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PATH: Prostate Flashcards

1
Q

What are the causes of acute bacterial prostatitis?

A

E. coli
Other GN rods
Enterococci
Staphylococci

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2
Q

What are the causes of chronic bacterial prostatitis?

A

same as acute (more indolent course usually with history of UTI)

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3
Q

What are the causes of chronic abacterial prostatitis?

A

mycoplasma
ureaplasma
chlamydia
(difficult to identify organisms)

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4
Q

Is BPH hypertrophy or hyperplasia?

A

HYPERPLASIA

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5
Q

What drives BPH?

A

androgens

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6
Q

True or false: BPH is NOT a precursor to malignancy.

A

True

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7
Q

What is the main androgne in the prostate?

A

DHT

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8
Q

What is the cause of the hyperplasia in BPH?

A

thought to stem from impaired cell death (accumulation of senescent cells)

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9
Q

What enzyme produces DHT in the prostate?

A

type 2, 5-alpha reductase

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10
Q

Where in the prostate is type 2, 5-alpha reducatase located?

A

stromal cells

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11
Q

What are the major growth factors stimulated by DHT-driven AR stimulation?

A

FGF

TGF-beta

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12
Q

What is the role of FGF in BPH?

A

these factors control pathways of androgen-stimulated epithelial growth during the embryonic period that are “reawakened” in BPH

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13
Q

What is the role of TGF-beta in BPH?

A

supposed to inhibit epitheilal proliferation (but a mitogen for fibroblasts and other mesenchymal cells)

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14
Q

How do FGF and TGF-beta work together to cause BPH?

A

Increase proliferation of stromal cells (TGF)

Decrease death of epithelial cells (FGF)

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15
Q

What part of the prostate does BPH involve?

A

central part (periurethral zone)

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16
Q

What is the major clinical problem in patients with BPH?

A

urinary obstruciton

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17
Q

How does BPH lead to infeciton?

A

increased size of prostate/SM contration–> obstruction–> urine build up in bladder–> urinary stasis–> nidus for infection

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18
Q

What are the common symtpoms of BPH?

A
  • Increased urinary frequency
  • Nocturia
  • Difficulty starting and stopping stream of urine
  • Overflow dribbling
  • Dysuria (if infection)
  • Abdominal pain (if sudden, acute urinary retention)
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19
Q

What is the most common form of cancer in men?

A

adenocarcinoma of the prostate

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20
Q

How common in prostate adenocarcinoma?

A

1/6 chance for every male

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21
Q

Who gets adenocarcinoma of the prostate?

A

older men (70% in men 70-80); MOST COMMON AMONG BLACKS and less common among asians

22
Q

What foods may increase risk of adenocarcinoma?

A

fats or carcinogens in charred red meats

23
Q

What foods may decrease risk of adenocarcinoma?

A

Lycopenes (cooked tomatoes)
Soy products
Vitamin D

24
Q

What does the X-linked AR gene contain?

A

polymorphic sequence with repeats of CAG (codes for glutamine)

25
True or false: longer polyglutamine (CAG) repeats predispose to cancer.
FALSE: shorter repeats are seen in African Americans who have the greatest incidence of prostate cancer.
26
List some ways that prostate cancer becomes resistant to androgen therapy.
- Acquisition of hypersensitivity to low levels of androgen (AR amplification) - Ligand-independent AR activation - Mutations in AR that allow it to be activated by non-androgen ligands - Mutation that activate alternative signaling pathways - Increased activation of PI3K/AKT signaling pathway (loss of the PTEN tumor suppressor gene)
27
Does family history play a role in prostate cancer?
YES- men with one first degree relative with prostate cancer have 2X the risk ; men with 2 first degree relatives with prostate cancer have 5X risk
28
What mutations are associated with increased risk of prostate cancer?
BRCA2 (20X increased risk) HOXB13 germline mutation (very rare) Other small mutations (most common in familial forms)
29
Where is prostate carcinoma usually located?
periphery of gland
30
What is the easiest way to check for prostate carcinoma?
DRE
31
Why is PSA an unreliable tool to diagnose prostate cancer?
it is NOT cancer specific (can rise in BPH and other conditions like prostatitis)
32
What is essential for the diagnosis of prostate cancer?
biopsy
33
What is one feature typical of prostate carcinoma?
back to back glands small glands limited stroma (opposite of breast cancer)
34
What are two other microscopic features you can see with prostate carcinoma?
perineural invasion | extracapsular extension of tumor
35
What do you use to grade prostate cancer?
Gleason Grading System - Pick two regions of the most common pathology in lesion - Give scores (1-5) to each of the two sections - Add them up for a score
36
If you do not see a basal layer of cells in the prostate gland, what should you think of?
malignant (but don't settle)
37
What is the normal cut-off for normal PSA?
4 ng/mL (but it may be too high because 20-40% of patients with prostate cancer have a PSA of 4ng/mL or less, so some consider 2.5 ng/mL abnormal)
38
What is the PSA density?
ratio between serum PSA value and volume of prostate gland
39
What is PSA velocity?
rate of change in PSA with time (higher in men with prostate cancer)
40
True or false: older men have higher PSA than younger men?
TRUE (6.5 may be normal for man over 70)
41
What is the PSA velocity that differentiates men with cancer versus without?
.75 ng/mL per year
42
What can PSA bind to in serum?
1-antichymotrypsin (major fraction)
43
True or false: the percentage of free PSA is higher in men with prostate cancer compared to BPH.
FALSE: free PSA is lower in men with prostate cancer than men with benign prostate disease
44
What is PCA3?
noncoding RNA overexpressed in 95% of prostate cancers
45
What do you screen for with PCA3 to get a diagnosis with very high sensitivity and specificity.
TMPRSS2-ERG fusion DNA
46
Should we screen all men for prostate cancer?
NO- more men are harmed than benefited from screening
47
Who should get screened for prostate?
- Men 55-69 (greatest benefit; every two years) - Individualized decisions for high risk men under 55 - NOT in men 70
48
When you think of prostate cancer mets, what should you think of?
OSTEOBLASTIC (bone making) bone metastases
49
What is the most common treatment for clinically localized prostate cancer?
radical prostatectomy with EXTENDED FOLLOW UP
50
What is the prognosis for a patient post-prostatectomy based on?
- Pathologic stage - margin status - Gleason grade

Reproductive (21 decks)

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