dz of prostate

Question 1

location of prostate

Answer 1

retroperitoneal

Question 2

zones of the prostate

Answer 2

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

Question 3

glandular structure of prostate

Answer 3

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

Question 4

Define corpora amylacea

Answer 4

aka prostate sand. Inspisation of secretions of prostate seen with aging

Question 5

acute prostatitis- describe and causes

Answer 5

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

Question 6

Chronic prostatitis- histology, etiology

Answer 6

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

Question 7

Malakoplakia- describe and etiology

Answer 7

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

Question 8

List the inflammatory dz of prostate and Sx

Answer 8

acute prostatitis, chronic prostatitis and malakoplakia. Sx: obstructive urinary Sx, low back pain, dysuria due to infection. Chronic prostatitis is often asymptomatic

Question 9

Benign prostatic hyperplasia treatment

Answer 9

5-10% require surgery. Androgen metabolism antagonists and alpha blockers

Question 10

BPH etiology, Sx

Answer 10

Androgen: estrogen imbalance. Sx: difficulty in starting and stopping urination, frequency and Nocturia (lower urinary tract symptoms)

Question 11

BPH histology

Answer 11

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

Question 12

BPH complications

Answer 12

acute urinary retention, recurrent UTI, renal failure, incontinence

Question 13

Most common cancer of prostate

Answer 13

adenocarcinoma

Question 14

Prostatic adenocarcinoma risk factors

Answer 14

age ( whites, diet, family history

Question 15

Prostatic adenocarcinoma sx

Answer 15

asymptomatic or obstructive

Question 16

prostatic adenocarcinoma morphology/ histology

Answer 16

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

Question 17

Which zone of prostate is more commonly affected by adenocarcinoma

Answer 17

peripheral zone > transition zone

Question 18

gleason grade for prostatic adenocarcinoma

Answer 18

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

Question 19

prostatic adenocarcinoma metastases

Answer 19

Metastatic spread usually hematogenous to bones of axial skeleton (osteoblastic) or lymphatic to obturator lymph nodes (and others)

Question 20

prostatic adenocarcinoma treatment

Answer 20

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.

Question 21

Prostatic adenocarcinoma markers

Answer 21

Prostate-specific antigen (PSA) and prostate-specific
alkaline phosphatase (PSAP-rarely used today)

Question 22

prostatic adenocarcinoma diagnostic criteria

Answer 22

uniform round glands, infiltrative pattern, single cell layer (loss of basal cells), nuclear enlargement w/ prominent nucleoli, perineural invasion

Question 23

Prostatic intraepitelial neoplasia (PIN)

Answer 23

Tufted, papillary or cribriform proliferations of atypical cells within ducts and acini surrounded by basal cell layer

Question 24

Prostatic intraepitelial neoplasia complications

Answer 24

•Believed to represent noninvasive precursor to some prostate cancers