Male Pathology: prostate Flashcards
Where is prostate located
base of bladder encircling the urethra
- anterior to rectum
what exam is used to look for prostate
digital rectal exam
- posterior aspect of prostate is palpated
what are 2 components of the prostate
glands and stroma
who maintains glands and stroma prostate
androgen
what are the glands composed of in prostate
- 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
what is acute prostatitis ?
acute inflammation of prostate
What causes acute prostatitis and what age group does it impact?
chlamydia trachomatis and neisseria gonorrhoeae: young adults
E coli and pseudomonas: older adults
clinical features of acute prostatitis
dysuria with fever and chills
what does prostate feel like in acute prostatitis in digital rectal exam
tender and boggy
what is seen in prostatic secretion for acute prostatitis
WBC
culture reveals bacteria
Chronic prostatitis
chronic inflammation prostate
clinical presentation of chronic prostatitis
dysuria with pelvic or low back pain
prostatic secretions of acute prostatitis
WBC
culture reveals bacteria
What is benign prostatic hyperplasia BPH
hyperplasia of prostatic stroma and glands
who gets BPH
older men
what hormone is related to BPH
DHT dihydrotestosterone
what converts testosterone to DTH
5alpha-reductase
What part of BPH does prostate usually impact
central periurethral zone of prostate
clinical features of BPH dealing with urination
- 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
What does BPH show in serum levels
prostate-specific antigen (PSA)
who makes PSA and what does it do
prostate glands
liquefies semen
What is used to treat BPH
alpha1-antagonist (Terazosin)
alpha1A-antagonist (Tamsulosin)
5alpha-reductase inhibitor
MOA action of Terazosin
- relax smooth muscle
- relaxes vascular smooth muscle lowering blood pressure
when is Tamsulosin used
normotensive individuals to avoid alpha 1B effects on blood vessels
MOA for 5alpha-reductase inhibitor
- blocker conversion of testosterone to DHT
Side effects of 5alpha-reductase inhibitor
gynecomastia and sexual dysfunction
what else of 5-alpha reductase used to treat
male pattern baldness
how long does it take for 5alpha reductase to work
months
What is the most common cancer in men, and 2nd most common cause of cancer-related death
prostate adenocarcinoma
what is prostate adenocarcinoma
malignant proliferation of prostatic glands
what are risk factors for prostate adenocarcinoma
age
race ( african american then caucasians then asians)
diet high in saturated fats
clinical symptoms of prostate adenocarcinoma
often silent
where in the prostate does prostate adenocarcinoma usually occur
peripheral, posterior region of prostate
when does screening begin for prostate adenocarcinoma
50 yrs with DRE and PSA
correlate normal PSA levels with age
increases
what type of PSA is suggestive of cancer
decreased % free-PSA
cancer makes bound PSA
what is required to confirm diagnosis of prostate adenocarcinoma
prostatic biopsy
histo for prostate adenocarcinoma
small, invasive glands with prominent nucleoli
what grading system is used for histo for prostate adenocarcinoma? what is it based on
Gleason grading system
based on architecture ( not nuclear atypia)
how does Gleason grading system work
- multiple regions of tumor assessed
- score 1-5
- add score
- higher score worse prognosis
Where does prostate adenocarcinoma spread? what does this result in
- 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)
how is prostate adenocarcinoma treated
prostatectomy: localized disease
hormone suppression to reduce testosterone and DHT: advanced disease
what hormone suppression drugs are used in prostate adenocarcinoma
- Leuprolide: GnRH analog
- Flutamide: competitive inhibitor at androgen receptor
