Gen Path Exam 4 - Male Reproductive Pathology

Question 1

Located at base of bladder, encircling urethra, anterior to rectum

Answer 1

Prostate

Question 2

Posterior aspect is palpable by digital rectal exam

Answer 2

Prostate

Question 3

___________ maintain the glands and stroma, which make a milky fluid added to sperm and fluid from seminal vesicle to make semen

Answer 3

Androgens

Question 4

Histologically consists of central zone, peripheral zone, and transitional zone

Answer 4

Prostate

Question 5

Which disease?

Very common after age 40; only 10% with histologic evidence have symptoms

Answer 5

Benign prostate hyperplasia (BPH)

Question 6

Which disease?

Arises from inner transitional or central zones; produces urinary obstruction

Answer 6

Benign prostatic hyperplasia (BPH)

Question 7

Which disease has the following symptoms?

Difficulty/hesitancy starting urinary stream and intermittent interruption of urinary stream

Answer 7

Benign prostatic hyperplasia (BPH)

Question 8

Which disease has the following symptoms?

With obstruction - urgency, frequency, nocturia (irritated bladder)

Answer 8

Benign prostatic hyperplasia (BPH)

Question 9

Which disease?

Caused by an increase in androgens

Answer 9

Prostatic hyperplasia

Question 10

Which disease?

5-alpha reductase -> Testosterone -> dihydrotestosterone (DHT) -> nodular hyperplasia

Answer 10

Prostatic hyperplasia

Question 11

Which disease?

Increased estrogen may also increase expression of DHT receptors in prostate

Answer 11

Prostatic hyperplasia

Question 12

Which disease has the following methods of treatment?

5-alpha reductase inhibitors: finasteride (Proscar, Propecia)
alpha-1-adrenergic blockers: relax prostate SM (Terazosin, Tamsulosin)

Answer 12

Prostatic hyperplasia

Question 13

Which disease?

Well-defined nodules compressing the urethra

Answer 13

Prostatic hyperplasia

Question 14

Which disease?

Variable amount of normal appearing but hyperplastic glandular and stromal components

Answer 14

Prostatic hyperplasia

Question 15

Most common cancer in men

Answer 15

Prostatic carcinoma

Question 16

Which disease?

Lifetime risk is ~11%; affects men aged 65-75

Answer 16

Prostatic carcinoma

Question 17

Which disease?

Highly variable disease course; can’t reliably predict which tumors will be aggressive

Answer 17

Prostatic carcinoma

Question 18

Which disease?

Androgens promote, but don’t initiate cancer growth

Answer 18

Prostatic carcinoma

Question 19

Which disease?

Increased risk in 1st degree relatives

Answer 19

Prostatic carcinoma

Question 20

Which disease?

Geographic variations and diet may play a role

Answer 20

Prostatic carcinoma

Question 21

Which disease?

Acquired genetic aberrations; most often seen androgen-regulated fusion genes

Answer 21

Prostatic carcinoma

Question 22

Which disease?

Inherited BRCA1 and BRCA2 mutations can increase risk

Answer 22

Prostatic carcinoma

Question 23

Which disease?

Often clinically silent

Answer 23

Prostatic carcinoma

Question 24

Which disease?

Arise from peripheral zone, which can be palpated on digital rectal exam

Answer 24

Prostatic carcinoma

Question 25

Which disease? First sign is metastasis, bone involvement is common (osteolytic or osteoblastic)

Answer 25

Prostatic carcinoma

Question 26

What is the normal product of prostatic epithelium that is secreted in semen?

Answer 26

Prostate specific antigen (PSA)

Question 27

What level of Prostate specific antigen (PSA) suggests cancer? What is normal?

Answer 27

Cancer: > 10 ng/mL Normal: < 4 ng/mL

Question 28

Is Prostate specific antigen (PSA) highly sensitive and specific?

Answer 28

NO

Question 29

What is Prostate specific antigen (PSA) helpful for?

Answer 29

Monitoring pts for progression/recurrence

Question 30

What age range of men have a small net benefit for doing PSA screening?

Answer 30

55-69

Question 31

What age range of men have benefits that do NOT outweigh the expected harms for doing PSA screening?

Answer 31

70+

Question 32

What are the benefits of PSA screening in men aged 55-69?

Answer 32

May prevent 3/1000 cases of metastasis and 1.3 death over 13 yrs (small reduction in risk of death)

Question 33

What are the risks of PSA screening in men aged 55-69?

Answer 33

False + leading to biopsy and potential overtreatment

Question 34

What are the complications of overtreatment, specifically after prostatectomy and radiation?

Answer 34

Prostatectomy = incontinence and ED Radiation = ED, bowel urgency, fecal incontinence

Question 35

How is prostate cancer pathologically graded?

Answer 35

Gleason score

Question 36

Describe the Gleason score

Answer 36

1 = well differentiated 5 = no differentiation Add the 2 most common patterns together Ex: most differentiated: 1+1 = 2; least differentiated: 5+5 = 10

Question 37

What does the Gleason score correlate with?

Answer 37

Prognosis

Question 38

Gleason score = 6 or less

Answer 38

Low risk

Question 39

Gleason score = 7

Answer 39

Intermediate risk

Question 40

Gleason score = 8, 9 ,10

Answer 40

High risk

Question 41

Which disease? Clinical spread and histologic grade (Gleason score) correlate with prognosis

Answer 41

Prostatic carcinoma

Question 42

Which disease has the following treatment? Active surveillance (watching/waiting) Surgery (robotic prostatectomy) Radiation Androgen deprivation (only for advanced metastasis)

Answer 42

Prostatic carcinoma

Question 43

Which disease? Stage T1 or T2 = good prognosis

Answer 43

Prostatic carcinoma

Question 44

Which disease? Disseminated disease = poor prognosis

Answer 44

Prostatic carcinoma