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Pathoma > Male Pathology: prostate > Flashcards

Male Pathology: prostate Flashcards

1
Q

Where is prostate located

A

base of bladder encircling the urethra

- anterior to rectum

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2
Q

what exam is used to look for prostate

A

digital rectal exam

- posterior aspect of prostate is palpated

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3
Q

what are 2 components of the prostate

A

glands and stroma

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4
Q

who maintains glands and stroma prostate

A

androgen

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5
Q

what are the glands composed of in prostate

A
  • inner layer of luminal cells and outer layer of basal cells
  • secrete alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen
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6
Q

what is acute prostatitis ?

A

acute inflammation of prostate

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7
Q

What causes acute prostatitis and what age group does it impact?

A

chlamydia trachomatis and neisseria gonorrhoeae: young adults
E coli and pseudomonas: older adults

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8
Q

clinical features of acute prostatitis

A

dysuria with fever and chills

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9
Q

what does prostate feel like in acute prostatitis in digital rectal exam

A

tender and boggy

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10
Q

what is seen in prostatic secretion for acute prostatitis

A

WBC

culture reveals bacteria

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11
Q

Chronic prostatitis

A

chronic inflammation prostate

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12
Q

clinical presentation of chronic prostatitis

A

dysuria with pelvic or low back pain

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13
Q

prostatic secretions of acute prostatitis

A

WBC

culture reveals bacteria

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14
Q

What is benign prostatic hyperplasia BPH

A

hyperplasia of prostatic stroma and glands

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15
Q

who gets BPH

A

older men

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16
Q

what hormone is related to BPH

A

DHT dihydrotestosterone

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17
Q

what converts testosterone to DTH

A

5alpha-reductase

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18
Q

What part of BPH does prostate usually impact

A

central periurethral zone of prostate

19
Q

clinical features of BPH dealing with urination

A
  • problems starting and stopping urine stream
  • impaired bladder emptying with increased risk for infection and hydronephrosis
  • dribbling
  • hypertrophy of bladder wall smooth muscle, increased risk for bladder diverticula
  • microscopic hematuria may be present
20
Q

What does BPH show in serum levels

A

prostate-specific antigen (PSA)

21
Q

who makes PSA and what does it do

A

prostate glands

liquefies semen

22
Q

What is used to treat BPH

A

alpha1-antagonist (Terazosin)
alpha1A-antagonist (Tamsulosin)
5alpha-reductase inhibitor

23
Q

MOA action of Terazosin

A
  • relax smooth muscle

- relaxes vascular smooth muscle lowering blood pressure

24
Q

when is Tamsulosin used

A

normotensive individuals to avoid alpha 1B effects on blood vessels

25
Q

MOA for 5alpha-reductase inhibitor

A
  • blocker conversion of testosterone to DHT
26
Q

Side effects of 5alpha-reductase inhibitor

A

gynecomastia and sexual dysfunction

27
Q

what else of 5-alpha reductase used to treat

A

male pattern baldness

28
Q

how long does it take for 5alpha reductase to work

A

months

29
Q

What is the most common cancer in men, and 2nd most common cause of cancer-related death

A

prostate adenocarcinoma

30
Q

what is prostate adenocarcinoma

A

malignant proliferation of prostatic glands

31
Q

what are risk factors for prostate adenocarcinoma

A

age
race ( african american then caucasians then asians)
diet high in saturated fats

32
Q

clinical symptoms of prostate adenocarcinoma

A

often silent

33
Q

where in the prostate does prostate adenocarcinoma usually occur

A

peripheral, posterior region of prostate

34
Q

when does screening begin for prostate adenocarcinoma

A

50 yrs with DRE and PSA

35
Q

correlate normal PSA levels with age

A

increases

36
Q

what type of PSA is suggestive of cancer

A

decreased % free-PSA

cancer makes bound PSA

37
Q

what is required to confirm diagnosis of prostate adenocarcinoma

A

prostatic biopsy

38
Q

histo for prostate adenocarcinoma

A

small, invasive glands with prominent nucleoli

39
Q

what grading system is used for histo for prostate adenocarcinoma? what is it based on

A

Gleason grading system

based on architecture ( not nuclear atypia)

40
Q

how does Gleason grading system work

A
  • multiple regions of tumor assessed
  • score 1-5
  • add score
  • higher score worse prognosis
41
Q

Where does prostate adenocarcinoma spread? what does this result in

A
  • lumbar spine or pelvis common
  • results in osteoblastic metastases that present as low back pain and increased alkaline phosphatase, PSA, and prostatic acid phosphatase (PAP)
42
Q

how is prostate adenocarcinoma treated

A

prostatectomy: localized disease

hormone suppression to reduce testosterone and DHT: advanced disease

43
Q

what hormone suppression drugs are used in prostate adenocarcinoma

A
  • Leuprolide: GnRH analog

- Flutamide: competitive inhibitor at androgen receptor

Pathoma (38 decks)

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