Prostate Flashcards
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?
Acute prostatitis
What are the two main components of the prostate?
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
Patient presents with dysuria LOW BACK PAIN!!!!!!!!!!!!!!!! Bloodwork shows white blood cells but blood cultures are NEGATIVE!!!!!!!!!
What is it?
Chronic prostatitis
What is benign prostatic hyperplasia of ?
Hyperplasia of prostatic stroma + glands
What age is BPH related to?
> 50
Does BPH increase the risk of cancer?
No
Explain how prostatic hyperplasia occurs
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
What effect does BPH have on the urethra?
What problems can this lead to?
Compression of urethra – >
Frequency, ⬇️emptying, nocturia, dysuria/dribbling Start + stop urine stream
Increased PSA (4 to 10)
Distension, UTI, it hydronephrosis,
hypertrophy Of bladder
Explain how The obstruction can lead to smooth-muscle hypertrophy of the bladder
Abstract – >impair bladder emptying – >bladder press against obstruction = SM hypertrophy
What is hydronephrosis
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)
Treatment of benign prosthetic hyperplasia?
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
What is the prostate adenocarcinoma
Malignantly proliferation of glands of prostatic gland
What is the incidents and mortality of prostate adenocarcinoma
Incidents = most common cancer in men
Mortality = 2nd most common cause of death due to cancer
Risk factors of prostate adenocarcinoma
Race = African >Caucasian >Asian
Age = greater than 50 years
Diet high in saturated fats
Why is prostate adenocarcinoma detected late
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
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?
Prostate adenocarcinoma
Cancer makes bound PSA – >decrease the percentage of free PSA
Apart from an abnormal DRE + increased PSA what else is required?
What does a biopsy histology show?
Need a biopsy
See small glands infiltrating normal prostatic tissue with nuclei containing DARK nucleoli
What is the Gleason grading system based on?
Based on architecture not on the nucleus atypia
How do they come up with the final score to grade a prostate adenocarcinoma?
Architecture varies from area to area – >multiple regions are assessed –> score different regions – >come up with final square
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?
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)
Patient has a local prostate adenocarcinoma. What is the treatment?
Prostatectomy
Patient has advanced disease what drugs can we give him?
- Continuous GnRH analogue = Leuprolide
Shutdown hypothalamus – >decreased FSH/LH
– >decreased prostate cancer thriving due to being androgen dependent
- Androgen receptor inhibitors e.g. flutamide
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?
Pulsatile = infertility
Continuous =
prostate cancer
Uterine fibroids
precocious puberty
