prostate cancer

Question 1

what is the protstate

Answer 1

funnel shaped accessory gland in pelvis
walnut
produces prostatic fluid
urethra runs through

Question 2

describe the glandular compoment of prostate histologu

Answer 2

responsible for producing fluid
made of luminal secretory epithelium + basal cells
tree trunk
end of branches = glands form acini

Question 3

describe the stomal component of prostate

Answer 3

tissue surrounding prostatic flands
fibroblasts, smooth muscle, + endo cells
regulates prostatic microenvuonrment

Question 4

describe the peripheral zone of prostate

Answer 4

majority glandular tissue
largest peripheral zone, close to rectal wall
prostate exam

Question 5

describe the central zone of prostate

Answer 5

25% glandular tissue
surrounds ejaculatory ducts
not common, but aggressive cancers here can invade seminal vesicles

Question 6

describe transitional zone of prostate

Answer 6

5% prostatic gladnular
surrounds urethra
grows with age
benign prostatic hyperplasia

Question 7

describe atnerior region of prostate

Answer 7

fibromuscular stroma = convex shape of anterior prostate
fibrous = capsule around prostate
muscular = forces fluid into urethra during ejaculation
lacks glandular tissue

Question 8

what is prostatitis different types + clinical presentation

Answer 8

inflammation of prostate (inflam cells)
= acute OR chronic bacterial, chronic (non-bacterial), granulomatous
pelvic pain, changes in urination

Question 9

describe benign prostatic hyperplasia

Answer 9

inc size prostate

exnteds upwards towards bladder (transitional zone), pinches urethra = obstructs outflow urine

Question 10

describe the pathogenesis of BPH

Answer 10

testosterone + dihydrotestosterone bind to receptors in stroma + epitheliul cells increased growth factor activation
hyperplasia of stromal and epithelial cells in trans zone
nodule formation

Question 11

what are the clinical manifestation of BPH

Answer 11

urinary tract symptoms
storage = frequency, urgency, inconrinence, nocturia
voiding = slow urinary stream, straining to void

Question 12

risk factors prostate cancer

Answer 12

age (inc after 40)
ethnicity
fam history 
diet - animal fat intake
smoking 
endogenous hormone levels

Question 13

describe the pathogenesis of prosteate cancer

Answer 13

dysplastic epithelial proliferation (prostatic intraepithelial neoplasia) = PIN -> cancer
PIN lesions = pre-malignant => adenocarcinoma

Question 14

desdcribe PIN development

Answer 14

develop occurence of proliferative inflam atrophy eg from infection/toxin
epithelial cells lining acini become dysplastic
abnormalities in epithelium
high grade PIN = carc in situ

Question 15

why is PIN considered pre-malignant lesion

Answer 15

PIN + invasive prostate cnacer = peripheral zone
cytologic similarity + certain markers are found in both
more frequent in prostates that contain cancer

Question 16

describe postatic adenocarcinoma

Answer 16

mostly in peripheral zone
acinar = cuboidal cells arranges in acini
ductal = columnar cells in papillary or cribriform pattern
elevated serum prostate-specific antigen levels

Question 17

what are the macroscopic features o of prostatic adenocarcinoma

Answer 17

someotimes not visible = needle biopsy
different colour
asymmetrical prostate
nodules

Question 18

prostate cancer clinically

Answer 18

earlt = asymptomatoc 
advances = obstructive voiding, intermittent urinary stream, nocturia, haematuria + haematospermia , renal failure

Question 19

describe the progression of prostatic adenocarcinoma

Answer 19

extra-prostatic extention = common = tumour in contact with extra-prostatic fat
local invastion into seminal vesicles + bladder base
rectal invasaion rare bc denonvillier’s fascia
metastasis to the bone

Question 20

what factors affect prognosis of prostate cancer

Answer 20

grade using gleason system 
measure how abnormal  tissue looks 
measure from 2 areas, add score together
\+ grade groups = histological descriptions 
Stage = progression of metastasis (TNM)

Question 21

general treatment for prostate cancer

Answer 21

radiotherapy = local lesions
hromone therapies = androgen deprivation therapy
chemotherapy - metastasis
surgery

Question 22

describe androgen deprivation therapy as a targeted treatment

Answer 22

apoptosis of prostate cells

can tagrget testosterone production at leydig cells in testicles or hypothalamic-pituitary gonadal axis

Question 23

prevention of prostate cancer

Answer 23

digital rectal examination = palpate peripheral prostate for abnormalities
prostate-specific antigen blood test = controversial
prostate imaging