Male Pathology: prostate

Question 1

Where is prostate located

Answer 1

base of bladder encircling the urethra

- anterior to rectum

Question 2

what exam is used to look for prostate

Answer 2

digital rectal exam

- posterior aspect of prostate is palpated

Question 3

what are 2 components of the prostate

Answer 3

glands and stroma

Question 4

who maintains glands and stroma prostate

Answer 4

androgen

Question 5

what are the glands composed of in prostate

Answer 5

• 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

Question 6

what is acute prostatitis ?

Answer 6

acute inflammation of prostate

Question 7

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

Answer 7

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

Question 8

clinical features of acute prostatitis

Answer 8

dysuria with fever and chills

Question 9

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

Answer 9

tender and boggy

Question 10

what is seen in prostatic secretion for acute prostatitis

Answer 10

WBC

culture reveals bacteria

Question 11

Chronic prostatitis

Answer 11

chronic inflammation prostate

Question 12

clinical presentation of chronic prostatitis

Answer 12

dysuria with pelvic or low back pain

Question 13

prostatic secretions of acute prostatitis

Answer 13

WBC

culture reveals bacteria

Question 14

What is benign prostatic hyperplasia BPH

Answer 14

hyperplasia of prostatic stroma and glands

Question 15

who gets BPH

Answer 15

older men

Question 16

what hormone is related to BPH

Answer 16

DHT dihydrotestosterone

Question 17

what converts testosterone to DTH

Answer 17

5alpha-reductase

Question 18

What part of BPH does prostate usually impact

Answer 18

central periurethral zone of prostate

Question 19

clinical features of BPH dealing with urination

Answer 19

• 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

Question 20

What does BPH show in serum levels

Answer 20

prostate-specific antigen (PSA)

Question 21

who makes PSA and what does it do

Answer 21

prostate glands

liquefies semen

Question 22

What is used to treat BPH

Answer 22

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

Question 23

MOA action of Terazosin

Answer 23

• relax smooth muscle

- relaxes vascular smooth muscle lowering blood pressure

Question 24

when is Tamsulosin used

Answer 24

normotensive individuals to avoid alpha 1B effects on blood vessels

Question 25

MOA for 5alpha-reductase inhibitor

Answer 25

- blocker conversion of testosterone to DHT

Question 26

Side effects of 5alpha-reductase inhibitor

Answer 26

gynecomastia and sexual dysfunction

Question 27

what else of 5-alpha reductase used to treat

Answer 27

male pattern baldness

Question 28

how long does it take for 5alpha reductase to work

Answer 28

months

Question 29

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

Answer 29

prostate adenocarcinoma

Question 30

what is prostate adenocarcinoma

Answer 30

malignant proliferation of prostatic glands

Question 31

what are risk factors for prostate adenocarcinoma

Answer 31

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

Question 32

clinical symptoms of prostate adenocarcinoma

Answer 32

often silent

Question 33

where in the prostate does prostate adenocarcinoma usually occur

Answer 33

peripheral, posterior region of prostate

Question 34

when does screening begin for prostate adenocarcinoma

Answer 34

50 yrs with DRE and PSA

Question 35

correlate normal PSA levels with age

Answer 35

increases

Question 36

what type of PSA is suggestive of cancer

Answer 36

decreased % free-PSA | cancer makes bound PSA

Question 37

what is required to confirm diagnosis of prostate adenocarcinoma

Answer 37

prostatic biopsy

Question 38

histo for prostate adenocarcinoma

Answer 38

small, invasive glands with prominent nucleoli

Question 39

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

Answer 39

Gleason grading system | based on architecture ( not nuclear atypia)

Question 40

how does Gleason grading system work

Answer 40

- multiple regions of tumor assessed - score 1-5 - add score - higher score worse prognosis

Question 41

Where does prostate adenocarcinoma spread? what does this result in

Answer 41

- 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)

Question 42

how is prostate adenocarcinoma treated

Answer 42

prostatectomy: localized disease | hormone suppression to reduce testosterone and DHT: advanced disease

Question 43

what hormone suppression drugs are used in prostate adenocarcinoma

Answer 43

- Leuprolide: GnRH analog | - Flutamide: competitive inhibitor at androgen receptor