DLA7- Male GUT Pathology I (prostate)

Question 1

list the regions of the prostate

Answer 1

(inside out)

• periurethral zone
• transitional zone
• central zone
• peripheral zone

Question 2

Most prostate carcinomas arise from (1) zone

Nodular hyperplasia (BPH) arises mostly from (2) zone

Answer 2

1- peripheral zone: palpable on DRE

2- transitional zone => urinary obstruction

Question 3

Prostatitis:

• (1) definition
• most affects (2) age group
• (3) are the common causes

Answer 3

1- prostate gland inflammation

2- all age groups, 9-14% of all men

3- unknown or bacterial (E. coli, urethral entry sometimes after urinary procedure- catheter, TURP, ect.)

Question 4

Prostatitis:

• Sxs
• DRE findings

Answer 4

• fever/chills
• dysuria (pain), obstruction (hesitancy), irritation (frequency/urgency)
• genital pain, back pain, leukocytosis

DRE: tender and boggy prostate

Question 5

Prostatitis:

• (1) are the blood work findings
• (2) Tx
• (3) complications

Answer 5

1- leukocytosis, elevated PSA

2- antibacterials

3- (untreated) prostatic abscess, chronic prostatitis, sepsis

Question 6

Chronic Bacterial Prostatitis results from (1) and has (2) as clinical presentation

Answer 6

1- inadequately treated acute infection

2- recurrent UTI Sxs (pain, frequency, urgency) + dec libido, painful erection / ejaculation

Question 7

BPH:

• (1) is most affected group
• (2)% are symptomatic
• (3) complications

Answer 7

1- >50y/o

2- 10%

3- via chronic urinary retention –> superimposed ascending UTI = cystitis, pyelonephritis, urinary calculi, hydronephrosis

Question 8

BPH:

• (1) storage Sxs
• (2) voiding Sxs

Answer 8

(LUTS Sxs)
1- inc daytime frequency, nocturia, urgency, incontinence

2- slow stream, hesitancy, straining to void, terminal dribbling

Question 9

BPH:

• (1) DRE results
• (2) Dx requirement

Answer 9

1- firm, smooth, nodular enlargement

2- biopsy (glandular proliferation)

Question 10

BPH gross and histological appearance

Answer 10

• nodular hyperplasia of transitional zone –> urethral compression (urethra = slit like lumen)
• soft, yellow-pink surface + milky white secretions
• crowded acini w/ cystically dilated lumen w/ 2 layers of epithelial cells (inner columnar, outer flat basal cells)

Question 11

discuss the 2 possible factors that are believed to be involved in the development of BPH

Answer 11

1)

• DHT synthesized via 5α-reductase in stromal cells
• -> GF for epithelial cells => hyperplasia
• even though testosterone is dec, DHT activity and receptors are upregulated in affected men

2) inc ratio of estrogen:androgen

Question 12

BPH Tx

Answer 12

• 5α-reductase inhibitors (mild / moderate Sxs)

- Surgery (TURP, for severe Sxs)

Question 13

(1) is the most common cause of cancer in men, usually of (2) group.

Answer 13

1- prostate cancer

2- >50y/o // blacks most, asians least

Question 14

list the risk factors for unknown etiology of prostate cancer

Answer 14

• age
• FHx, race (black)
• high fat diet
• hormone levels

Question 15

Prostate Cancer:

• (1)% of cases are hereditary and are therefore seen in (2) people
• (3) have important role in the growth of prostate cancer, therefore (4) can be treatment

Answer 15

1- 9%
2- children / early age

3- androgens –> AR (androgen receptors) => pro-growth / pro-survival gene activation (maintains cancer growth / survival)
4- castration / anti-androgens

Question 16

Prostate Cancer:

• (1) main Sx
• (2) other Sxs

Answer 16

1- asymptomatic

2- hematuria, back pain (vertebral metastasis- osteosclerotic / osteoblastic on X-Ray), weight loss

Question 17

Prostate Cancer:

• (1) methods of discovery
• (2) DRE findings

Answer 17

1- usually asymptomatic => incidentally upon autopsy, DRE, PSA screening

2- irregular enlargement, multiple nodules with gritty hard consistency

Question 18

Prostate Cancer:

• mostly of (1) type
• (2) gross appearance (/location)
• (3) histological appearance

Answer 18

1- adenocarcinoma

2- multiple white solid nodules in peripheral zones (little to no necrosis)

3- small neoplastic glands in highly crowded arrangement and diminished stroma: columnar cells lining lumen (absent basal cell layer)

Question 19

Prostate Cancer describe histological grading

Answer 19

(Gleason score- based on architecture)
Low Grade: small uniform acini

High Grade: neoplastic glands of variable shape/size, with areas of necrosis

Question 20

Prostate Cancer:

• (1) purpose of fPSA
• Dx is confirmed after (2)
• (3) Tx

Answer 20

1- low fPSA:total PSA ratio in prostate cancer (since PSA is elevated in many prostate pathologies)

2- Transrectal US, biopsy

3- radical prostatectomy, radiotherapy, hormonal therapy, cryosurgery