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Renal System > Diseases of the Prostate > Flashcards

Diseases of the Prostate Flashcards

1
Q

Which zone of the prostatic gland can be felt during a DRE examination?

A

The peripheral zone is mainly palpated

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2
Q

What are the functions of the prostate?

A

Ejaculation

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2
Q

What is the histology of the prostatic gland like?

A

Inner luminal cells and outer basal cells in basement membrane

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3
Q

What do luminal cells of the prostate produce?

A

Prostate-specific antigen (PSA) which helps liquify semen after ejaculation

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4
Q

What is prostatitis?

A

Inflammation of the prostate

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5
Q

What causes acute bacterial prostatitis?

A

Same organisms associated with other acute urinary tract infections

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6
Q

What causes chronic bascterial prostatitis?

A

Caused by common uropathogens as well

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7
Q

What are the different cases of chronic pelvic pain syndrome?

A

Can be inflammatory cases, which is associated with leukocytes in prostatic secretion and noninflammatory cases, in which leukocytes are absent

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8
Q

If acute bacterial prostatitis was to be caused by Chlamydia trachomatis or Neisseria gonorrhoea, what would be the target population?

A

Young sexually active adults

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9
Q

If acute bacterial prostatitis was to be caused by E. coli and proteus, what would be the target population?

A

Older adults

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10
Q

What are the lab findings of acute bacterial prostatitis?

A

Leukocytosis, pyuria and bacteriuria

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11
Q

What are the clinical manifestations of acute bacterial prostatitis?

A

Patient is ill –> dysuria, fever, chills and pelvic or perineal pain

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12
Q

What are the findings of acute bacterial prostatitis in a DRE?

A

Prostate is tender, firm and boggy

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13
Q

What are the common complication of acute bacterial prostatitis?

A

Bacteremia, prostatic abscesses, and metastatic infections

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14
Q

How is the causative organism of bacterial prostatitis identified?

A

Urine culture

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15
Q

What is chronic prostatitis?

A

Uncommon, recurrent UTI bracketed by asymptomatic periods

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16
Q

What are the clinical manifestations of chronic prostatitis?

A

Low back pain
Dysuria
Perineal and suprapubic discomfort

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17
Q

What is granulomatous prostatitis?

A

Fungal infection which has to be followed by BCF treatment for bladder cancer

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18
Q

What is non specific granulomatous prostatitis?

A

Foreign body giant cell reaction, diagnosis of exclusion

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19
Q

What is chronic pelvic pain syndrome?

A

Clinical syndrome which is defined primarily by pelvic pain with or without urinary symptoms. The most common diagnosis in men presenting with prostatitis

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20
Q

What are the clinical manifestation of chronic pelvic pain syndrome?

A

Chronic pain is localized to the perineum, suprapubic area, and penis. Pain during or after ejaculation is a prominent finding

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21
Q

What is the etiology of chronic pelvic pain syndrome?

A

Unknown

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22
Q

How is a diagnosis of chronic pelvis pain syndrome made?

A

Diagnosis of exclusion

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23
Q

What are the findings of urine and prostatic secretion cultures like?

A

They are both negative

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24
Q

What is Benign Prostatic Hyperplasia?

A

Hyperplasia of both glands and stroma, one of which may dominate

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25
Q

When is BPH experienced?

A

Age-related change: most men > 40 years, 90% are affected by their 80s

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26
Q

Is BPH associated with cancer risk?

A

No increased risk of cancer

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27
Q

Where does BPH occur? What is the result of it?

A

In the periurethral (transitional) zone –> as a result, it compresses the urethra

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28
Q

What is the pathogenesis of BPH?

A

Excessive androgen-dependent growth of stromal and glandular elements

–> Prostatic cells rely on androgens (like testosterone and dihydrotestosterone) for survival and to prevent apoptosis

–> With age, testosterone decreases, but 5-a reductase is more potent, leading to an increase in dihydrotestosterone formation, –> increase in proliferation, and a decrease in apoptosis

–> Prostate enlarges uniformly with multiple firm hyperplasticity nodules

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29
Q

What is the function of 5a-reductase?

A

To convert testosterone into dihydrotestosterone, which is a more active androgen

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30
Q

What are the clinical features of BPH? (5)

A
  1. Weak and inconsistent stream of urine (dribbling)
  2. Strain to urinate
  3. Pain when urinating
  4. Trouble initiating urination
  5. Urine builds up in the bladder –> sense of incomplete bladder emptying
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31
Q

When do the symptoms of BPH start?

A

When the prostatic urethra is obstructed

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32
Q

What is the result of complete urinary obstruction?

A

Painful distention of the urinary bladder, if not treated –> hydro-ureter and hydronephrosis

33
Q

How is BPH diagnosed?

A
  1. Digital rectal examination –> significant for enlarged and nodular prostate
  2. Prostate-specific antigen (PSA) slightly elevated
  3. Imagine as US and MRI
  4. Urodynamic test
34
Q

What is the treatment of BPH?

A
  1. Medical treatment to release the obstruction and allow urine to flow
  2. a1 antagonists to relax smooth muscle
  3. 5-a reductase inhibitor (blacks conversion to DHT)
  4. Surgical treatment
35
Q

What are the side effects of 5-a reductase inhibitors for BPH treatment?

A

Gynecomastia and sexual dysfunction

36
Q

What is the surgical treatment for BPH?

A

TURP (Transurethral resection of the prostate)

37
Q

What is the gross appearance of BPH?

A

Enlarged gland with multiple nodules

38
Q

What is the microcopy of BPH?

A

Hyperplastic nodules of fibromuscular connective tissue stroma and glands lined by two layers of epithelium.

Small cysts represent dilated acini; some contain laminated concertion (corpora amylacea)

39
Q

What is the epidemiology of prostate carcinoma?

A

The most frequent cancer diagnosis is made in men and is the second leading cause of death in the US

Incidence and mortality are related to age

40
Q

Which race has the highest incidence rates and most aggressive types of prostate cancers?

A

African american

41
Q

What is the most important risk factor of prostatic cancer?

A

Age

42
Q

What are the risk factor so prostatic cancer?

A

Age
Family history
Environmental factors such as diet
Acquired genic aberration

43
Q

What is the relation between androgens and carcinogenesis?

A

No tumour develop in males who are castrated before puberty –> no evidence that androgens initiate carcinogenesis

44
Q

What is acquired genetic aberration when it comes to prostatic cancer?

A

Most common acquired mutations create TPRSS2-ETS fusion genes or act to enhance PI3K/AKT signaling, which promotes tumor cell growth and survival

45
Q

What are the clinical features of prostatic cancer?

A

Initially asymptomatic
Can compress the urethra –> nonspecific urinary symptoms such as dysuria, or pain with ejaculation, hematospermia, hematuria, inability to void, incontinence, erectile dysfunction, weight loss, anemia

46
Q

Why are prostatic tumors initially asymptomatic?

A

They arise in the peripheral zone

47
Q

What is the metastasis of prostatic cancer like?

A

It can spread to the lumbar spine and pelvis, –> osteoblastic metastasis –> hip and back pain

–> Increase in alkaline phosphatase, PSA and prostatic acid phosphatase

48
Q

What are the diagnostic methods of prostatic cancers?

A

DRE
Transrectal US or MRI
PSA > 10μg/L, decreased free PSA, which increases over time

49
Q

How could prostatic screening be done?

A

Prostatic screening by DRE and PSA

50
Q

Who should be screened for prostatic cancer?

A

Everyone but specifically patients wih family history

51
Q
A
51
Q

Which procedure is done in order to confirm final diagnosis?

A

Prostatic biopsy

51
Q

What is the most common prostatic cancer?

A

Prostatic adenocarcinoma

51
Q

What is the histology of prostatic adenocarcinoma?

A

Small invasive glands with prominent nucleoli

52
Q

How does the Gleason grading system work?

A
  1. Multiple regions are assessed as architecture varies from one area to another
  2. A score of 1 to 5 is assigned for the two most common areas & added to produce a final score (2 to 10)
  3. The higher the score –>, the worse the prognosis
53
Q

What is the grading system for prostatic cancers?

A

Gleason grading system

54
Q

What is the importance of a grading system?

A

Grading and staging affects treatment and can predict the diagnosis and correlated mortality

55
Q

What are the findings of the prostatic adenocarcinoma microscopically?

A

Glands with cells having prominent nucleoli and glands lined by SINGLE cell layer and are back-to-back

56
Q

What is a score 1 on the Gleason’s pattern scale?

A

Small, uniform glands

57
Q

What is a score 2 on the Gleason’s pattern scale?

A

More space (stroma) between glands

58
Q

What is a score 3 on the Gleason’s pattern scale?

A

Distinctly infiltration of cells from glands at margins

59
Q

What is a score 4 on the Gleason’s pattern scale?

A

Irregular masses of neoplastic cells with few glands

60
Q

What is a score 5 on the Gleason’s pattern scale?

A

Lack of or occasion glands, sheets of cells

61
Q

What is the treatment for prostatic cancer?

A

If the tumor is confined to the prostate and has not metastasized: “watchful waiting” –> active surveillance, routine tumor marker measurement & imagine –> ensure cancer remains confined to prostate

If the tumor spreads:
a. Surgery
b. Radiation therapy
c. Chemotherapy
d. Hormonal therapy

62
Q

How are advanced metastatic carcinomas treated?

A

Androgen deprivation, either by orchiectomy or by administration of synthetic agonists of LHRH

63
Q

What is prostatic intraepithelial neoplasia (PIN)?

A

Neoplastic growth of epithelial cells within pre-existing benign prostatic acini or ducts

64
Q
A
64
Q

Why is high grade-prostatic intraepithelial neoplasia considered a precursor to prostate cancer?

A

PIN satisfies almost all requirements for a premalignant condition, 1/3 of patients develop cancer within 10 years
–> Patients are followed up by PSA monitoring

64
Q
A
65
Q

What is PSA?

A

A protein produced by the prostate gland cells, circulated through the body in two ways

66
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A
66
Q
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66
Q
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67
Q
A
67
Q

What are the two ways with which PSA can circulate around the body?

A

Either bound to other proteins or on its own (free PSA)

68
Q

What is the PSA assay?

A

The most widely used test in the diagnosis and management of prostate cancer, but it suffers a few limitations

69
Q

What are the limitations of the PSA assay?

A

It is nonspecific and can be increased due to increased production like in cases such as BPH or trauma to the prostate

70
Q

What is the normal range of PSA?

A

Normal range usually increases with age (up to 2.5 in men < 50 years of age and up to 6.5 in men > 70 years of age)

71
Q

What are serial measurements of PSA?

A

They are measurements taken a series of times; they are very important and of great value in assessing the response to therapy

72
Q

What would a rising PSA level be after radical prostatectomy or radiotherapy indicate?

A

Recurrency or disseminated disease

73
Q
A

Renal System (24 decks)

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