Prostate Flashcards
Glandular tissue comprises ___% of the prostate
30%
How is the glandular tissue of the prostate organized?
stratified epithelium lined with a layer of cuboid or columnar cells
“arranged like a tree”
____ is a collagen elastic and fibrous tissue that supports glandular tissue.
It comprises ___% of the prostate
Stroma
70%
___ is the smallest structure in the glandular component of the prostate and is surrounded by stroma
Acini
The proliferation of acini can lead to ____
BPH
What is BPH influenced by?
A decrease in testosterone
Increases of estrogen and adipose
What are the glandular zones of the prostate?
Periurethral zone
Peripheral zone
Central zone
The ___ contains mucosal glands
Periurethral zone
Changes of the ___ elements contribute to urethral pressure along with ____ zone changes that cause BPH
Stromal
Transitional
The ___ zone is the origin of 70% prostate adenocarcinomas
Peripheral
The majority of prostatic glandular tissue (70%) is in what zone?
Peripheral
What is the epidemiology of BPH?
What population if BPH more severe in?
50% of men by 60 y/o
90% by 80 y/o
*normal part of aging
More severe in African Americans
Testosterone –> 5 reductase –> ____, which binds to nuclear receptors in the prostate gland leading to hyperplasia
DHT
Where are A1 receptors?
In the muscle of the stroma, in the capsule of the prostate, and in the bladder neck, which causes smooth muscle contraction and contribute by worsening urinary sxs –> LUTs (lower urinary tract sx)
What are the prostate areas that are involved in BPH?
What is occurring in these area(s)?
Transition and periurethral zones
Epithelium proliferation (acini proliferation) Smooth muscle proliferation Stromal support changes
What LUTS (lower urinary tract sx) occur w/ BPH? (x3) What are examples of each?
Obstructive urinary sx (weak stream, hesitancy, incomplete emptying, double voiding)
Irritative urinary sx (urgency, frequency, nocturia)
Urinary incontinence (“paradoxcial” overflow incontinence, hx of UTI, sx worse w/ cold medications)
Sx of BPH are classified as either ___ or ___
Voiding (obstructive)
Storage (irritative)
What are some special work-up tools you may use to dx BPH? (5)
Post-void urinary residual (PVR) –> bladder sonogram
Uroflow –> measure urine flow rate/ pattern
Transrectal U/S
Cystoscopy
Upper tract imaging –> (US or CT) stones, CKD, hematuria
What medications can be used to tx BPH?
How do they work to tx BPH?
Open up the gland by relaxing the smooth muscle
Nonselective alpha-blockers: doxazosin, terazosin
selective alpha-blockers: tamsulosin, silodosin
Shrink the gland
5-alpha reductase inhibitors: finasteride, dutasteride
Antimuscarinics: oxybutynin
What are surgical options for BPH? (x4)
TUMT (microwave treatment)
TUNA (insert hot wire under direct vision) ( = coagulative necrosis)
TURP (resect the obstructing tissue)
PVP (vaporize the obstructing tissue)
What are the indications for surgical tx of BPH? (x6)
Refractory sxs to medications Urinary retention Cannot tolerate medical therapy Prefers surgical therapy Recurrent UTI attributable to BPH Impaired renal function attributed to BPH
What other dx can mimic BPH? (x8)
UTI Prostatitis Neurologic dz (CVA/TIA, Parkinson’s, MS) Dietary indiscretion (caffeine, alcohol, etc.) Diabetes (polyuria) Timing of diuretics OSA (“Does he snore?”) Advanced CA of the prostate (rare)
What is the epidemiology of prostate CA?
Most common non-skin CA in men in the US
2nd leading cause of cancer death in men in the US
What prostate CA screenings are available?
Prostate specific antigen (PSA)
Digital rectal exam (DRE)
What is PSA? What is it’s sensitivity for dx prostate CA?
PSA is an enzyme that liquifies ejaculate
21% sensitivity (nonspecific)
50% for high-grade CA
What is the sensitivity and specificity for detecting prostate CA using DRE?
sensitivity: 59%
specificity: 94%
Who needs to have an annual prostate screening?
Men > 50 y/o (<50 y/o if 1st degree relative)
African American men >40 y/o
What is the normal range for PSA?
0.0-4.0 ng/mL
Other than prostate CA, what can cause PSA to increase?
BPH Prostatitis trauma instrumentation ejaculation
T/F DRE can significantly increase PSA levels?
False; DRE has minimal effect on PSA value (increases 0.26-0.4 ng/mL)
What medications can alter PSA values?
5-ARI (finasteride, dutasteride)
What is a limitation of using DRE to detect prostate CA?
Only 85% of CA arise peripherally (palpable)
How does prostate CA present?
Screening: elevated PSA, nodular prostate
Constitutional sx: wt loss, night sweats, and bony metastatic sx
T/F Urinary sx are rare in prostate CA?
True
Usually only when advanced
How is a prostate needle bx performed?
Pt awake
Local anesthetic
Use transrectal US guidance
Where does prostate CA metastasize?
Lymph nodes
Bone
What is a risk of prostate needle bx?
Significant risk of prostatitis
Self-limited bleeding (urine, stool, semen)
How many locations are prostate samples taken from during a needle bx? Where are they taken from?
6
- right apex, mid, base
- left apex, mid, base
What is the scoring method called used for prostate CA? Describe it.
Gleason scoring
Creates a score by assigning all observed CA cell types a score of 1-10, w/ two most common types receiving a final combined score
(Grading/Staging) is determining the type of CA and how aggressive
(Grading/Staging) is determining how much CA there is and where
Grading
Staging
What is used in the staging w/u of prostate CA?
CXR
Labs: CBC, LFT
Bone scan if PSA >20 ng/mL
CT of pelvis
What are the tx options for a pt w/ prostate CA?
Radical retropubic prostatectomy (RRP)
Radiotherapy
Androgen suppressive therapy
Active surveillance
___ are radiated and implanted in the prostate and remain even after radiation has degraded for ~60 days
What type of CA is this tx best for?
Brachytherapy
Best for localized, contained CA
