Neoplasms of the Prostate

Question 1

Prostate Neoplasms

Answer 1

1. Nodular hyperplasia/benign prostatic hyperplasia

2. Prostatic carcinoma

Question 2

Features of BPH

Answer 2

• common in men >50y

- compression of prostatic urethra - bladder distension, bladder hypertrophy, infection

Question 3

Pathogenesis of BPH

Answer 3

• enzyme type 2 5α-reductase in stromal cells converts testosterone - DHT
• DHT binds androgen receptors in the epithelial & stromal cells
• induces prod of growth factors - increase growth rate & decrease death rate
• hyperplasia of stromal and epithelial cells, forming nodules
• in the transitional zone (region of prostate surrounding prostatic urethra)
• prostatic smooth muscle tone (mediated via α1-adrenergic receptors) worsens the lower urinary tract obstruction

Question 4

Features of prostatic carcinoma

Answer 4

• usually in men >50y, risk increases w age

- screening by serum Prostate Specific Antigen available but controversial

Question 5

Types of prostatic carcinoma

Answer 5

1. Acinar adenocarcinoma (more common)

2. Ductal adenocarcinoma

Question 6

Clinical features of prostatic carcinoma

Answer 6

• T1a tumours (low grade) are of questionable significance
• metastatic disease is uniformly fatal, bone is a common site for mets
• diagnosis: needle biopsy
• prognosis: Gleason grading & score, TMN staging
• Gleason grading depends on degree of glandular differentiation, architecture of neoplastic glands, nuclear anaplasia, mitotic activity