Prostate Flashcards
the two layers of epithelial cells in prostate glands
luminal secretory cells (PSA, PAP+); basal cells (HMCK+)
what is the prostate made of other than glands?
fibromuscular stroma
benign prostatic tissue will stain positive with?
HMW keratin (stains basal cells which are absent in malignancies)
in which zone do most carcinomas rise? Hyperplasias?
peripheral (posterolateral); transitional
this hormone is required for prostatic hyperplasia and carcinoma
DHT
testosterone is converted to DHT by?
5 alpha-reductase
types of prostate specimens
needle biopsies (dx), transurethral resections (tx obstruction), suprapubic prostatectomy (tx obstruction, leave peripheral zone), radical prostatectomy (tx carcinoma)
prostatitis is a (pathological/clinical) diagnosis
clinical (rarely biopsied)
granulomatous prostatitis mimics ____ and is due to?
cancer (by increasing PSA); ruptured ducts cause irritation and are walled off
complications of untreated BPH
hydroureter, hydronephrosis, renal failure
in BPH, glands are?
nodular and hyperplastic (and large with lots of white space)
BPH treatment
usually medical; can do cryo, RF ablation, TURPs
prostate cancer is highly prevalent, but most people?
die with it rather than of it
who has highest prostate cancer death rate in the world
African American men
precurser to prostate cancer
prostatic intraepithelial neoplasia (proliferation of malignant cells)
downsides to PSA screening for prostate cancer
lots of false positives
diagnosis of prostate cancer
usually needle core biopsies (TURP more often to tx BPH but may incidentally find cancer)
98% of prostate carcinomas are?
adenocarcinoma
microscopic appearance of adenocarcinoma of the prostate
small glands, more compact than normal, lack of basal cell layer, prominent nucleoli, PSA+
histologic grading of prostate cancer is?
Gleason score: sum of two most prevalent patterns graded 1-5
tx of prostate cancer
radical prostatectomy or radiation, pathology evaluates type, grade, and stage of cancer
common sites of prostate cancer mets
regional LNs, bone
common locations of bone mets
axial skeleton, ribs, pelvis
how do you recognize cancer on a fine needle aspirate?
cells stick together (according to Hadler)
purpose of prostate
secrete bacteriocidal fluid into semen to liquify it and activate sperm
receptors located in the prostate gland
alpha receptors in muscular strome; testosterone/androgen receptors
prostatitis is (common/rare) and presents when you are (young/old)
common; young
four glass test for diagnosis of prostatitis
VB1 and VB2 negative (no urethritis or cystitis), EPS and VB3 positive for WBC +/- bacteria (with and after prostatic massage)
etiology of acute bacterial prostatitis
gram negative rods (usually E coli, also proteus and pseudomonas)
clinical presentation of acute bacterial prostatitis
fever/chills, pain (pelvic and perineal), urinary sx (dysuria, frequency, retention)
physical exam findings of prostatitis
suprapubic tenderness; tender, enlarged, boggy prostate
diagnostic tests for suspected acute bacterial prostatitis
voided urine, don’t do prostate massage bc may cause seeding, consider CT scan to look for abscess
tx of acute bacterial prostatitis
IV or oral ABX, quinolones work well
if an abscess exists, how do you treat it?
surgical resection
diagnosis of chronic bacterial prostatitis
post-massage urine culture or EPS shows organ
tx of chronic bacterial prostatitis
quinolone or sulfa abx for 4-6 weeks! (long time)
the most common form of prostatitis is?
non-bacterial (pelvic pain syndrome)
clinical presentation of non-bacterial prostatitis
pain; voiding dysfunction; sexual dysfunction
diagnosis of non-bacterial prostatitis
rule out bladder or prostate infection with 4-glass test; check residual urine
tx of non-bacterial prostatitis
lifestyle changes, medicine (anti-inflamm, alpha-blockers, trial of ABX in case)
cause of BPH
glandular and stromal proliferation in response to DHT levels (embryological awakening)
treatment of BPH
alpha-blockers (relax muscle in stroma), 5 alpha-reductase inhibitors (block DHT formation and shrink prostate)
evaluation of patient presenting with LUTS
prostate exam; lab tests (urine, PSA); optional = flow rate, postvoid residual, questionnaires, urodynamics
what is the purpose of the urinalysis when evaluating LUTS?
rule out infection, DM, cancer
complications of LUTS from BPH
1/10 develops urinary retention, 1% get stone; some get kidney obstruction
LUTS tx
drink less natural diuretics, tx contributing dz (DM, no diuretics before bed); meds (alpha blockers or 5 alpha-reductase inh); surgery (TURP, open, ablation/cryo)
what is the advantage of radical prostatectomy over minimally invasive ablation or cryo?
minimally invasive tx lasts 12-18 months at most
side effects of alpha blockers
dizziness, retrograde ejaculation
side effects of 5 alpha-reductase inhibitors
mild: gynecomastia, decreased libido, ED; also shrink size of prostate (can be good)
side effects of prostate TURP
surgical bleeding, intraop fluid absorption (not with isotonic fluid), retrograde ejaculation, urinary incontinence
risk factors for prostate cancer
age (exponential after 50), ethnicity (black), fam hx (early dx), geographic variation (NA, europe, austr), ?high fat diet, ?hormone balance
FDA currently advises against use of ____ for prevention
finasteride
what % of prostate cancer is familial?
10% (depends on how many relatives you have with it)
symptoms of prostate cancer
only occur once it has started to spread; local spread = voiding sx; mets = bony pain
the majority of prostate cancer is?
clinically unimportant, not diagnosed
prostate cancer screening
digital rectal exam & PSA blood test
worrisome findings on digital rectal exam
nodular, indurated, loss of sulcus, loss of lateral borders, fixed to pelvic wall
PSA elevation could indicate?
CANCER, BPH, prostatitis, prostate infact (RARE)
transrectal ultrasound is used to?
image prostate and direct prostate needle biopsy
tx of clinically localized prostate cancer
active surveillance, radical prostatectomy, or radiation (external beam or radioactive seeds)
tx of metastatic prostate cancer
start with androgen ablation (medical), chemo (limited response), anti-angiogenic drugs, palliative therapy for bone mets
side effects of radical prostatectomy
urinary incontinence, ED
side effects of radiation on prostate
LUTS exacerbated, ED, cystitis (less common)
side effects of hormone therapy for prostate cancer
hot flashes, loss of libido, osteoporosis, metabolic syndrome
