Pathology of Prostate Flashcards by Geun Young Park

gland distal to the bladder; surrounds the urethra; provides ~30% of seminal secretions and has testosterone receptors

Prostate

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Two types of epithelial cells of prostate and their chemical markers

Luminal (secretory cells) –> PSA+ and PAP+

2. Basal cells –> HMCK+

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Zones of the prostate

Peripheral zone
Transitional zone
Central zone

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Zone of prostate 75% of total prostate volume and where most carcinomas arise

Peripheral zone

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Zone of prostate most prone to hyperplasias

Transitional

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Zone of prostate that is most RESISTANT to pathology

Central zone

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Normal prostatic growth depends on _________; blocking these can help with hyperplasia and malignancies

androgens

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testosterone is required for prostatic hyperplasia and carcinoma (True or False)

False: testosterone is converted to di-hydrotestosterone (DHT) by prostatic cells, and that contributes to hyperplasia and carcinoma

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Receptors in the prostate

a-receptors (in stromal tissue)

Testosterone receptors

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increased amount of prostate stromal and epithelial tissue; increased prevalence with age; more glands with dilated lumens; associated with increased a-1 receptors (increased smooth muscle resulting in restricted urine flow)

Benign Prostatic Hyperplasia

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In the setting of BPH, the degree of obstruction doesn’t correlate with severity of symptoms, and vice versa (True or False)

True

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Common symptoms of BPH

Hesitancy
Slow stream
Straining to void
Frequency/nocturia/urgency

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Symptoms and Severity
Prostate exam
Urinarlysis
PSA
Flow and residual volume
Frequency and volume charts...

can be used to

Diagnose for BPH

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Treatment for BPH

a1-blockers (help relax urethra)

5a-reductase inhibitors (Finasteride)

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Side effects for a-receptor blockers

Postural hypotension/dizziness
Retrograde ejaculation (relaxed sphincter)

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Side effects for 5a reductase inhibitors

Decrease PSA by 50% after 6 months

post-finasteride syndrome

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Procedural treatments for BPH

TURP (trim away)
Urolift (dilation of urethra)
Simple Prostatectomy (remove)

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inflammation of prostate; ranges from acute bacterial infection of the prostate to chronic aching in pelvic region; almost always NOT caused by infection; very common and can present before age 50

Prostatitis

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Most common type of Prostatitis

Type III (chronic non-bacterial) (95%)

type of prostatitis; caused by gram negative rods; NEUTROPHILS are seen on microscopy; believed to be caused by refluxed urine, contamination via intercourse or compromised immunity; presents with fever/chills, boggy prostate

Acute Bacterial Prostatitis

Diagnostic test for Acute Bacterial Prostatitis

Voided Urine
CT scan for abscesses

DON’T due prostate massage (risk of bacteremia/sepsis)

Treatment for Acute Bacterial Prostatitis

Antibiotics (especially quinolones)

Why are quinolones preferred for treating bacterial prostatitis

can penetrate the prostate tissue well

type of prostatitis; prostate serves as a long-term reservoir for bacteria with recurrent symptoms; urinary difficulties WITHOUT fever; LYMPHOCYTES seen on microscopy

Chronic Bacterial Prostatitis

Diagnostic tests for Chronic Bacterial Prostatitis

Post massage urine culture

Treatment for Chronic Bacterial Prostatitis

Quinolones or Sulfa antibiotics for 4-6 weeks (long course!)

type of prostatitis; most common form; relapsing problem with significant impact on quality of life; unknown etiology; pain in pelvis, voiding and sexual dysfunction

Non-Bacterial Prostatitis

Diagnostic tests for Non-Bacterial Prostatitis

4 glass test | Residual volume

Treatment for Non-Bacterial Prostatitis

NO antibiotics! Lifestyle changes Treat symptoms

How can you tell between chronic bacterial prostatitis and non-bacterial prostatitis

4 glass test

Explain the 4 glass test for determining the type of prostatitis (chronic bacterial or non-bacterial)

VB1: initial urine VB2: midstream urine EPS: prostatic massage fluid VB3: post massage urine all negative= non-bacterial prostatitis

Risk factors for prostate cancer

Age Family history Race (African American)

95% of prostate cancers occur between the ages of ____ and ____

45-90

What are some examples of Prostate Cancer Screening

Digital Rectal Examination (finger test) | Serum Tumor Markers (PSA blood test)

When would a TRUS (ultrasound) and prostate biopsy be indicated

When you have a positive screening

What findings on digital examination of the prostate are worrisome

Nodules Loss of distinct borders Fixed to pelvic wall (asymmetry, enlargement or loss of sulcus NOT worrisome)

antigen specific for the prostate; glycoprotein present in ejaculate; most useful for longitudinal marker for prostatic abnormalities (NOT cancer specific!)

Prostate Specific Antigen (PSA)

What level of PSA density (PSA/prostate volume) indicates for biopsy?

>1.5

What age range is it now recommended to start screening for prostate cancer

55-69 years old

What testings are used to after prostate cancer screening is positive?

TRUS (prostate U/S) | Prostate Needle Biopsy

Transrectal Ultrasound (TRUS) are NOT diagnostic (True or False)

True

vast majority of prostate cancers (98%); firm, yellow nodule grossly; numerous small glands and lack of basal cell layer and prominent nucleoli; PSA+ and PAP+; most arise in PERIPHERAL ZONE

Prostate adenocarcinoma

histologic grading for Prostate Adenocarcinoma; higher scores correlate to worsening differentiation

Gleason score

Treatment for Prostate Cancer

Hormone Therapy/Medication Radiation Surgery (Prostatectomy)

Common sites of metastases by prostate CARCINOMA

regional lymph nodes | BONE!

What serum marker is helpful for tracking prostate cancer metastases

PSA

Treatment for Metastatic Prostate Cancer

Androgen Ablation (block testosterone action) Chemo Palliative therapy