of diagnosis for men w/ sx’s of acute or chronic bacterial prostatitis is contraindicated as it may lead to sepsis?

A

Biopsy

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13
Q

Is nodular hyperplasia of the prostate considered a pre-malignant lesion?

A

No

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14
Q

What % of individuals w/ microscopic evidence of BPH have clinically detectable enlargement of the prostate?

A

50%

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15
Q

What is the believed to be the ultimate cause of BPH and which cells are proliferating and which cells have impaired cell death?

A
  • DHT-induced GF’s act by increasing proliferation of stromal cells
  • Act by decreasing the death of epithelial cells, which causes increased accumulation of sensecent cells
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16
Q

Which cells of the prostate are responsible for the production of DHT from T; thus responsible for the androgen-dependent prostatic growth?

Via what enzyme?

A
  • Stromal cells
  • Type 2 5α-reductase
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17
Q

Is there increased epithelial cell proliferation in BPH?

A

No clear evidence of increased epithelial cell proliferation

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18
Q

Binding of DHT to AR’s in stromal and epithelial cells leads to an increase in which 2 important GF’s?

A

1) TGF-β
2) FGF

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19
Q

Nodular hyperplasia of the prostate originates almost exclusively where?

A

Inner periurethral (transition zone)

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20
Q

In some cases of BPH, nodular enlargement may project up into the floor of the urethra as a hemispheric mass directly beneath mucosa of urethra, which is termed?

A

Median lobe hypertrophy

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21
Q

What is the major clinical problem in those with BPH?

A

Urinary obstruction

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22
Q

The inability to empty the bladder in BPH causes an increased risk for?

A

Infections

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23
Q

Can diagnosis of BPH be made with a needle biopsy?

A

No, biopsies are too small and do not usually sample the TZ

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24
Q

What has been the gold standard invasive procedure for moderate to severe cases of BPH that are not responding to other therapies or in circumstances of recurrent urinary retention?

A

Transurethral Resection of the Prostate (TURP)

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25
Q

What are 3 recommendations for treating mild-moderate BPH that do not require medical or surgical therapy?

A

1) ↓ fluid intake (especially before bed)
2) Moderating alcohol and caffeine intake
3) Following timed voiding schedules

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26
Q

What is the most common form of cancer in men?

A

Adenocarcinoma of the Prostate

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27
Q

Cancer of the prostate is typically a disease in men of what age?

A

Older than 50 yo –> 65-75 yo

28
Q

Which race has a high incidence of prostate cancer and which race has a low incidence?

A
  • Most frequently in blacks
  • Uncommon in Asians
29
Q

Which gene is of particular interest in the difference of prostate cancer risk among races?

This gene contains a polymorphic sequence of?

A
  • X-linked AR gene
  • Repeats of codon CAG (glutamine)
30
Q

How does the length of the polymorphic sequence of CAG repeats in X-linked AR gene affect the sensitivity of AR’s to androgens?

Which race has the shortest repeat and which has the longest repeats?

A
  • Shorter stretches = ↑↑↑ sensitivity of AR –> common in blacks
  • Longer stretches = ↓↓↓ sensitivity of AR –> common in asians

*Whites have intermediate stretches of repeats

31
Q

What type of relationship exists between the length of CAG repeats of the X-linked AR gene and rate of developing prostate cancer?

A

Inverse relationship

32
Q

Activation of which pathway and loss of which tumor suppressor by prostate tumors allow for them to bypass the need for the AR altogether?

A
  • ↑ PI3K/AKT signaling ​
  • Loss of PTEN tumor suppressor
33
Q

Germline mutations in which tumor suppressor gene is associated with 20x ↑ risk for prostate cancer?

34
Q

What is a common chromosomal rearrangement implicated in prostate cancer?

A
  • Juxtaposition of ETS family TF gene (ERG or ETV1) next to the androgen-regulated TMPRSS2 promoter
  • TMPRSS2-ERG fusion
35
Q

The ETS gene under control of the TMPRSS2 promoter is common in which race affected by prostate cancer?

Overexpression of ETS TF’s cause epithelial cells to become more what?

A
  • Seen in 50% of cases in caucasians
  • Makes epithelial cells more invasive
36
Q

What is the most common epigenetic alteration in prostate cancer?

Which chromosome?

A

Hypermethylation of GSTP1 gene on chromosome 11

37
Q

Amplification of which locus (i.e., chromosome) containing which gene is a common genetic alteration seen in prostate cancer?

A

Amplification of 8q24 locus containing MYC oncogene

38
Q

Which factors indicate that prostatic intraepithelial neoplasia (PIN) is a putative precursor lesion for prostate cancer?

Is PIN considered CIS?

A
  • Both PIN and cancer predominate in peripheral zone and are uncommon in other zones
  • Prostate cancers have high frequency of PIN
  • Share many of the molecular changes

*NOT considered CIS!*

39
Q

Majority of prostate cancer arises in which zone and on which aspect (anterior/posterior) of the gland?

A

Arise in peripheral zone, classically in posterior location

*Posterior location allows for palpation during DRE

40
Q

Where does lymphatic spread and hematogenous spread of prostate cancer go?

A
  • Lymphatic —> Obturator nodes and then para-aortic
  • Hematogenous –> Axial skeleton
41
Q

The bony metastases of prostatic cancer are called what?

Which bones are commonly involved in descending order of frequency?

A
  • Osteoblastic metastases
  • Lumbar spine > prox. femur > pelvis > thoracic spine > ribs
42
Q

In contrast to benign glands, how do prostate cancer glands differ morphologically?

Which feature typical of benign glands is missing?

A
  • Are MORE crowded and LACK branching and papillary infolding
  • The OUTER basal cell layer typical of benign glands is ABSENT
43
Q

Which histological finding on biopsy is specific for prostate cancer?

A

Perineural invasion

44
Q

Immunohistochemical stain for which marker is a sensitive diagnostic marker that can be used in conjunction w/ biopsy?

A

α-methylacyl-coenzyme A-racemase (AMACR)

45
Q

What are the 2 best prognostic predictors for prostate cancer?

A

Grade and Stage

46
Q

What is used to grade prostate cancer?

What does a grade 1 represent vs. grade 5?

A
  • Gleason system
  • Stage 1 = most well-differentiated w/ round, uniform, neoplastic glands packed into well-circumscribed nodules
  • Stage 5 = no glandular differentiation, cells infiltrating stroma in form of cords, sheets, and nests
47
Q

The most well-differentiated prostate cancers will have a Gleason score of?

Least well-differentiated have score of?

A
  • Most well-differentiated = 2 (1+1)
  • Least = 10 (5+5)
48
Q

Which range of Gleason Scores is considered to represent the most-well differentiated tumors with an excellent prognosis?

A

Grades of 2-6

49
Q

Which range of Gleason Scores is considered to represent the poorly differentiated tumors with a aggressive biologies and least potential for cure?

A

Grades 8-10

50
Q

Majority of potentially treatable prostatic cancer detected w/ needle biopsy have Gleson scores of?

A

Scores of 6-7

51
Q

What diagnostic study is required to confirm the diagnosis of prostate cancer?

A

Transrectal needle biopsy

52
Q

Ratio between the serum PSA value and volume of prostate gland is known as?

A

PSA density

53
Q

The rate of change of PSA with time is known as what?

A

PSA velocity

54
Q

DRE and detection of PSA levels are useful in detection of prostate cancer, but lack what 2 things?

A

Sensitivity and specificity

55
Q

The real value of PSA for prostate cancer comes in its utility for assessing what?

A

PSA = best for monitoring response to therapy

56
Q

Which 2 additional genetic markers have increased sensitivity and specificity of detecting prostate cancer compared to just PSA alone?

A

1) Urinary PCA3 = noncoding RNA overexpressed in 95% of pts
2) Screening urine for TMPRSS2-ERG fusion DNA

57
Q

What is the most common treatment for clinically localized prostate cancer?

A

Radical prostatectomy

58
Q

Advanced metastatic prostate carcinoma is treated via?

A
  • Androgen deprivation therapy by:
  • Orchiectomy

or

  • Using synthetic analogs of LHRH
59
Q

Ductal adenocarcinoma of the prostate arising in larger periurethral ducts may show signs/sx’s similar to what malignancy?

What are these signs/sx’s?

A
  • Similar to urothelial cancer
  • Hematuria + urinary obstruction sx’s
60
Q

What is the prognosis of ductal adenocarcinomas of the prostate?

61
Q

Prostate cancer that reveals abundant mucinous secretions are termed what?

A

Colloid carcinoma of the prostate

62
Q

What is the significance of small-cell cancer of the prostate (aka neuroendocrine carcinoma)?

A
  • Most aggressive variant
  • Almost all cases = rapidly fatal
63
Q

What is the most common tumor to secondarily involve the prostate?

2 distinct patterns of involvement exist, what are they?

A
  • Urothelial cancer
    1) Large invasive urothelial cancer which directly invade from bladder –> prostate
    2) Carcinom in situ of bladder that extends into the prostatic urethra and down into prostatic ducts and acini
64
Q

What are the mesenchymal tumors that can arise in the prostate?

A
  • Same ones that involve bladder may also involve prostate
  • Unique mesenchymal tumors arising from the prostatic stroma
65
Q

What is used for staging of prostate cancer?

A

TNM designation

  • T = depth of invasion of primary tumor
  • N = regional lymph node involvement
  • M = distant metastases

CPR EXAM 2 (52 decks)

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