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Reproductive > PATH: Prostate > Flashcards

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
Q

True or false: longer polyglutamine (CAG) repeats predispose to cancer.

A

FALSE: shorter repeats are seen in African Americans who have the greatest incidence of prostate cancer.

26
Q

List some ways that prostate cancer becomes resistant to androgen therapy.

A
  • 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
Q

Does family history play a role in prostate cancer?

A

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
Q

What mutations are associated with increased risk of prostate cancer?

A

BRCA2 (20X increased risk)
HOXB13 germline mutation (very rare)
Other small mutations (most common in familial forms)

29
Q

Where is prostate carcinoma usually located?

A

periphery of gland

30
Q

What is the easiest way to check for prostate carcinoma?

A

DRE

31
Q

Why is PSA an unreliable tool to diagnose prostate cancer?

A

it is NOT cancer specific (can rise in BPH and other conditions like prostatitis)

32
Q

What is essential for the diagnosis of prostate cancer?

A

biopsy

33
Q

What is one feature typical of prostate carcinoma?

A

back to back glands
small glands
limited stroma (opposite of breast cancer)

34
Q

What are two other microscopic features you can see with prostate carcinoma?

A

perineural invasion

extracapsular extension of tumor

35
Q

What do you use to grade prostate cancer?

A

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
Q

If you do not see a basal layer of cells in the prostate gland, what should you think of?

A

malignant (but don’t settle)

37
Q

What is the normal cut-off for normal PSA?

A

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
Q

What is the PSA density?

A

ratio between serum PSA value and volume of prostate gland

39
Q

What is PSA velocity?

A

rate of change in PSA with time (higher in men with prostate cancer)

40
Q

True or false: older men have higher PSA than younger men?

A

TRUE (6.5 may be normal for man over 70)

41
Q

What is the PSA velocity that differentiates men with cancer versus without?

A

.75 ng/mL per year

42
Q

What can PSA bind to in serum?

A

1-antichymotrypsin (major fraction)

43
Q

True or false: the percentage of free PSA is higher in men with prostate cancer compared to BPH.

A

FALSE: free PSA is lower in men with prostate cancer than men with benign prostate disease

44
Q

What is PCA3?

A

noncoding RNA overexpressed in 95% of prostate cancers

45
Q

What do you screen for with PCA3 to get a diagnosis with very high sensitivity and specificity.

A

TMPRSS2-ERG fusion DNA

46
Q

Should we screen all men for prostate cancer?

A

NO- more men are harmed than benefited from screening

47
Q

Who should get screened for prostate?

A
  • Men 55-69 (greatest benefit; every two years)
  • Individualized decisions for high risk men under 55
  • NOT in men 70
48
Q

When you think of prostate cancer mets, what should you think of?

A

OSTEOBLASTIC (bone making) bone metastases

49
Q

What is the most common treatment for clinically localized prostate cancer?

A

radical prostatectomy with EXTENDED FOLLOW UP

50
Q

What is the prognosis for a patient post-prostatectomy based on?

A
  • Pathologic stage
  • margin status
  • Gleason grade

Reproductive (21 decks)

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