Male repro 2 Flashcards
What is the structure located post to the prostate
Retroprastatic fascia (Denonvilliers fascia)
-seperates the prostate and urinary bladder from the rectum
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What is the venous drainage of the prostate
collects into the periprostatic venous plexus where it is returned to the internal iliac vein by inferior vesicle veins
-eventually drains into the common iliac vein
Hypertrophy of what zones of the prostate may cause sig obstruction of the urethra
Hypertrophy of the pre prostatic shpinchter or transitional zone
causes of transmisson of acute bacterial prostatis
- unprotected sex
- during surgucal intervention
- dematogenic spreas as a result of general inf
-can progress to chronic bacterial protatis
inflammatory cronic pelvix pain syndrome- what is it / why does it happen
involves presence of active bacterial body or acute/subacute inflammation
-improper tx of chronic bac prostatis may cause inflammatory spread int the pelvis and surrounding tissue
symptomatology of BPH
- Urinary frequency
- Urinary urgancy
- Hesistency (difficulty initiating stream)
- Urinary intermittecy- interrupted/weak stream
- Incomplete bladder emptying
- straining
- decreased force of stream
- dripply
general pathogenesis of BPH/ where
Glandular epithelial cells, stromal cells undergo androgen dependent hyperplasia in transitional zone
Horomonal pathogenesis of BPH
- Test converted to DHT
- DHT binds to nuclear androgen receptors
- DHT mediated transcription of genes leads to increased prod of growth factors from fibroblast growth factors fam
complications of BPH
- acute urinary retention + UTI
- Detruser hyperatropy
- pyelonephrits
- hydronephritis
Hallmark antomical and histopathology of BPH
Hallmark fx= nodular prostatic enlargement
histo- glands and stroma become hyperplastic
Risk factors of protate cancer
Smoking
inflmamatory proceses
familial prostate cancer markers (BRCA2/1 gene mutation)
pathogenesis of prostate cancer (androgens)
Androgen receptors can muatte causing perm androgen receptor activation (causing cell div)
Hereditory pathogenesis of prostate cancer
- MYC oncogene on chromosome 8q24
- Environment
- aquired somatic mutations (TMPRSS2-ETS fusion genes, ETS transcription factors)
What is the gleason score
based on the architectural features of prostate cancer cells
-higher score indicates a greater likelihood of having worse outcome
Local invasion of prostate cancer
2st step- is thru capsul and commonly invade seminal glands
invasion of the bladder/rectum or penile bulb is less common (T4 disease
lymphatic spread of prostte cancer
typically to internal iliac nodes (more advanced to lumbar nodes)
Hematogenous spread of prostate
very likely to spread to the bones of the axial skeleton if it becomes metastatic beyond nodes
-vertebreal metastases are common pres
What adoes a PSA velocity of >2ng/ml/year associated w
a higher risk of finding glaeson >7 prostate cancer on prostaectomy
What PSA density makes it more likely to find prostate cancer on biopsy
PSA density >.15ng/ml/cm
What % of free PSA makes it more likely for prostate cancer
a ratio of <7% of free PSA
Recoendations for PSA screening
-US preventative service- recomend against
american cancer society- recoemnds beginning at 50
surgical procedures for prostate cancer
- Radical prostactomy
- robot assisend
- Transurethral resection of the prostate
