prostate

Question 1

4 zones of the prostate

Answer 1

TZ = transitional zone
CZ = central zone
PZ = peripheral zone
anterior fibromuscular stroma

Question 2

TZ

Answer 2

transitional zone surrounds the urethra and is the part of the prostate predominantly affected by nodular hyperplasia
only 20% of prostate carcinomas occur here

Question 3

PZ

Answer 3

peripheral zone is the zone that is palpable on rectal examination
75% of prostate carcinomas occur here

Question 4

3 common conditions affecting the prostate gland

Answer 4

• nodular hyperplasia (benign prostatic hyperplasia BPH)
• neoplasms of the ports tae
  inflammatory conditions (prostates, (acute, chronic, bacterial, bacterial, granulomatous))

Question 5

nodular hyperplasia

Answer 5

benign prostatic hyperplasia BPH
common after age 50
uncommon before 40
seen in most older males but only clinically significant in some

Question 6

cause of nodular hyperplasia

Answer 6

unknown

theory - imbalance of oestrogen/testosterone/dihydrotestosterone

Question 7

nodular hyperplasia affects

Answer 7

TZ

compresses the urethra causing difficulty passing and storing urine

Question 8

symptoms of nodular hyperplasia

Answer 8

frequency, nocturne, urgency and incontinence

slow and weak stream, difficulty initiating and stopping flow, dribbling

Question 9

histology of nodular hyperplasia

Answer 9

proliferation of epithelial cells of the glands and ducts

proliferation of the smooth muscle cells and fibroblasts within the stroma

Question 10

complications of nodular hyperplasia

Answer 10

chronic obstruction - hypertrophy of the bladder, urinary stasis, recurrent urinary tract infections
backpressure if obstruction is prolonged causing hydrometer, hydronephrosis, renal failure and death

Question 11

prostatic adenocarcinoma

Answer 11

all other tumours of the prostate are rare (TCC, SCC, sarcomas, lymphoma)

Question 12

risk factors for prostate cancer

Answer 12

• increasing age
• ethnicity - rare in asian males, common in African males,
• family history
• genetic factors - BRCA1 and 2, Lynch syndrome
• dietary factors - obesity, diet high in fat

Question 13

diagnosis of prostate cancer

Answer 13

most men with early age prostate cancer have no symptoms
- urinary frequency, urgency, nocturne and hesitancy - difficult to seperate from symptoms of nodular hyperplasia
haematuria/haematospermia
- bone pain - when carcinoma metastasises
usually diagnosis is made after biopsy for elevated PSA (marker in the blood)

Question 14

PSA

Answer 14

marker in the blood
protein made only in the prostate
produced by secretory cells of the prostate glands, and also by prostate ca cells

Question 15

PSA rises with

Answer 15

rises with age - should be compared to the norm of that age group

Question 16

PSA in cancer

Answer 16

production is increased and tissue barriers between prostate glands and capillaries are dirupted, releasing more into the blood stream

Question 17

causes of elevated PSA

Answer 17

• nodular hyperplasia
• prostate carcinoma
• prostates
• perineal trauma (cyclists)

Question 18

approach to PSA screening

Answer 18

some organisations are agianst PSA screening due to high rate of false positives
some organisations recommend a discussion with a health care provider before PSA test

Question 19

acinar adenocercinaom

Answer 19

glandular
most common type
small crowded glands with no basal cell layer
clear with large nuclei and prominent nucleoli

Question 20

Gleason score

Answer 20

given number 3, 4, or 5 based on the pattern

Gleason score = sum of the most predominant pattern + worst pattern in core biopsy

Question 21

other things in the pathology report of prostate cancer

Answer 21

• type
• size
• grade - Gleason score
• Stage (TNM)
• extraprostatic extension, lymph node status, distant metastases
  perineurial invasion
  margins

Question 22

treatment options for prostate cancer

Answer 22

• active surveillance
• surgery
• radiation
• hormone
• chemotherapy

Question 23

treatment go localised prostate cancer

Answer 23

• active surveillance - for small volume, lower grade tumours eg. Gleason score of 6 (men who are older or have other illnesses
• surgery, radial prostatectomy
• radiation therapy

Question 24

treatment of locally advances prostate cancer

Answer 24

radiation therapy combined with hormone therapy

surgery (radial prostatectomy) and radiation therapy

Question 25

treatment of metastatic prostate cancer

Answer 25

hormone therapy combined with chemotherapy

radiation therapy to bone metastasis

Question 26

nodular hyperplasia is most commonly located in

Answer 26

the transition zone where it compresses the urethra

Question 27

prostate cancer most commonly located in the

Answer 27

peripheral zone - palpable on rectal exam but few symptoms