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Reproductive System Week 2 > Diseases Of Prostate > Flashcards

Diseases Of Prostate Flashcards

1
Q

A young patient comes with fever, chills, dysuria for 6 hrs and exquisitely tender prostate on rectal exam
Positive urine culture :
To gram -ve rods

A

Acute bacterial prostatitis

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2
Q

How organisms reach the prostate in acute bacterial prostatitis?

A
  1. Organisms reach the prostate through reflux of contaminated urine or lymphohematogeneous routes
  2. Sometimes follow surgical manipulation
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3
Q

What causes acute bacterial prostatitis?

A

E.coli
Gram negative rods
Enterococcus
Staphylococcus

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4
Q

A patient with history of recurrent UTIs and positive urine culture

Low back pain
Dysuria
Perineal and super pubic discomfort —> though it also may be asymptomatic

A

Chronic bacterial prostatitis

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5
Q

What is a factor that cause chronic bacterial prostatitis?

A

Poor antibiotic penetration

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6
Q

A patient comes with low back pain , dysuria , and perineal and Supra;Unix discomfort
No history of recurrent UTIs and bacterial cultures -be

A

Chronic a bacterial prostatitis

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7
Q

What are the types of granulomatitis prostatitis?

A

Could be
A. Infectious —. TB, fungal
B. Non-infectious

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8
Q

What is a common cause of granulomatous prostatitis?

A

Instillation of BCG for treatment of bladder cancer (no clinical significance)

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9
Q

Where is fungal granulomatous prostatitis is typically seen?

A

It is typically seen in Immunocompromised hosts

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10
Q

What happens in nonspecific granulomatous prostatitis?

A

Is relatively common and represents a reaction to secretions from ruptured prostatic ducts and acini

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11
Q

Fever , chills , dysuria + many neutrophils

A

Acute bacterial prostatitis

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12
Q

A patient received intravesical BCG therapy for urothelial carcinoma. A prostate biopsy showed non-caseating granulomas

A

Granulomatous prostatis after instillation of BCG for treatment of bladder cancer (no clinical significance)

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13
Q

An area of fibrinoid necrosis walled off by a cuff of histiocytes. This is a most likely in response to a previous biopsy

A

Post-biopsy granuloma

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14
Q

Is the most common benign prostatic disease in men older than age 50 years with histologic eveidence of BPH found in up to 90% of men by age 80

A

Benign prostate hyperplasia

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15
Q

It is a not premalignant lesion?

A

Benign prostatic hyperplasia

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16
Q

What happens to the size of prostate in benign prostatic hyperplasia?

A

The weight of the prostate enlarges 3 to t folds

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17
Q

What is a complication of benign prostatic hyperplasia?

A

May encroach on the urethra compressing it to a slit like orifice

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18
Q

What is the microscopic features of Benign prostatic hyperplasia?

A

Nodules contain small to cystic-ally dilated glands separated by stromal cells

Glands still lined by two layers of cells

We could have —> nodule of epithelial and stromal elements
Nodule of stromal cells

We see the corpora —> indicate a benign condition

When we do immunohisyochemistry for the prostate the basal cells are present

19
Q

What is the major hormonal stimulus for proliferation?

A

Dihydrotestosterone DHT—> it is an androgen derived from testosterone

20
Q

What has a central role in generating DHT?

A

Stromal cells have a central role in generating DHT which is more potent than testosterone

21
Q

What happens if DHT binds to ARs ?

A

It stimulates ARs to translocate from the cytoplasm to the nucleus and activate the transcription of androgen-dependent genes, which encode several growth factors and their receptors —> most important are members of fibroblast growth factor (FGF) family and transforming growth factor TGF B

During embryonic prostatic development, FGFs act as paracrine regulators of epithelial growth while TGFB act as an inhibitor for epithelial proliferation

22
Q

What promotes cell proliferation in Benign prostate hyperplasia?

A

DHT-induced FGFs promotes epithelial cell proliferation

Estrogen inhibit the inhibitor of proliferation = estrogen —> also helps tip the balance toward cell proliferation

23
Q

What are symptoms of BPH due to urinary obstruction?

A
  1. Bladder hypertrophy and stone formation
  2. Bladder trabeculation
  3. Bladder dilation and trabeculation in an autopsy specimen

Symptoms of BPH are due to urinary obstruction:
A. Increased frequency
B. Nocturnal
C. Difficult in starting and stopping the stream of urine
D. Overflow dribbling
E. Dysuria
Sudden acute urinary retention may occur that requires emergency catheterization for relief

Increased resistance to urinary outflow leads to bladder hypertrophy and distention

Inability to empty the bladder completely creates a reservoir of residual urine that is a common source of bacterial infections

24
Q

How we treat benign prostatic hyperplasia?

A

Medical treatments:
Alpha Adrenergic blockers
5 alpha reductive inhibitors

Surgical treatments:
Transurethral reaction of the prostate (TURP),
High -intensity focused ultrasound (HIFU)

Laser therapy

Hyperthermia

Transurethral electrovaporization
Radio frequency abalation

25
Q

What are risk factors for prostate cancer?

A 
1. Gene
Race/ ethnicity 
Germ line mutations:
MYC
BRACA2 
HOXB13

Acquired :
TMPRSS2-ETS
Epigenetic alteration

2. Environment:
Charred red meats 
Animal fats 
Androgens 
Chronic inflammation 
Aging
26
Q

What is the stepwise progression of prostate cancer?

A

Normal prostate epithelium —TMPRSS2-ETS fusion (initiation)—> prostatic intraepithelial neoplasia PIN = dysplasia —p27 loss (progression)—< invasive adenocarcinoma —loss of PTEN(advancement)—> castration reseistance and metasis

27
Q

What type of invasion in prostate cancer?

A

Vascular invasion
Perineurial invasion
Direct invasion of adjacent organs

28
Q

What is the role of androgens in prostatic adenocarcinoma?

A

Growth and survival of prostate cancer cells depends on androgens which bind to AR and induce expression of pro-growth genes

29
Q

What are ways to escape and cause high androgens?

A
  1. AR amplification —> leading to increased sensitivity to low levels of androgen
  2. AR variants that lack ligand binding domain —> ligand independent AR activation
  3. Mutation in AR that allow it to be activated by non-androgen ligand

Mutations that activate alternative signaling pathways that bypass ar

30
Q

What are characteristic features of prostatic adenocarcinoma?

A
  1. Perineural inavasion
  2. Prominent nucleoli are an important feature in the diagnosis of prostate cancer
  3. Fock of cancer often stand out as they contain small crowded glands
    Small size of the cancer glands and their round lumens are in sharp contrast to the larger benign glands with complex branching lumens
31
Q

Are prostatic adenocarcinoma stained for basal cells

A

No

32
Q

What is the Gleason grading system?

A

There are 5 grades on the basis of glandular pattern
Most tumors contain more than one

Combined Gleason score —> a primary grade is assigned to dominant pattern and secondary grade to the second most frequent pattern

33
Q

Which grade is this?

Neoplasticism glands are uniform and round and are packed into well -circumscribed nodules

A

Grade 1

34
Q 
Which grade is this:
No glands 
Single tumor 
Infiltrating in cords 
Sheets 
Solid nests
A

Grade 5

35
Q

Which T stage is this :

Tumor not felt in exam

A

T1

36
Q

Which T stage is this

Tumor felt but still confined in prostate

A

T2

37
Q

Which T stage is this

Extra-prostatic extension

A

T3

38
Q

Which T stage is this

Tumor is fixed or invades adjacent organs e.g bladder rectum

A

T4

39
Q

No distance met

A

M0

40
Q

Distant met

A

M1

41
Q

No regional lymph

A

N0

42
Q

Regional lymph node spread

A

N1

43
Q

Where do prostate cancer metasize?

A

Hematogeneous spread occurs chiefly to bones, particularly the axial skeleton

Bone metases are typically osteoblasts —> feature that in men points to prostatic origin

44
Q

What is used to monitor prostate cancer treatment

A

PSA

Reproductive System Week 2 (5 decks)

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