dz of prostate Flashcards
location of prostate
retroperitoneal
zones of the prostate
a. Central zone – an inverted cone with its base forming the base of the prostate and its apex at verumontanum. ejaculatory ducts pass through central zone. b. Transition zone – two “lobes” that surround the prostatic urethra laterally and anteriorly. separated (more or less) by fibrous band from peripheral zone. c. Peripheral zone – major portion (~70%) of gland, which surrounds transition zone posteriorly, laterally, and apically
glandular structure of prostate
Compound tubuloalveolar gland. Basal layer of low cuboidal to flattened cells resting on basement membrane. Luminal layer of columnar epithelial cells which secrete mucus and protease rich fluid
Define corpora amylacea
aka prostate sand. Inspisation of secretions of prostate seen with aging
acute prostatitis- describe and causes
An acute focal or diffuse suppurative (neutrophilic) inflammation caused by bacterial infection – most common organisms include E. coli or other enterobacteria and S. aureus. Usually comes from bladder infection
Chronic prostatitis- histology, etiology
Aggregates of lymphocytes, plasma cells, and macrophages within the prostatic substance. Etiology unknown. Granulomatous form may occur surrounding “eroded” corpora amylacea and may also occur with tuberculus infections
Malakoplakia- describe and etiology
Nodular aggregate of histiocytes containing intracytoplasmic calcified inclusions (Michaelis-Gutmann bodies). Believed to be due to abberrant phagocytic process which leads to retention of bacterial wall fragments that subsequently calcify
List the inflammatory dz of prostate and Sx
acute prostatitis, chronic prostatitis and malakoplakia. Sx: obstructive urinary Sx, low back pain, dysuria due to infection. Chronic prostatitis is often asymptomatic
Benign prostatic hyperplasia treatment
5-10% require surgery. Androgen metabolism antagonists and alpha blockers
BPH etiology, Sx
Androgen: estrogen imbalance. Sx: difficulty in starting and stopping urination, frequency and Nocturia (lower urinary tract symptoms)
BPH histology
Nodules form in transition zone. Variable areas of glandular and stromal hyperplasia. Glands are cystically dilated and thrown into numerous papillary infoldings. Stromal component shows increased density of spindle cells, vessels and progressive scarring
BPH complications
acute urinary retention, recurrent UTI, renal failure, incontinence
Most common cancer of prostate
adenocarcinoma
Prostatic adenocarcinoma risk factors
age ( whites, diet, family history
Prostatic adenocarcinoma sx
asymptomatic or obstructive
prostatic adenocarcinoma morphology/ histology
yellowish nodule. Abnormal collections of atypical glands lined by single layer of malignant cuboidal to columnar cells (lack basal cells). Increased N:C ratio, prominent nucleoli
Which zone of prostate is more commonly affected by adenocarcinoma
peripheral zone > transition zone
gleason grade for prostatic adenocarcinoma
As tumors become higher in grade (less “differentiated”) they tend to become larger, more invasive, and have a greater propensity for penetrating the prostatic capsule and metastasizing
prostatic adenocarcinoma metastases
Metastatic spread usually hematogenous to bones of axial skeleton (osteoblastic) or lymphatic to obturator lymph nodes (and others)
prostatic adenocarcinoma treatment
Localized dz (confined to prostate): surgery, external beam radiation, radioactive seeds. Advanced dz: androgen ablation therapy (orchiectomy, anti-androgens, 5a-reductase inhibitors, GnRH inhibitors), chemo.
Prostatic adenocarcinoma markers
Prostate-specific antigen (PSA) and prostate-specific alkaline phosphatase (PSAP-rarely used today)
prostatic adenocarcinoma diagnostic criteria
uniform round glands, infiltrative pattern, single cell layer (loss of basal cells), nuclear enlargement w/ prominent nucleoli, perineural invasion
Prostatic intraepitelial neoplasia (PIN)
Tufted, papillary or cribriform proliferations of atypical cells within ducts and acini surrounded by basal cell layer
Prostatic intraepitelial neoplasia complications
•Believed to represent noninvasive precursor to some prostate cancers
