Pathology Of The Prostate Flashcards by Iseoluwa Ojo

The normal prostate weighs approximately ________.

It is a ____peritoneal organ that is shaped like a ________ or ________ encircling the ________ of the ________ and _______________

20grams

retro; walnut or chestnut

neck ; bladder

prostatic urethra.

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The prostate can be said to be _________ shaped with _____, an _____, an _____ and ____________ surfaces.

It measures ___cm x ___cm x___cm

conically

base, an apex, an anterior and two lateral surfaces.

4cm x 3cm x2cm

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The urethra courses through the prostate to become the ________ urethra at the ________ of the prostate.

In the substance of the gland, __________ duct merges with the ________ to form the ______________.

membranous urethra

apex of the prostate.

seminal vesicle’s

vas deferens ; ejaculatory ducts.

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The paired ejaculatory duct perforates the prostate and opens into the _______ of the __________ at the ____________

middle of the prostatic urethra

seminal colliculus

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seminal colliculus

Aka

__________

verumontanum

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In the adult, prostatic parenchyma can be divided into four biologically and anatomically distinct zones or regions:

List them

the peripheral,
central,
transitional zones, and
the region of the anterior fibromuscular stroma

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The types of proliferative lesions are different in each region.

For example, most hyperplasias arise in the ______ zone, whereas most carcinomas originate in the ______ zone.

transitional

peripheral

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The prostate is devoid of a distinct capsule
1. Peripheral zone – makes up the _____ of the gland (approx ____%)

Central zone – surrounds the ____________ (approx ____%)
Transitional zone – surrounds the ___________________ and comprises about ___% of the glandular tissue
Anterior fibromuscular stroma – contains ____________ and lies (anteriorly or posteriorly?)

bulk; 70

ejaculatory ducts ;20

proximal prostatic urethra; 5%

no glandular tissue ;anteriorly

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Normal prosate

It is composed of (simple or complex?) ____________ in a ____________ ————-

The glands are lined by inner ____________ epithelium and an outer ____________ epithelium.

complex; branching glands

fibromuscular stroma.

tall columnar epithelium

cuboidal epithelium.

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Normal prostate

Prostatic secretion is normally ___________ (important because adenoca secretes ___________) and contains ___________ enzymes that aid in ___________ of the ejaculate to release the sperm deposited in the upper vagina during intercourse.

neutral mucin ;acidic mucin

proteolytic ; liquefaction

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The prostate consists of about ____ glands with (single or multiple?) ducts, which empty into the __________ (on both sides of the __________ in the __________ urethra)

30 glands ; single

prostatic urethra ; Colliculus

prostatic urethra

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The prostatic fluid is (thin or thick?) , and forms about ____% of semen volume.

It contains ________ (for the ______ of sperms), _____ (affects _____ metabolism of the prostate), ______ (act as _____), immunoglobulins, ________ and ________

thin; 20%

spermine ;motility

zinc ;testosterone

citric acid ;buffer

phosphatases ; proteases

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The common pathologic lesions of the prostate include in order of occurrence:

_________
_____________
________________

Benign prostatic hypertrophy
Carcinoma
Prostatitis

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Prostatic cancer - epidemiology

The adenocarcinoma of the prostate is the most common cancer in ______ males and accounts for ____% of cancer deaths in US

Its commoner above age ______ with incidence increasing from 20% in the fifties to 70% between ____yrs.

Nigerian ;10%

50; 70- 80yrs.

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Prostatic cancer - epidemiology

The highest rates are from US particularly among (whites or blacks?). It is less common in the ______ and ________

At the Ibadan cancer registry(1981-95), it represented ____% of cancer in both sexes

blacks

Chinese ; Japanese

4.7%

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Aetiology-risk factors Of prostate cancer

Age- Risk ____eases with age.

While only one in 10,000 men under age _____ will be diagnosed with prostate cancer, one in 15 men in their _____ will be diagnosed with the disease

increases

60s

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Aetiology-risk factors Of prostate cancer

Race-rates among (whites or blacks?) is almost double those among (white or black?) males, less common in ____ & __________.

blacks ; white

Japanese & Chinese.

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Aetiology-risk factors Of prostate cancer

Geography -For men in the U.S., the risk of developing prostate cancer is ___%. For men who live in rural China, it’s ___%.

However, when Chinese men move to the _____ culture, their risk _____eases substantially.

17%.

2%.

western culture

Increases.

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Aetiology-risk factors Of prostate cancer

Family history/Genetics: father, brother or son who has had prostate cancer is ___________ times more likely to develop prostate cancer.

______ mutation of the ________ gene _____ is associated with ____ fold increased risk of prostate cancer

2 to 3 times

Germline; tumour suppressor gene

BRCA2 ; 20

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Aetiology-risk factors Of prostate cancer

diets:
____ease fat consumption
__________(in tomatoes), vit A, D, E, selenium & soy products may _______/______ or _________ prostatic cancer

Obesity- obese patients are more likely to have ________ disease

Lack of exercise and sedentary life style

Incr ; Lycopenes

inhibit/prevent or delay prostatic cancer

aggressive

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Role of Androgen receptors

Androgens play a ________ role (androgen is necessary for ________ of prostatic ________) as no ____ease levels of testosterone have been found.

permissive role

maintenance ; epithelium

increase

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Role of Androgen receptors

Evidences include

Is not known in ________ that were ______ before _______ and incidence is low in _________ due to liver cirrhosis

Tumour regresses with ___________

Neoplastic epithelial cells have _______ receptors

eunuchs ;castrated ; puberty

hyperoestrogenism

orchidectomy

androgen receptors

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There is demonstrable correlation of prostatic cancer with venereal disease, sexual habits, smoking or occupational exposure

T/F

There is no demonstrable correlation with venereal disease, sexual habits, smoking or occupational exposure

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there is convincing evidence that people with BPH or those who have had transurethral resection have increased risk for development of prostate cancer

T/F

Although BPH can co-exist with cancer, there is no convincing evidence that people with BPH or those who have had transurethral resection have increased risk for development of prostate cancer

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BPH can co-exist with prostate cancer T/F

Pathologic features of prostate cancer Based on the presumptive site of origin and morphologic appearance, it can be divided into the following: ________ of _______ ducts and acini arises from the __________ zone. Other variants Carcinoma of _____ ducts arises from the ______ zone Primary ___________ carcinoma

Adenocarcinoma ; peripheral ducts peripheral zone. large ducts ;peri-urethral zone Transitional cell carcinoma

_____ of ________ is the most common cancer of the prostate

Adenocarcinoma of peripheral ducts

peri-urethral zone is also site for BPH T/F

Other histology types of prostate cancer Carcinoma with _________ _________ carcinoma _________ carcinoma _________ carcinoma _________ cell tumour _________ carcinoma

Carcinoma with endocrine features Signet ring carcinoma Adenosquamous carcinoma Squamous cell carcinoma Adenoid basal cell tumour Basaloid carcinoma

Other histologic types of prostate cancer Large duct carcinoma These are (more or less?) common and are located in the ________ location Macro Seen as _________ or________ tumour on cystoscopy Microscopically It presents at a (more or less?? advance stage and has a (lower or higher?) short time survival rate. It is characterized by _________ change in the _________ ducts PSA, PAP are positive

less ; peri-urethral location polypoid villous ; infiltrative urethral More; higher; malignant Large dilated

•Primary transitional cell adenocarcinoma - ___% of cases of prostatic cancer. -Arises from the ——— portion of the prostatic ————- ducts which are lined by ————- epithelium. •Mixed adenocarcinoma-transitional cell carcinoma

-2% outer ; peri-urethral ducts transitional epithelium.

Primary transitional cell adenocarcinoma Microscopy resemble ________ of the bladder. Must exclude _________ of ________ of the bladder

TCC prostatic extension of TCC

Carcinoma with endocrine features-(poor or good?) prognosis Mucin secreting adenoca- ___ metastasis rare, lack _____ dependence and is radio(sensitive or resistance?) Signet ring adenoca- highly (benign or malignant?) Adenosquamous ca- occur ______, or after ______ or ________therapy.

Poor bone metastasis; hormone resistance; malignant de-novo hormonal or radiotherapy.

Squamous cell ca- (common or rare?) ,occur _______ or after ______ treatment Adenoid basal cell tumour- resemble ___________ ca of ___________ gland Basaloid ca- highly (indolent or aggressive?) Lymphoepithelioma-like adenoca-like that of ___________

-rare; de-novo oestrogen treatment adenoidcystic ca ; salivary gland aggressive; nasopharynx

Adenocarcinoma of peripheral ducts Most of this arise from the ______ zone May appear as _____ or ______ (well or poorly?) defined (loose or firm?) area

peripheral zone gray or yellowish poorly; firm area

Morphology of prostate cancer In approximately 70% of cases, carcinoma of the prostate arises in the ________ zone of the gland, classically in a (anterior or posterior?) location, where it may be palpable on ______ examination

peripheral ; posterior rectal examination

Morphology of prostate cancer Characteristically, on cross-section of the prostate the neoplastic tissue is _____ and _____, but when embedded within the prostatic substance it may be extremely difficult to _____ and be more readily apparent on _____.

gritty and firm visualize; palpation.

Cytologic features of adenocarcinoma include (enlarged or shrunken?), (flat or round?) , _____chromatic nuclei that have single prominent nucleolus. ___________ suggest carcinoma.

enlarged round; hyper Mitotic figures

Histologic characteristics of prostate cancer Architectural disturbance Prostatic adenocarcinomas are composed of (small or large ?) glands that lie ________, with ______ intervening stroma or are _____________ distributed Stroma Malignant glands have ______ stroma between them

small glands back-to-back little or no ; haphazardly little or no stroma

Histologic characteristics of prostate cancer Gland pattern The glands in well differentiated adenocarcinomas are ___________ sized Poorly differentiated tumours _________ glands, rather are seen in ______,_______ or ________ pattern Moderately differentiated glands are _________

Gland pattern small or medium sized do not form glands sheets, solid or trabecular pattern inbetween

Histologic characteristics of prostrate cancer Tumour cell The ____________ layer cells are lost. The tumour cells may be (light or dark?) , (clear or turbid?) or _____philic with prominent nucleoli. Anaplasia and nuclear atypia are generally (mild or severe ?) Invasion; is the most important diagnostic feature of malignancy. There may be __________ or __________ invasion

outer basal dark, clear or eosinophilic mild lymphovascular or perineural invasion

Microscopy of prostrate cancer The tumour cells can form various patterns: 1. Medium sized glands- _____ packed glands with (regular or irregular?) outline, with ________ intervening stroma 2. Small glands- appear as _______ on low power, the individual glands having (round o flat?) (regular or irregular ?) outline and small size 3. Cribriform pattern-the tumour cells form ______ glands 4. Diffuse cell infiltration- resembles ______ cancer of the _______ with files of (benign or malignant?) cells infiltrating the stroma

closely packed ; irregular little ; expansive nodules round; regular fused glands; lobular breast ; malignant

Microscopy The well differentiated tumour is composed of _______________ sized glands. Poorly differentiated carcinomas have _____ glands (______ glands), as well as ________ or ________ of tumor cells, and many tumors have two or more of these patterns.

medium and small fused; cribriform solid nests or sheets

Clinical course of prostate cancer Localized prostate cancer is (asymptomatic or symptomatic?) , and is usually discovered by the detection of a ______________ on ________ examination or elevated ______________ level. Most prostatic cancers arise ______________ away from the urethra, and therefore urinary symptoms occur (early or late?). Patients with clinically advanced prostatic cancer may present with _________ symptoms, such as difficulty in ______________________, dysuria, ______________ or —————-.

asymptomatic ; suspicious nodule rectal ; serum PSA level. peripherally ; late. urinary ; starting or stopping the stream frequency, or hematuria.

Clinical course : Prostate cancer Today it is uncommon for patients to come to attention because of ______ pain caused by ______ metastases. The finding of _________ metastases by ________ surveys or the much more sensitive ___________ scanning is virtually diagnostic of this form of cancer in men.

back pain ; vertebral metastases. osteoblastic ; skeletal surveys radionuclide bone

Diagnosis of Prostate cancer The triad of ____________, ____________& serum ____________ serve a good diagnostic tool for early detection Transurethral ultrasound-appear as ____________ lesion PSA -prostate cancer produces ___ (more or less?)

digital rectal exam, transrectal ultrasound & serum PSA hypoechoeic 10x more

Diagnosis of Prostate cancer It is sometimes difficult to distinguish clinically from nodular ________, granulomatous ________, ____, infarct

hyperplasia granulomatous prostatitis TB

Diagnosis of Prostate cancer The PSA is normally less than ___ μg/L. A mildly increased PSA (____ to _____ μg/L) in a patient with a very large prostate can be due to ___________, or to ________, rather than carcinoma. A rising PSA (more than _____ μg/L per year) is suspicious for _______, even if the PSA is _______________________________

4 μg/L. 4 to 10 μg/L nodular hyperplasia; prostatitis carcinoma.; 0.75 μg/L prostatic carcinoma the normal range.

Diagnosis of Prostate cancer Transrectal core needle biopsy, often guided by ________, is useful to confirm the diagnosis Incidental carcinomas can be found in ______ resections for ________ _______ section is equally effective Transrectal FNAC is also effective in detecting ________. Overall accuracy in a study was ______% _______ examination of ______ is not useful ______ section and _______ of ______ are also useful to detect metastasis

ultrasound transurethral resections ; nodular hyperplasia. Frozen section; prostatic cancer 85.6%; Cytologic prostatic fluid; Frozen section touch imprints ; lymph nodes

Diagnosis of Prostate cancer ________________ biopsy ________ carcinomas _______ section _________ ———- ________ and __________ are also useful to detect metastasis

Transrectal core needle biopsy Incidental carcinomas Frozen section Transrectal FNAC Frozen section and touch imprints of lymph nodes

Spread and metastasis of prostate cancer Spread occurs by ________,_________, and __________ Extension into the seminal vesicles, prostatic urethra & bladder in __________ tumour. __________ invasion is less common Common metastatic sites are- __________& __________

local invasion, blood stream and lymph advanced tumour; Rectal invasion skeletal system & lymph nodes.

Spread and metastasis of prostate cancer Common metastatic sites are- skeletal system & lymph nodes. bone metastasis is ________ (resembles ________ or ________ on X-ray) Bone metastasis may precede ________ symptoms Lumbar, sacrum & pelvis are common sites through the ________ system ________ involvement leads to spinal cord ________

osteoblastic osteosarcoma or Paget’s disease urologic symptoms vertebral venous system Epidural ; compression

Lymph node metastasis of prostate cancer Most common route is the ______ chain of lymph nodes, leading to ______peritoneal ____________ lymph node may also be involved _______ or ________ lymph node involvement can be a first sign of the disease in poorly differentiated tumours _____ metastasis may occur Massive ____________ can occur

pelvic ; retroperitoneal Supradiaphragmatic Supraclavicular or mediastinal lymph node Lung ;Massive pleural effusion

Prostate Metastatic cancer can be found in ________ specimen rarely

orchidectomy

Prostate Metastatic cancer Can also spread to breast, often ___lateral particularly in patients ________ and may be confused with ___________ Other sites are liver, adrenal gland, CNS, eye, skin, penis, salivary glands

bi; taking oestrogen gynaecomastia

Staging and Grading of prostate cancer CAP can be divided into Clinical- cancers that produce ___________, and diagnosis made by ______examination, biopsy and histology latent- CaP found _________ as a (small or large?) focus in the prostate during autopsy studies in men dying of other causes. Incidental: __________ done for ______ reveal incidental carcinoma of the prostate Occult- patient presents with evidence of ________ in clinically ______________tumour

clinical symptoms ; rectal examination unexpectedly ; small prostatectomies; BPH metastatic disease undetected primary tumour

TNM staging of Prostate cancer It takes into account cases with abnormal ______ and findings of __________________

PSA and findings of DRE (Digital Rectal Examination)

TNM staging of prostate cancer T1 – Cancer is (absent or present?), but ______________________ T1a – Found ———-, _____________ of sample is malignant and (low or high?) -grade. T1b – Found _______ , __________ of sample malignant and/or not (low or high?) -grade. T1c – PSA is _______, (palpable or not palpable?) , found in ________.

Present not detectable in DRE or on imaging. incidentally ; Less than 5 percent ; low incidentally; More than 5 percent ; low elevated; not palpable needle biopsy.

TNM staging of prostate cancer T2 – Tumor is palpable in _______ ; organ confined. T2a – Confined to _________________ of the prostate’s two lobes. T2b – Confined to _______________ gland but ________ T2c – The tumor is _________ but ______

DRE half or less than half in one more than one half of one lobe of ; not both. in both lobes ; within the prostatic capsule.

TNM staging of prostate cancer T3 – ________ ———— cancer. T3a – Penetration of ————- on one or both sides. T3b – Invasion into the ___________.

Locally extensive cancer. prostate capsule seminal vesicle.

TNM staging of prostate cancer T4 – Tumor _______ to _______ T4a – Cancer that has invaded the _______ and/or _____ and/or _________ T4b – Cancer that involves other areas ___________

extension to other organs. bladder neck and/or rectum and/or external urinary sphincter. near the prostate.

TNM staging of prostate cancer N – Lymph node involvement. NO – _____ cancer detected in the lymph nodes. N1 – Cancer spread to _______ lymph nodes measuring (more or less?) than _____. N2 – Cancer spread to ______ lymph nodes measuring _______ N3 – Cancer spread to ______ lymph nodes measuring (more or less?) than ______ .

No one or more ; less than 2cm. one or more ;2-5cm. one or more ; more than 5cm.

TNM staging of prostate cancer M – Metastasis to distant sites other than lymph nodes (cancer spread). MO – Cancer that is _________________________________________________ M1 – Cancer that _________________________________________________

confined to the prostate, surrounding tissues and pelvic lymph nodes. has spread beyond the pelvic area to bones, lungs, etc

Gleason’s microscopic grading Based on degree of glandular architectural pattern formed by tumour cells: 1-(Single or multiple ?) (separate or fused?) (uniform or variable?) (closely or loosely?) packed glands 2- -(Single or multiple ?) (separate or fused?) (more or less?) uniform glands, (closely or loosely?) packed glands with ______ intervening stroma 3 -( Single or multiple ?) (separate or fused?) , much (more or less?) variable glands, (small or large?) glands or tiny cell clusters, sometimes seen in between normal glands 4- (Separate or Fused?) glandular infiltrating tumour forming _______ pattern, ______ outlined 5-(rounded or flattened?) masses of circumscribed solid tumour, _____ masses of ______ tumour

Single ; separate ; uniform ; closely Single; separate; less; loosely ; little intervening stroma Single; separate ; more ; small Fused ; cribriform ; raggedly rounded ; ragged ; anaplastic tumour

The prognosis of prostatic adenocarcinoma varies widely with ________ and __________. The grade and the stage correlate well with each other and with the prognosis. The poorly differentiated grade 5 carries _____ prognosis while the well differentiated lower grades carry _____ prognosis

tumor stage and grade poor better

Treatment of prostatic cancer Expectant management (watchful waiting) or ________ for well differentiated tumours. Surgery. ________ therapy. ____therapy __________ therapy _______therapy.

active surveillance Radiation therapy. Cryotherapy Hormone therapy Chemotherapy.

Benign Enlargement Benign _______________ BPH BPH is an extremely (common or rare?) disorder in men over age ____.

Benign Prostatic Hyperplasia BPH common 50.

Benign Enlargement It is characterized by ________ of prostatic _______ and _______ cells, resulting in the formation of (small or large?), fairly _______ nodules in the _______ region of the prostate.

hyperplasia stromal and epithelial cells large; discrete periurethral region

BPH When sufficiently large, the nodules ________ and ________ the urethral canal to cause partial, or sometimes virtually complete, ____________________

compress and narrow obstruction of the urethra.

Incidence of BPH Histologic evidence of BPH can be seen in approximately 20% of men ____ years of age, a figure that increases to 70% by age ____ and to 90% by age ___.

40 60 80

Classification of BPH Microscopic BPH Histologic diagnosis of usual _______ or ________ hyperplasia Macroscopic BPH Describes an _______ prostate which can be detected by ___________ or by radiologic means usually _____________ Clinical BPH Is a diagnosis based on ________ symptoms and _______ dysfunction.

glandular or stromal enlarged; digital rectal examination (DRE) transrectal ultrasonography (TRUS) urinary tract symptoms ; bladder dysfunction.

Classification of BPH ________ BPH ________ BPH ________ BPH

Microscopic BPH Macroscopic BPH Clinical BPH

Clinical diagnosis of BPH is often made by a combination of assessments for _________ and ______ BPH, which includes evaluation of _______ and ________

macroscopic and clinical prostate size and urinary symptoms

Aetiology and pathogenesis Of BPH Despite the fact that there is ____eased number of epithelial cells and stromal components in the ______ area of the prostate, there is no clear evidence of ____________________________ in human BPH. It is believed that the main component of the “hyperplastic” process is ________________. It has been proposed that there is an overall _________________, resulting in the accumulation of ________ in the prostate.

increased ; periurethral area increased epithelial cell proliferation in impaired cell death reduction of the rate of cell death senescent cells

Aetiology and pathogenesis Of BPH _______, which are required for the development of BPH, can not only increase ____________, but also ________

Androgens cellular proliferation inhibit cell death.

Aetiology and pathogenesis Of BPH The main androgen in the prostate, constituting 90% of total prostatic androgens, is __________ It is formed in the prostate from the conversion of _______ by the enzyme type ___, _______ This enzyme is located almost entirely in _______ cells; _______ cells of the prostate do not contain ___________, with the exception of a few _______ cells.

dihydrotestosterone (DHT). testosterone ; type 2, 5α- reductase. stromal cells; epithelial type 2 5α reductase basal cells.

Aetiology and pathogenesis Of BPH DHT binds to the (nuclear or cytoplasmic?) ____ receptor (AR) present in _______________________ prostate cells. DHT is (more or less?) potent than testosterone because it has a (lower or higher?) affinity for AR and forms a (more or less?) stable complex with the receptor. Binding of DHT to AR activates the _______ of __________ genes.

Nuclear ; androgen both stromal and epithelial prostate cells. more; higher ; more transcription of androgen-dependent genes.

Thus ______ cells of the prostrate are responsible for androgen- dependent prostatic growth.

Stromal

Aetiology and pathogenesis of BPH DHT-mediated transcription of genes results in the ____eased production of several growth factors and their receptors eg the ___________ (FGF) family, and particularly FGF-__ (_________________; ).

incr fibroblast growth factor 7 keratinocyte growth factor

Aetiology and pathogenesis Of BPH FGF-7, produced by ______ cells, is probably the most important factor mediating the _______ regulation of ______- stimulated prostatic ______. Other growth factors produced in BPH are ______ and ______ , and _______, which promote ______ proliferation.

stromal ; paracrine androgen FGFs 1 and 2, ; TGFβ fibroblast proliferation.

Although the ultimate cause of BPH is _________, it is believed that DHT-induced growth factors act by increasing the _____________ cells and decreasing the _____________ cells.

unknown proliferation of stromal cells and decreasing the death of epithelial cells.

BPH morphology The prostate weighs between ___________ gm. Nodular hyperplasia of the prostate originates almost exclusively in the (inner or outer?) aspect of the prostate gland (______ zone). The early nodules are composed almost entirely of ______ cells, and later predominantly ____________ arise. The nodular enlargements may encroach on the ______ walls of the ______ to compress it to a _________ orifice.

60 and 100 gm inner ;transition stromal cells; epithelial nodules lateral walls ; urethra a slit-like orifice.

BPH morphology On cross-section, the nodules vary in _____ and ________ . In nodules that contain mostly glands, the tissue is ________ with a (soft or tough?) consistency, and a ________ prostatic fluid oozes out of these areas. In nodules composed primarily of fibromuscular stroma, each nodule is ________, is (soft or tough?), does not _______, and is (more or less?) clearly demarcated from the surrounding uninvolved prostatic tissue.

color and consistency. yellow-pink ;soft ; milky-white pale gray; tough ; exude fluid less

BPH Although the nodules do not have ________, the compressed surrounding prostatic tissue creates a plane of ______ about them.

true capsules cleavage

Microscopically, the hallmark of BPH is _______

nodularity

Microscopy of BPH The composition of the nodules ranges from purely __________________nodules to ____________ nodules with a _______ predominance. Glandular proliferation takes the form of _________ of ______,_______ to _____ dilated glands, lined by ____ layers, an inner ______ and an outer ______ or ______ epithelium.

stromal fibromuscular ; fibroepithelial glandular aggregations small, large to cystically dilated glands two ;columnar ; cuboidal or flattened epithelium.

Clinical features of BPH The smooth muscle-mediated (contraction or relaxation?) of the prostate causes urethral ________. The increased resistance to _________ leads to bladder ______ and ______, accompanied by urine ________. The inability to empty the bladder completely creates a ______________ that is a common source of infection.

contraction ;urethral obstruction. urinary outflow ; hypertrophy and distension urine retention reservoir of residual urine

Clinical features Of BPH Patients experience increased urinary _______, nocturia, difficulty in ___________ of urine, ____________ , dysuria (_____ micturition), ______uria and they also have an increased risk of developing __________ of the bladder and kidney. In many cases, sudden, acute urinary retention appears for unknown reasons that requires _____________

frequency starting and stopping the stream overflow dribbling ; painful haematuria ;bacterial infections emergency catheterization.

Complications of BPH Bladder muscle ________, _____, ________ formation ___________ __________ UTI ______,_____ ______ retention

Bladder muscle hypertrophy, trabeculation, diverticulum formation Hydroureters Hydronephrosis Azotaemia, uraemia Acute retention

Management of BPH Mild cases of BPH may be treated without medical or surgical therapy, such as by ___________, especially before bedtime; moderating the intake of _______ and ______ containing products. The most commonly used and effective medical therapy for symptoms relating to BPH are _________, which decrease prostate ____________________ via inhibition of ____________________ receptors

decreasing fluid intake alcohol and caffeine α-blockers smooth muscle tone α1-adrenergic receptors

Medical treatment of BPH Another common pharmacologic therapy aims to decrease symptoms by ___________ the prostate with an agents that __________________ of _____, inhibitors of _____________________ enzyme.

physically shrinking inhibit the synthesis of DHT Type 2 5-α- reductase

Surgical treatment Of BPH For moderate to severe cases recalcitrant to medical therapy, ____________ of the prostate (TURP) has been the gold standard in terms of reducing symptoms, improving flow rates, and decreasing post- voiding residual urine. It is indicated as a first line of therapy in certain circumstances, such as _____________________

transurethral resection of the prostate (TURP) recurrent urinary retention.

Alternative procedures of BPH include (low or high?)-intensity focused ———, _____ therapy, _____thermia, transurethral ____________, and transurethral ________ using radiofrequency.

High ultrasound; laser; hyper electrovaporization; needle ablation

Nodular hyperplasia is considered to be a premalignant lesion. T/F

F Nodular hyperplasia is not considered to be a premalignant lesion.