Male GU Disorders Flashcards
1
Q
Male Genital Disease
Introduction
A
- Wide range of benign and malignant conditions
- Effect 80-100% of men in their lifetime (if include BPH)
- Dx predominantly by hx and PE
2
Q
Penis
Anatomy
A
3
Q
Male Genital Disease
History
A
- Presenting complaints vary from asymptomatic mass to acute pain
- ID prodromal sx
- Localize pain, intensity and duration
- Question both voiding and defecation patterns
- Sexual function/libido issues
- Hx of infections/STD’s
4
Q
Male Genital
Exam
A
- Perform both standing and supine
- Wear gloves
- Explain to pt the plan
- Be sensitive to the intimacy of the exam
- Examine penis, scrotum, scrotal contents, neurologic status, anal anatomy and prostate
5
Q
Hypospadias
A
Abnormal opening of urethra on ventral surface of penis.
- Relatively common, 1/300 live male births
- No specific genetic deficiency
- 70% have distal type
6
Q
Epispadias
A
Abnormal opening of the urethra on dorsal surface of penis.
- Can be associated w/ bladder exstrophy or undescended testis
- Rare: 1/100,000 male births
- Can cause partial urinary obstruction that can lead to UTI
7
Q
Phimosis
A
-
Definition: The prepuce cannot be retracted over the glans of penis.
- Most frequently the result of chronic infection w/ scarring due to poor hygiene
- Less frequently presents as a congenital anomaly
- Clinical findings: swelling, redness, pain
- Inflammation is caused by smegma
- Aggregation of desquamated epithelial cells, secretions and inflammatory debris that forms beneath the prepuce in uncircumcised males
8
Q
Balanoposthitis
A
Inflammation of the foreskin and glans.
- Can be due to a variety of organisms
- Can result from poor local hygiene esp. if uncircumcised
- Leads to inflammation & scarring
9
Q
Systemic Dermatoses
Penile Manifestations
A
Inflammatory disorders affecting the penis:
- Contact dermatitis
- Fungal and parasitic infestation
- Lichen planus
- Psoriasis vulgaris
- Fixed drug eruptions
10
Q
Sexually Transmitted Diseases
A
- Syphilis
- Gonorrhea
- Chancroid
- Granuloma inguinale
- Lymphogranuloma venereum
11
Q
Balanitis Xerotica Obliterans
A
-
Atrophy of glans penis
- Counterpart to vulvar lichen sclerosus in women
- Present in 37% of penile carcinomas
- May present as phimosis or stricture of distal urethra
- See pale gray areas around the urethra
-
Histology:
- Marked epithelial atrophy w/ absence of rete pegs
- Band-like homogenous pale tissue in upper dermis
- Lymphocytic infiltrate perivascular and periappendiceal
12
Q
Condyloma Acuminatum (Genital Wart)
Pathogenesis
A
- Results from infection w/ human papillomavirus (HPV)
- Sexually transmitted disease
- Virus appears to ⊗ terminal differentiation of squamous cells
- Condylomas almost all pts w/ HPV 6 and/or 11
- Can occur at various sites including the urethral meatus (frequently) penile urethra, penis, perineum, and anus
13
Q
Condyloma Acuminatum (Genital Wart)
Histomorphology
A
- Single or multiple
- Papillary, sessile or pedunculated
- Manifests as papillomatosis, acanthosis, focal parakeratosis, and hyperkeratosis of epithelium
- Prominent branching of rete ridges
- Koilocytosis of the superficial malpighian (prickle) layer
- Koilocyte: cell w/ large, hyperchromatic, irregular nucleus surrounded by a clear halo
14
Q
Bowen Disease
A
- Carcinoma in Situ (CIS)
- Associated w/ infection w/ high-risk HPV
- Seen in men and women, usually > age 35
-
Gross:
- Gray-white thickened opaque plaque on penile shaft or scrotum
- Shiny or velvety red plaques on glans or prepuce
-
Micro:
- Hyperproliferative epidermis w/ many mitoses
- Dysplastic cells w/ large, hyperchromatic nuclei
- Can become invasive Squamous Cell Carcinoma (SCC) in 10% of cases
15
Q
Bowenoid Papulosis
A
- Younger pts
- Multiple (rather than solitary) reddish–brown papular lesions
- Usually regresses spontaneously, does not become invasive
16
Q
Squamous Cell Carcinoma (SCC)
Characteristics
A
- Linked to high-risk HPV infection
-
Circumcision is protective
- Reduces exposure to carcinogens that may be concentrated in smegma
- ↓ likelihood of infection w/ oncogenic HPV
-
Macroscopic patterns:
-
Papillary: looks like a condyloma
- Cauliflower-like fungating mass
- Flat: thickened gray fissured plaque, then ulcerates
- Verrucous: locally invasive but rare metastasis
-
Papillary: looks like a condyloma
-
Epidemiology:
- Incidence: 0.7-0.9/10k men
- 1% of CA in US males, less than 0.2% of CA deaths
-
Presentation:
- Peaks at 50-70 y/o
- Indurated, usu. ulcerated lesion
- Most commonly on the glans, prepuce or coronal sulcus
17
Q
Squamous Cell Carcinoma (SCC)
Clinical Management
A
-
Treatment:
- Partial or total penectomy w/ inguinal node dissection
-
Prognosis:
- 65% survival at 5 yrs when confined to penis
- 25% when LN involved
18
Q
Testicle
Microanatomy
A
19
Q
Cryptorchidism
A
-
Undescended testis
- Seen in 1% of 1 y/o boys
- 75% unilateral, 25% bilateral
-
Two phases of testicular descent:
-
Transabdominal
- Controlled by Muellerian-inhibiting substance
- Arrest here is rare
- 5-10% of cases
-
Inguinoscrotal
- Androgen-dependent
- Testis can be located anywhere along path of descent
-
Transabdominal
- Normally, descent into the scrotum takes place by ~ 7th month of gestation
- Should not dx cryptorchidism until after age 1 ⇒ may spontaneously descend up to that time
- Cause is unknown
- Associated w/: Trisomy 13, Beckwith’s syndrome, Prader-Willi and Fanconi’s syndrome
-
Consequences:
- 7-11x ↑ risk for development of germ cell neoplasms
- Risk persists even if corrected (orchiopexy) before age 2
- ↑ risk is also in unaffected testis thus
- Intrinsic defect in testicular development
- Infertility can also result
- 7-11x ↑ risk for development of germ cell neoplasms
-
Histology:
- Undescended testis is small
- ↓ tubular diameter
- ↓ number of germ cells
- Treatment: Orchiopexy, the earlier the better
20
Q
Hypospermatogenesis
A
- ↓ number of spermatogonia, spermatocytes, spermatids and spermatozoa
- Non-specific etiologies
- May be reversible
-
Maturation arrest: Near total lack of mature forms
-
@ Spermatocyte stage
- Ass. w/ chromosomal and genetic abnormalities
-
@ Spermatogonial stage
- Ass. w/ radiation & chemotherapy
-
@ Spermatocyte stage
-
Germ Cell Aplasia (Sertoli cell-only syndrome)
- No germ cells
21
Q
Gonadal Atrophy
A
- Gonad size is reduced due to shrinkage of seminiferous tubules
- Shrinkage is due to loss of spermatogenic activity
- Ass. w/ thickening of the peritubular tissue
- Causes: Atherosclerosis, end stage inflammatory orchitis, cryptorchidism, hypopituitarism, malnutrition, irradiation, anti-androgen therapy, Klinefelter syndrome, alcohol abuse & cirrhosis, Vit E def, DM, AIDS
22
Q
Hydrocele
A
Accumulation of fluid in the sac between visceral and parietal tunics vaginalis
Types:
- Congenital w/ communication to the abdominal cavity
- Infantile w/ no communication
- Acquired as a result of trauma, cardiac failure or renal disease
23
Q
Granulomatous Orchitis
(Autoimmune)
A
- Unknown etiology, may be due to trauma, autoimmunity to lipid fraction of sperm
- Causes unilateral painless testicular enlargement w/ oligospermia
- Histology: non-caseating granulomas around seminiferous tubules
- Differential dx includes TB, syphilis, brucellosis, leprosy, sarcoidosis, and infection w/ fungi, rickettsia or parasites
24
Q
Gonorrhea
Histology
A
Epididymis shows acute inflammation
25
Q
Mumps
GU Effects
A
- Testicular involvement is more frequent in adults (20-30%) than in children
- Unilateral orchitis usually follows parotiditis
- Histology: edema and infiltration of lymphocytes, plasma cells and MΦ
- Process is patchy w/in the testis and usually does not result in infertility
26
Q
Varicocele
A
- Most common cause of male infertility (37%)
- Congenital absence or insufficiency of valves in internal spermatic vein leads to reflux
- Causes varix-like distention in the pampiniform plexus
-
More frequent in the left side
- Left spermatic vein → left renal vein
- 8-10 cm longer than right
- Courses b/t superior mesenteric artery and aorta
- Right spermatic vein → inferior vena cava
- Left spermatic vein → left renal vein
- Treatment: surgical excision
- Recovery of spermatogenesis in up to 80% of pts
27
Q
Testicular Torsion
A
-
Types:
- Infantile (8%)
- Adults (92%)
-
Bell-clapper abnormality
- Tunica vaginalis reflected from spermatic cord vs anterior portion of testis
- Results in lack of connections to scrotal wall
- 10% men
-
Bell-clapper abnormality
- Torsion may occur w/ trauma or exertion, but can also happen during sleep
-
Clinical:
- Sudden severe testicular pain, followed by scrotal tenderness
- ± Swelling, leukocytosis, nausea, fever
- Urologic emergency
-
Histology:
- First 6 hours: congestion, edema, and hemorrhage but the germinal cells appear viable
- After 6 hours: hemorrhagic infarction
- Dx: Need to obtain Doppler US if torsion suspected to evaluate blood flow
-
Treatment:
- Surgical correction w/in 4-6 hrs might salvage the testis
- Bell-clapper abnl is b/l ⇒ requires contralateral orchiopexy
28
Q
Erectile Dysfunction (ED)
Overview
A
The consistent inability to achieve and/or maintain an erection or erection satisfactory for intercourse.
- Very common condition with many men
- Undiagnosed for many reasons
- Multifactorial etiology: vascular, neurologic, DM, trauma, surgery, meds, psychological, HTN, HLD
- ED prevalence ↑ with age
- Hx is essential for diagnosing ED accurately
- Must differentiate from premature ejaculation and situational issues
- Work up includes PE, measurement of serum testosterone levels
29
Q
Erectile Dysfunction (ED)
Associated Meds
A
Drugs Associated with ED include:
- Estrogens, Antiandrogens
- Antihypertensives: Clonidine, methyldopa, HCTZ, β-blockers, Spironolactone, Diuretics
- Psychotropics: MAOi, TCAs, antidepressants, phenothiazine, benzodiazepines, SSRIs
- CNS depressants: sedatives, narcotics, alcohol
- Alcohol, Marijuana, Narcotics, Cigarettes, Cocaine
- H2 blockers, anticholinergics, Atropine, lipid-lowering agents, NSAIDs
- Cytotoxic drugs, Ketoconazole
30
Q
Erectile Process
A
- Muscles of the arteries and sinusoids relax
- Erectile tissue fills w/ blood at arterial pressure
- Compression of the plexus of subtunical arteries ⇒ ↓ venous outflow
- Detumescence occurs through the reversal of this process
31
Q
Erection Control
A
-
Erection
- Extrinsic factors via supraspinal pathways + neurotransmission ⇒ ∆ cavernosal artery tone
-
Central neural input is an absolute requirement
-
NANC (nonadrenergic noncholinergic) system
- Key neural pathway
- Releases nitric oxide (NO)
-
Within cavernosal smooth muscle cells:
NO ⇒ ⊕ guanylate cyclase ⇒ ↑ cGMP ⇒ ↓ intracellular Ca2+ ⇒ relaxation ⇒ engorgement
-
NANC (nonadrenergic noncholinergic) system
-
Detumescence
- Cyclic GMP broken down 1° by phosphodiesterase-5
- Partly accounts for detumescence
-
Norepi released from SNS nerves plays a larger role
- cAMP & cGMP involved in smooth muscle relaxation
- Work via kinases ⇒ ℗ of proteins that leads to:
- Opening of K+ channels ⇒ hyperpolarization
- Sequestration of intracellular Ca2+ by ER
- ⊗ Voltage-dependent Ca2+ channels ⇒ ⊗ Ca2+ influx
- Activation of myosin phosphatase
- Cyclic GMP broken down 1° by phosphodiesterase-5
32
Q
Erectile Dysfunction (ED)
Therapeutic Options
A
- First try lifestyle changes or if possible, termination of drugs which may cause ED
-
5-Phosphodiesterase Inhibitors ⇒ mainstay of therapy
- Therapeutic effect is via nitric oxide pathway resulting in smooth muscle relaxation and vasodilation
- Effective in 60% of men
-
Testosterone (T) replacement therapy
- Topical gels or injections
- Gels better: more convenient & provides steady-state T levels
- T can stimulate existing prostate CA & exacerbate BPH
- No evidence that T replacement causes cancer or BPH
- Topical gels or injections
- Penile injection therapy with vasoactive agents
- Vacuum device
- Penile prosthesis
- Sexual counseling for psychogenic ED
33
Q
Injectable
ED Drugs
A
-
Injected into base of the penis
- There are minimal pain fibers in the penis
- Takes 5-10 min to work
- Response rate is excellent
- Drugs can be effective if PO meds fail
- Most common AE is pain @ injection site
- Fibrotic episodes are rare
34
Q
PGE1
[Alprostadil]
A
Vasodilator
- 1st drug approved for ED as an injection
- Intraurethral form available
- Less effective and may cause burning and itching
35
Q
Trimix
A
Contains phentolamine, papaverine, and prostaglandin E1
- Phentolamine ⇒ ⊗ α-adrenergic receptors which can cause constriction
- Papaverine ⇒ vasorelaxation either directly or via ⊗ of phosphodiesterase
- PGE1 ⇒ ↑ cAMP
- Combo allows pharmacologic synergy
- Each agent used @ lower concentration ⇒ ↓ penile fibrosis
36
Q
Phosphodiesterase-5 Inhibitors
A
- > 50 phosphodiesterase enzymes in the body
-
5 PDE enzymes in penile tissues
- Most prominent form is PDE-5, found in the corpus cavernosum
- AEs of PDE-5 inhibitors attributed to ⊗ of enzyme in other tissues
-
Mechanism of action:
- ⊗ PDE-5 ⇒ potentiates relaxant effects necessary for erection initiated by NO release from autonomic nerves of PNS and vascular endothelium
- ⊗ PDE-5 ⇒ prevents degradation of cGMP ⇒ potentiates relaxation of corporeal arterial and sinusoidal smooth muscle
-
Contraindications:
- Recent hx of CVA, MI, low BP, unstable angina, severe cardiac failure, severe liver impairment and/or ESRD
37
Q
Sildenafil
[Viagra]
A
Phosphodiesterase-5 Inhibitor
- Pharmacodynamics:
- Onset of action usu. hour after PO ingestion
- High fat meals ↓ rate of absorption
- Recommended that drug be taken 1 hour before sexual intercourse and not w/ heavy meals
- T½ 4-6 hrs
- Duration of effect 4-5 hrs
- Pharmacokinetics:
- Degraded in liver by cytochrome P-450 3A4 and 2C9
- Pts w/ hepatic dysfunction, > 65 y/o, or taking cytochrome P-450 inhibitors will have ↑ levels
- Ex. of drugs that inhibit the same P-450 system: grapefruit juice, cimetidine, erythromycin
- Ritonavir inhibits both P-450s
- Efficacy:
- 70% of pts will get an erection even w/ comorbidities such as CAD/PVD
- ↓ Response in diabetics
- Some pts may switch to injectables b/c rigidity of erection is greater
- Oral form is more convenient
- Adverse effects:
- Headache (16%), flushing (10%), dyspepsia (6%), nasal congestion (4%), altered vision (3%), and diarrhea
- Visual disturbance: subtle change in color perception (blue aura)
- Priapism
- Only occurred if sildenafil used in combo w/ other therapies for ED
-
Interactions and contraindications:
- Can potentiate effect of NO donors ⇒ life-threatening hypotension
- Caution in pts taking α-blockers
- Caution in pts w/ coronary related problems
- ? Ass. w/ Nonarteritic anterior ischemia optic neuropathy (NAION)
38
Q
Vardenafil
[Levitra]
A
Phosphodiesterase-5 Inhibitor
All aspects are similar to sildenafil
39
Q
Tadalafil
[Cialis]
A
Phosphodiesterase-5 Inhibitors
-
Pharmacokinetics and pharmacodynamics:
- T½ 18 hrs (longer than Sildenafil and Vardenafil)
- Duration of effect 36 hrs
- Onset of action maybe slightly longer
- Plasma concentration unaffected by food
- Similar effects in regard to cytochrome P-450
-
Efficacy:
- Similar efficacy but longer duration of action
- Pts may prefer Tadalafil over Sildenafil
-
Adverse effects:
- Similar to the other two
- Drug has greatest selectivity of PDE5 vs PDE3A
- Potentially less cardiac effects
- Greater selectivity for PDE5 vs PDE6 (found in the retina)
- Potentially less visual effects
41
Q
Apomorphine
A
- Centrally acting agent
- Dopamine D1/D2 agonist
- Works at the level of the hypothalamus
- Sublingual formulation works within 20 min
- Efficacy: ~ 50% as effective as PDE inhibitors
- Adverse effects: nausea, headache, yawning, and dizziness
46
Q
Intratubular Germ Cell Neoplasia (ITGCN)
A
CIS = Intratubular Germ Cell Neoplasia
- Precursor lesion for most germ cell carcinomas
- Seminoma, embryonal carcinoma, teratocarcinoma, mixed germ cell tumors
- Not present in: yolk sac tumors, benign teratomas, spermatocytic seminomas
- ITGCN appears to arise in utero
- Stays dormant until puberty
- Then can progress to seminoma or non-seminoma GCT
50
Q
Spermatocytic Seminoma
Morphology
A
-
Gross:
- Tend to be larger than seminomas
- Well-circumscribed, bulging
- No necrosis or hemorrhage
-
Histology:
- Tumor cells are arranged in solid sheets separated by fine septa
- No lymphocytic infiltrate (differs from seminoma)
- Cells do not contain glycogen (PAS ⊖)
- Atypical mitosis can be seen
53
Q
Embryonal Carcinoma
Morphology
A
-
Gross:
- Large, irregular hemorrhagic, necrotic mass
- Local extension to spermatic cord is frequent
-
Histology:
- Varies depending on components
- Solid sheets, trabeculae, abortive glands, papillary and cleft-like spaces
- No lymphoplasmacytic infiltrate
- Large cells w/ high N/C ratios, scanty cytoplasm
- Mitosis is abundant
- Cells can contain AFP and HCG
55
Q
Yolk Sac Tumor (Endodermal Sinus Tumor)
Morphology
A
-
Gross:
- Tumors tend to be large
- Compresses surrounding testis
- Extend to epididymis
- Yellow or pale gray
- Can be solid or microcystic
- Hemorrhage is frequent
- Tumors tend to be large
-
Histology:
- Lace-like (reticular) network of cuboidal “hobnailed” cells
- Various histologic patterns including: microcystic, papillary, glandular, solid, and enteric glandular
- Schiller-Duval bodies: papillary structures resembling glomeruli (20% of cases)
-
Intra and extracellular hyaline globules (AFP or AAT) (85% of cases)
- AFP = Alpha-fetoprotein
- AAT = Alpha1-antitrypsin
57
Q
Testicular Teratoma
Morphology
A
-
Gross:
- Well-demarcated
- Can have solid and cystic components w/ other materials like bone, cartilage, sebum, etc.
-
Histology:
- Cysts lined by a variety of epithelia
- Can see skin and adnexal differentiation, immature and mature neural tissue, respiratory and intestinal tract differentiation
60
Q
Leydig Cell Tumor
Morphology
A
-
Gross:
- Homogenous well-demarcated brown to light yellow mass
- Measures between 3-5cm
- Extension to cord and rete is infrequent (15%)
-
Histology:
- Architecture of solid sheets, nests, or trabeculae surrounded by stroma
- Polygonal cells w/ granular acidophilic, or vacuolated cytoplasm
- Reinke crystals in 25-40% of cases
- Lipofuscin is seen in most
62
Q
Sertoli Cell Tumor
Morphology
A
-
Gross:
- Small pale yellow or gray w/ areas of hemorrhage and necrosis
-
Histology:
- Tubular arrangement w/ no lamina but surrounded by a BM
-
Two histological variants:
- Tubules w/ eosinophilic masses (sex cord tumor w/ annular structures)
- Large cell calcifying sertoli cell tumor
63
Q
Prostate Zones
A
-
Peripheral zone
- Located at posterior and lateral aspect of gland
- Constitutes 75% of the gland
- Site of ≈ 70% of prostatic adenocarcinoma
-
Central zone
- Cone shaped structure
- Surrounds the ejaculatory ducts
- Apex at the verumontanum, base at area between the SV and the bladder
- Constitutes 20% of the gland
-
Transitional zone
- Anteriorly located
- Surrounds the urethra
- Comprises 5% of the normal gland
- Can markedly expand by a combination of glandular and stromal hyperplasia ⇒ Benign Prostatic Hypertrophy (BPH)
- May cause obstruction of urinary flow by blocking urethral outflow tract
64
Q
Prostate
Microscopic Anatomy
A
-
Epithelial-Stromal units
- Glands + adjacent connective tissue
- Seen in all zones but not in:
- Ejaculatory ducts
- Vermontanum
65
Q
Prostatic Gland
Cell Types
A
-
Secretory cell
- Lines the lumen
-
Basal Cell (Stem Cell)
- Between BM and secretory cell
- Intermediate cells
- Possible stem cells
- Not yet fully defined
68
Q
Acute Prostatitis
Morphology
A
-
Histology
- Acute inflammation in stroma
- Gland destruction
- Micro-abscesses
-
TURP Findings
- Acute inflammation ≠ Symptomatic acute prostatitis
-
Biopsy
- May be a cause of ↑ PSA
70
Q
Nodular Hyperplasia
“Benign Prostatic Hyperplasia (BPH)”
A
- Growth in the transitional zone of the prostate
- Probably a normal aging process
- Affects nearly all men if you examine (DRE) the prostate
- 50% men > 50 y/o
- Almost 100% by ≥90 yrs of age
- Associated w/ concomitant glandular atrophy
73
Q
BPH
Morphology
A
-
Variable histology
- Glandular and stromal hyperplasia
- Atrophy
- Lymphocytic infiltrate
- Largest nodules ⇒ periurethral
74
Q
BPH vs Prostate CA
Location
A
75
Q
Prostatic Intraepithelial Neoplasia (PIN)
A
-
Precursor lesion for adenocarcinoma (CA)
- Peripheral zone lesion
- Present in almost all prostates w/ CA
-
Two-tiered grading system
-
Low grade PIN
- Stratification of secretory cells, minimal atypia, small nucleoli, retained basal cell layer
- Management: unchanged
-
High grade PIN
- Marked stratification of secretory cells
- Marked atypia
- Prominent nucleoli
- Discontinuous basal cell layer
- Management: re-biopsy
- CA found in 30-50%
-
Low grade PIN
76
Q
Prostatic Adenocarcinoma
Epidemiology
A
-
Most common cancer in men, 2nd leading cause of cancer death in men
- ~200k men are diagnosed each yr, 28k die
- Variable risk in US: African American > Whites > Asians, Hispanics, Native Americans
- Most cancers present as prostatism (like BPH)
-
Marked age-related ↑ in incidence
- 40x ↑ from 50 to 85 y/o
-
Death rate has been declining
- Reason for decline uncertain
-
Potential reasons include:
- Early detection programs w/ DRE and PSA
- Tx of localized disease
- Environmental reasons: diet, supplements, exercise
77
Q
Prostate Cancer
Diagnosis
A
- Most common presentation is elevated PSA only / asymptomatic
-
Sx usually occur only w/ advanced disease
- Clinical prostatism
- 20% of men w/ prostate CA have normal PSA and abnormal digital rectal examination (DRE)
- Both PSA and DRE needed to screen properly
- Biopsy makes definitive dx
- Biopsy is performed in combo w/ transrectal US
81
Q
Prostate Adenocarcinoma
Morphology
A
83
Q
Prostate Adenocarcinoma
Gleason’s Grading System
A
Gleason’s Grading System
- Based on architecture of glands
-
5-tiered system (patterns 1-5)
- Most predominant pattern added to 2nd most common pattern to assign a score
-
Score range 2-10
- Gleason pattern 1: Lobular masses, uniform small glands, no invasion outside the “lobule”
- Gleason pattern 2: Lobular masses, irregular glands, minimal invasion
- Gleason pattern 3: Irregular glands, infiltrative, cribriform and papillary patterns
- Gleason pattern 4: Fusion of glands, sheets, infiltrative, some w/ clear cytoplasm
- Gleason pattern 5: Sheets of anaplastic cells infiltrative, comedonecrosis
3-tiered classification based on Gleason score used for management:
- Low grade cancer: Gleason scores 2-6
- Intermediate grade cancer: Gleason score 7
- High grade cancer: Gleason score 8-10
84
Q
Prostate Adenocarcinoma
Staging
A
TMN staging system
Most common stage is T1C
87
Q
Prostate Cryosurgery
A
- Transrectal US guided
- Transperineal placement of 6-8 CRYOprobes
- Transperineal placement of 4-6 TEMP probes
- Warming device to preserve urethra
89
Q
Prostate Cancer
Hormonal Antiandrogen Therapy
A
- Palliation, for those w/ extension of CA beyond the prostate
- Based on prostate CA being androgen (testosterone) sensitive
- ↓ Serum testosterone ⇒ shrinkage of CA via apoptosis
- Usually not curative but adds to effectiveness of Radiation Tx in certain pts
- Used as 1° treatment in metastatic disease
-
Androgen ablation therapy
- Orchiectomy
- Luteinizing hormone releasing hormone (LHRH)
91
Q
Metastatic Prostate Carcinoma
A
Can use PSA immunohistochemical stain to determine that origin of metastatic tumor is from prostate.
Metastasis to bone is characteristic.
