Prostate

Question 1

What bacterias often cause acute prostatitis?

Answer 1

Chlamydia trachomatis; Neisseria gonorrhoeae (common causes in young adults)

Escherichia coli and Pseudomonas (common causes in older adults)

Question 2

Presentation of acute prostatitis

Answer 2

Presents as dysuria with fever and chills

Prostate is tender and boggy on digital rectal exam

Question 3

Histo and culture of prostate secretions in acute prostatitis show what?

Answer 3

Secretions show WBCs and culture reveals bacteria

Question 4

Presentation of chronic prostatitis

Answer 4

Dysuria with pelvic or low back pain

Question 5

What is seen in the histo and culture of prostate secretions in chronic prostatitis?

Answer 5

Secretion shows WBC but culture is negative

Question 6

What is benign prostatic hyperplasia?

Answer 6

Hyperplasia of prostatic stroma and glands

Question 7

What is unique about BPH?

Answer 7

It is a form of hyperplasia but does NOT increase the risk for cancer

Question 8

What hormone is BPH related to? How?

Answer 8

Related to dihydrotestosterone (DHT)

Testosterone converted to DHT by 5a-reductase in stormal cells

DHT acts on androgen receptors of stromal and epithelial cells resulting in hyperplastic nodules

Question 9

What portion of the prostate undergoes BPH?

Answer 9

Central periurethral zone

Question 10

Clinical features of BPH

Answer 10

PRoblems starting and stopping urine stream

Impaired bladder emptying with increased risk for infection and hydronephrosis

Dribbling

Hypertrophy of bladder wall smooth muscle; increased risk for bladder diverticula

Microscopic hematuria may be present

Prostate-specific antigen (PSA) is often SLIGHTLY elevated due to increased number of glands

Question 11

Tx for BPH

Answer 11

• alpha1-antagonist to relax smooth muscle
  
  • also relaxes vascular smooth muscle
  • use selective alpha1b-antagonists to avoid vascular effects
• 5a-reductase inhibitor
  
  • block conversion of T ⇒DHT

Question 12

What are the risk factors of prostate adenocarcinoma?

Answer 12

Age

Race (AA > Caucasians > Asians)

Diet high in saturated fats

Question 13

Is prostatic adenocarcinom usually symptomatic?

Answer 13

Normally clinically silent

Question 14

What area of the prostate does prostatic adenocarcinom usually arise?

Answer 14

Peripheral, posterior region of the prostate and, hence, does not produce urinary symptoms early one

Question 15

Histo of prostatic adenocarcinom

Answer 15

Small, invasive glands with prominent nucleoli

Question 16

What is hte Gleason grading system based on for prostatic adenocarcinom?

Answer 16

Architecture alone (not nuclear atypia)

Question 17

How is the Gleason grading system calculated?

Answer 17

Multiple regions of the tumor is assessed

A score (1-5) is assigned for two distinct areas and tehn added to produce a final score (2-10)

Higher score = worst prognosis

Question 18

What structures does prostatic adenocarcinom often spread to? What is the result of this spread?

Answer 18

Lumbar spine or pelvis

Results in osteoblastic metastases that present as lower back pain, and increased serum alkaline phosphatase, PSA and prostatic acid phosphatase

Question 19

What is the difference in the Tx of localized and advanced prostatic adenocarcinom?

Answer 19

Localized = prostatectomy

Advanced = hormone suppression to reduce T and DHT

Question 20

What drugs are used to Tx advanced prostatic adenocarcinom?

Answer 20

Continuous GnRH analogs

• Shut down the hypothalamus (LH and FSH reduced)

Flutamide

• Competitive inhibitor at the androgen receptor