Prostate

Question 0

Patient presents with
dysuria
increased frequency and
NO back pain.
Rectal examination = tender and boggy rectal examination.
Prostatic secretions of your white blood cells with the culture revealing A bacteria

What is it?

Answer 0

Acute prostatitis

Question 1

What are the two main components of the prostate?

Answer 1

Stromal layer = connective-tissue

Glands = functional unit =
secretes alkaline milky liquid =
added to sperm + seminal vesicle fluid

Glands have inner luminal layer + outer basal layer

Question 2

Patient presents with 
dysuria
LOW BACK PAIN!!!!!!!!!!!!!!!! 
Bloodwork shows white blood cells but 
blood cultures are NEGATIVE!!!!!!!!!

What is it?

Answer 2

Chronic prostatitis

Question 3

What is benign prostatic hyperplasia of ?

Answer 3

Hyperplasia of prostatic stroma + glands

Question 4

What age is BPH related to?

Answer 4

> 50

Question 5

Does BPH increase the risk of cancer?

Answer 5

No

Question 6

Explain how prostatic hyperplasia occurs

Answer 6

Testosterone converted via 5 alpha reductase + stromal cells into DHT

DHT acts @ androgen receptors of
stromal + epithelial cells– >

Smooth elastic firm hyperplastic nodules of periurethral lobes

Question 7

What effect does BPH have on the urethra?

What problems can this lead to?

Answer 7

Compression of urethra – >

Frequency, ⬇️emptying, nocturia, dysuria/dribbling Start + stop urine stream

Increased PSA (4 to 10)
Distension, UTI, it hydronephrosis,
hypertrophy Of bladder

Question 8

Explain how The obstruction can lead to smooth-muscle hypertrophy of the bladder

Answer 8

Abstract – >impair bladder emptying – >bladder press against obstruction = SM hypertrophy

Question 9

What is hydronephrosis

Answer 9

BPH, injury to ureter, stones, cervical cancer – >
Obstruction of bladder – >buildup of fluid into kidney and cannot be drained – >hydronephrosis – >

(ureter dilate)
 \+ 
(Atrophy all Renal cortex + medulla
  & 
dilation of renal pelvis + calyces)

Question 10

Treatment of benign prosthetic hyperplasia?

Answer 10

Alpha-1 antagonists
Terazosin =
- relax SM of bladder – > relieve obstruction
- relax SM of BV wall if patient = hypertensive

Tamsulosin =
- Relax SM of bladder = relieve obstruction
AVOID alpha 1b effects on vascular smooth muscle

5 alpha reductase inhibitor = decrease DHT – >
decrease stimulation of
androgen receptors + stromal + epithelial cells

Question 11

What is the prostate adenocarcinoma

Answer 11

Malignantly proliferation of glands of prostatic gland

Question 12

What is the incidents and mortality of prostate adenocarcinoma

Answer 12

Incidents = most common cancer in men

Mortality = 2nd most common cause of death due to cancer

Question 13

Risk factors of prostate adenocarcinoma

Answer 13

Race = African >Caucasian >Asian

Age = greater than 50 years

Diet high in saturated fats

Question 14

Why is prostate adenocarcinoma detected late

Answer 14

Doesn’t produce your no symptoms until very late

As cancer grows On the post periphery of the prostate therefore the cancer has to grow extensively in order to eventually compress the periurethral zone

Question 15

Patients Presents with a PSA >10 and digital rectal exam feels a mass at the posterior periphery of the prostate. The percentage of free PSA however is low.

What is it and why is the percentage of free PSA low?

Answer 15

Prostate adenocarcinoma

Cancer makes bound PSA – >decrease the percentage of free PSA

Question 16

Apart from an abnormal DRE + increased PSA what else is required?

What does a biopsy histology show?

Answer 16

Need a biopsy

See small glands infiltrating normal prostatic tissue with nuclei containing DARK nucleoli

Question 17

What is the Gleason grading system based on?

Answer 17

Based on architecture not on the nucleus atypia

Question 18

How do they come up with the final score to grade a prostate adenocarcinoma?

Answer 18

Architecture varies from area to area – >multiple regions are assessed –> score different regions – >come up with final square

Question 19

Which part of the spine is prostate cancer likely to spread to?
How does this metastases present?
What sort of metastases occurs?
What serum markers are increased? And what does this indicate?

Answer 19

Lumbar spine = osteoblastic metastases = sclerotic lesions of bone

Patient has low back pain

⬆️ALP = alkaline phosphate = sign of osteoblastic activity indicating bone is being laid down

Increased PSA + PAP (Prostatic acid phosphate)

Question 20

Patient has a local prostate adenocarcinoma. What is the treatment?

Answer 20

Prostatectomy

Question 21

Patient has advanced disease what drugs can we give him?

Answer 21

1. Continuous GnRH analogue = Leuprolide
   Shutdown hypothalamus – >decreased FSH/LH

– >decreased prostate cancer thriving due to being androgen dependent

2. Androgen receptor inhibitors e.g. flutamide

Question 22

When leuprolide is used in a pulsatile fashion what is it being used for?

If you Leuprolide is being used in a continuous fashion what is it being used for?

Answer 22

Pulsatile = infertility

Continuous =
prostate cancer
Uterine fibroids
precocious puberty