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MRCS B pathology > Pathology: prostate > Flashcards

Pathology: prostate Flashcards

1
Q

What are the risk factors for BPH?

A

Fhx
Obesity
Advancing age
T2 DM

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2
Q

In which part of the prostate is BPH most common?

A

Median lobe
Transitional zone

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3
Q

What non interventional tx are available to treat BPH?

A

Conservative
Bladder training, no drinks before bed

Medical
Selective alpha 1 blockers (tamsulosin, alfulosin)
5 alpha reductase inhibitors: prevent conversion of testosterone to dihydrotestosterone

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4
Q

What medications should be avoided in patients with BPH

A

avoid calcium channel blockers (relaxes bladder, worsens symptoms)
avoid pseudephidrine (nasal decongestant)

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5
Q

What interventional options are available for BPH?

A

Trans-urethral needle ablation
High intensity US
Embolisation
TURP

Gold standard: above 80g increases risk of TURP syndrome–> open prostatectomy

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6
Q

What irrigating fluids are used for TURP?

A

Osmotically active solutes: sorbitol, glycine, mannitol
Saline can be used with bipolar diathermy

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7
Q

What type of diathermy should be used with each irrigating fluid?

A

GLycine: monopolar
Saline: bipolar

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8
Q

What are the signs and symptoms of TURP syndrome?

A

Dilutional hyponatraemia
–> seizure
–> confusion
–> cerebral oedema

Hypotension
Bradycardia

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9
Q

How can TURP syndrome be avoided?

A

Reduce operating time <60 mins
Finasteride pre-op to reduce bleeding
Giving set low down to avoid increased fluid pressure
Reduce intraoperative bleeding
Reduce hypo/hypertension

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10
Q

What features would be concerning on prostatic DRE?

A

Irregular firm nodules
Loss of median sulcus
Induration
Craggy prostate

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11
Q

What type of cancer is most common in prostate?

A

Adenocarcinoma (95%)
Small cell
TCC

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12
Q

In which part of prostate is cancer most common?

A

Posteiror lobe
peripheral zone

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13
Q

Name some risk factors for prostate ca

A

Fhx
Advancing age
High fat diet

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14
Q

What genes are associated with prostate ca?

A

Brca 1, brca 2, homeobox 33

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15
Q

What investigations would you consider for suspected prostate ca?

A

DRE
PSA
MRI
US guided biopsy: trans rectal/transperineal

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16
Q

What is a normal PSA level in an adult?

A

40-49 <2.5ng/ml
50-59: <3.5
60-69: <4.5
>70: <6.5

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17
Q

What is the gleason score?

A

6-12 biopsies taken
Grade 1-5: most common cell type added to next most common cell type. If there are 3 patterns, the most common is added to the most aggressive.
Total score: 10 most aggressive and most likely to spread

18
Q

Name options to treat prostate ca

A
  1. Watchful waiting
  2. Active surveillance
  3. Surgery–> radical prostatectomy
  4. Radiotherapy/chemo for mets
  5. Hormone therapy
19
Q

What does active surveillance entail?

A

PSA every 3-4 months for 1 year, then rectal exam + MRI
2nd year: PSA every 6 mths, annual rectal exam

20
Q

What is brachytherapy and what are the indications in prostate ca?

A

Insertion of radiation seeds into prostate, slowly emitting radiation

Indication:
–PSA +++, pt not suitable for surg
–High gleason score

21
Q

Name some hormonal approaches to treat prostate ca

A

GNRH agonist (suppresses axis) (goserelin)
Antiandrogens (flutamide)
Orchidectomy

22
Q

LUTS differentials

A

Bladder outlet obstruction
-Prostate ca
-BPH
-Urethral stricture

Bladder dysfunction
-Bladder oversensitivity/overactivity
-Detrusor overactivity

23
Q

What is bladder outlet obstruction?

A

Urodynamic condition implying high pressure low flow rate

24
Q

What is PSA?

A

Prostate specific antigen
Glycoprotein released from prostate to liquefy semen allowing sperm to move freely and dissolves cervical mucous
Elevated in certain prostatic conditions

25
Q

Approach to ++ PSA

A

Repeat
Us guided biopsy
MRI +/- isotope bone scan/spine radiograph
Urology MDT

26
Q

What is the difference between grading and staging?

A

Stage: how far tumour has spread
Grade: level of cell differentiation. Higher grade indicates faster growing ca

27
Q

How frequently should PSA be checked after radical prostatectomy?

A

after 6 weeks
Then every 6 months for first 2 years
Annual thereafter

28
Q

Complications turp

A

UTI, bleeding
Sexual dysfuncion
retrograde ejaculation
urethral strciture
Turp syndrome

29
Q

What is the cause of prostate enlargement in BPH?

A

Androgens

30
Q

What investigations would you do for BPH>

A

-PSA
-MSU analysis
-U + E

31
Q

Why do you take multiple prostate biopsies?

A

-Prostate cancer can be focal, so important to take samples from different sites
-There is often only scant amount of tissue available for histologic examinations in needle biopsies
-Malignant glands may be mixed with numerous benign glands
-histological findings pointing to malignancy can be subtle, leading to underdiagnosis

32
Q

How would you differentiate between rectum and prostate cells in a needle biopsy?

A

-Using immunohistochemical marker (alpha-methylacyl-coenzyme A-racemase) (AMACR)
-CEA ( in rectal cells)

33
Q

What are the gene mutations involved in the pathogenesis of prostate cancer?

A

-mutations or deletions that activate the PI3K/AKT pathway

34
Q

How can you judge the success of a radical prostatectomy?

A

-Fall in level of PSA below detectable levels within 4-6 weeks
-High PSA after prostatectomy–> consider recurrence

35
Q

Why is PSA not reliable?

A

-PSA is organ specific, not cancer specific
-Although serum levels of PSA are elevated to a lesser extent in BPH than prostate Ca there is considerable overlap
-Other factors e.g. prostatitis, instrumentation of the prostate and ejaculation elevate PSA

36
Q

What test could be used to exclude bony metastasis?

A

ALP

37
Q

What type of bony metastasis occurs in prostate cancer? And why?

A

Sclerotic

Due to increased bone deposition due to increased osteoblastic activity

38
Q

What are the types of bone metastases?

A

Characterised based on radiographic and/or pathologic appearance of the lesions as:
–> lytic
–> sclerotic
–> mixed

39
Q

What is the rational in treating prostate cancer by bilateral orchidectomy?

A

-Androgen deprivation
-The growth and survival of prostate cancer cells depends on androgens, which bind to the androgen receptor (AR) and induce the expression of pro-growth and pro-survival genes

40
Q

What cells produce testosterone?

A

Leydig cells

41
Q

What are the lobes of the prostate?

A

-Anterior lobe
-Median love
-Posterior lobe
-Lateral lobes

MRCS B pathology (14 decks)

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