Pathology of the Prostate Gland Flashcards
1
Q
What is the prostate?
A
- small, round organ that lies at the base of the bladder encircling the urethra.
- sits anterior to the rectum; posterior aspect of prostate is palpable by digital rectal exam (DRE).
2
Q
What does the prostate consist of?
A
- glands= composed of an inner layer of luminal cells and an outer layer of basal cells.
- stroma= connective tissue, maintained by androgens (glands are also maintained by androgens).
3
Q
What do the glands of the prostate secrete?
A
- alkaline, milky fluid that is added to sperm and seminal vesicle fluid to make semen.
4
Q
*** What is ACUTE prostatitis?
A
- acute inflammation of the prostate usually due to bacteria
- Chlamydia trachomatis and Neisseria gonorrhoeae are common causes in YOUNG adults.
- Escherichia coli and Pseudomonas are common causes in OLDER adults.
5
Q
*** How do patients with ACUTE prostatitis present?
A
- pain on urination (dysuria) with fever and chills.
- prostate is TENDER and BOGGY on rectal exam.
- prostatic secretions show WBCs and culture reveals bacteria.
6
Q
*** How does CHRONIC prostatitis it differ from acute prostatitis?
A
- chronic inflammation of the prostate that presents as dysuria with pelvic or low back pain. More vague.
- prostatic secretions show WBCs, but cultures are NEGATIVE.
7
Q
*** What is Benign Prostatic Hyperplasia (BPH)?
A
- age-related (usually by age 60) hyperplasia of prostatic stroma and glands; specifically in the PERIURETHRAL ZONE. Driven by androgens.
- NO increased risk for cancer :)
8
Q
** How is BPH related to DHT?
A
- testosterone is converted to DHT by 5 alpha-reductase in stromal cells. This DHT then acts on the androgen receptor of STROMAL cells (increasing proliferation) and EPITHELIAL cells (decreasing death), resulting in hyperplastic nodules.
- FGF-7 is a growth factor involved.
9
Q
*** What are the clinical features of BPH?
A
- problems starting and stopping urine stream.
- impaired bladder emptying with increased risk for infection and hydronephrosis.
- dribbling
- hypertrophy of bladder wall smooth muscle; increased risk for bladder diverticula.
- microscopic hematuria
- prostate-specific antigen (PSA) is often slightly elevated (usually less than 10 ng/mL) due to the increaed number of glands; PSA is made by prostatic glands and liquefies semen.
10
Q
*** What is a normal PSA?
A
- 0-4 ng/mL
11
Q
What treatment options are available for BPH?
A
- alpha 1-antagonist (terazosin) to relax smooth muscle in bladder and blood vessels (helps with HTN).
- selective alpha 1A-antagonist (tamulosin) in normotensive individuals.
- 5 alpha-reductase inhibitor to block converstino of testosterone to DHT. Takes months to produce results, but also useful for male pattern baldness.
12
Q
What are the side effects of 5 alpha-reductase inhibitors?
A
- gynecomastia and sexual dysfunction.
13
Q
*** What is prostate adenocarcinoma?
A
- malignant proliferation of prostatic glands.
* has wide rang of clinical types from very aggressive to clinically insignificant.
14
Q
** What is the most common cancer in men?
A
- prostate adenocarcinoma
* 2nd most common cause of cancer-related death.
15
Q
*** What are the risk factors for prostate adenocarcinoma?
A
- age
- race (African Americans more than Caucasians, which are both more than Asians).
- diet high in saturated fats.
- BRCA2 gene
16
Q
*** Where do prostatic adenocarcinomas usually arise?
A
- in the PERIPHERAL, POSTERIOR region of the prostate and hence, does not produce urinary symptoms early on (aka clinically silent).
17
Q
When does screening begin for prostate adenocarcinoma?
A
- age 50 with DRE and PSA.
- PSA greater than 10 ng/mL is worrisome at any age.
- we can also look at decreased % of free-PSA, which is suggestive of cancer bc cancer makes bound-PSA.
18
Q
What is performed to confirm prostate adenocarcinoma if clinical suspicion is high?
A
- prostatic BIOPSY
19
Q
What will you see on biopsy of prostatic adenocarcinoma?
A
- small, invasive gland with prominent DARK NUCLEOLI.
20
Q
*** How do we grade prostate cancer?
A
- GLEASON GRADING system= based on ARCHITECTURE ALONE and NOT nuclear atypia.
- multiple regions of the tumor are assessed because architecture varies from area to area.
- 1-5 is assigned for two distinct areas and then added to produce a final score 2-10 (higher score= worse prognosis).
21
Q
*** Where does prostate adenocarcinoma like to spread?
A
- lumbar spine or pelvis= OSTEOBLASTIC metastases. This presents as low back pain and increased serum ALK PHOS, PSA, and prostatic acid phosphatase (PAP).
22
Q
How do we treat LOCAL prostate adenocarcinoma?
A
- prostatatectomy
- radiation
23
Q
How do we treat ADVANCED disease of prostate adenocarcinoma?
A
- continuous GnRH analogs (LEUPROLIDE), which causes negative feedback to shut down the anterior pituitary gonadotrophs (LH and FSH reduced).
- FLUTAMIDE= androgen receptor inhibitor
24
Q
What is GRANULOMATOUS prostatitis?
A
- granulomas present in inflamed prostate gland.
- usually occurs due to installation of BCG in the bladder for treatment of bladder cancer. No need to treat in this case.
- fungi can also cause this in immunocompromised.
25
What is a prostatic infarct?
- seen mostly in large prostates with nodular hyperplasia.
- may be caused from infection or indwelling catheters or trauma.
- grayish yellow semen and streaked with blood.
- coagulative necrosis
- most clinically silent, but may cause urinary retention due to edema.
26
Can calculi form in the prostate?
- YES and can cause blood clots or bacteria may be found in some stones.
- mainly phosphated salts, calcium carbonate, and calcium oxalate.
* may mimic carcinoma on palpation.
27
*** What is the most common epigenetic alteration in prostate cancer?
- hypermethylation of glutathionine S-transferase (GSTP1), causing it's down-regulation.
* GTSP1 prevents a wide range of carcinogens
28
*** What marker tends to be upregulated in prostate cancer?
- AMACR= involved in the beta-oxidation of branched chain amino acids
29
*** Is the outer basal layer seen in benign prostate glands ABSENT in malignant glands?
YES
| *perineural invasion is another marker of malignancy
30
What is prostatic intraepithelial neoplasia (PIN)?
- architecturally benign glands lined by cytologically atypical cells with prominent nucleoli.
- divided into low vs high grade based on nuclear and nucleolar changes.
- also found in peripheral zone.
31
How do we GRADE prostate cancer?
- stage T1= incidentally found
- stage T2= organ confined center
- stage T3= extra-prostatic extension
- stage T4= direct invasion of contiguous organs.
- N0/N1= presence or absence of node involvement
- M1= distant metastasis
32
*** What is important to remember about PSA?
- it is organ specific but NOT cancer specific.
