prostate cancer Flashcards
what is the protstate
funnel shaped accessory gland in pelvis
walnut
produces prostatic fluid
urethra runs through
describe the glandular compoment of prostate histologu
responsible for producing fluid
made of luminal secretory epithelium + basal cells
tree trunk
end of branches = glands form acini
describe the stomal component of prostate
tissue surrounding prostatic flands
fibroblasts, smooth muscle, + endo cells
regulates prostatic microenvuonrment
describe the peripheral zone of prostate
majority glandular tissue
largest peripheral zone, close to rectal wall
prostate exam
describe the central zone of prostate
25% glandular tissue
surrounds ejaculatory ducts
not common, but aggressive cancers here can invade seminal vesicles
describe transitional zone of prostate
5% prostatic gladnular
surrounds urethra
grows with age
benign prostatic hyperplasia
describe atnerior region of prostate
fibromuscular stroma = convex shape of anterior prostate
fibrous = capsule around prostate
muscular = forces fluid into urethra during ejaculation
lacks glandular tissue
what is prostatitis different types + clinical presentation
inflammation of prostate (inflam cells)
= acute OR chronic bacterial, chronic (non-bacterial), granulomatous
pelvic pain, changes in urination
describe benign prostatic hyperplasia
inc size prostate
exnteds upwards towards bladder (transitional zone), pinches urethra = obstructs outflow urine
describe the pathogenesis of BPH
testosterone + dihydrotestosterone bind to receptors in stroma + epitheliul cells increased growth factor activation
hyperplasia of stromal and epithelial cells in trans zone
nodule formation
what are the clinical manifestation of BPH
urinary tract symptoms
storage = frequency, urgency, inconrinence, nocturia
voiding = slow urinary stream, straining to void
risk factors prostate cancer
age (inc after 40) ethnicity fam history diet - animal fat intake smoking endogenous hormone levels
describe the pathogenesis of prosteate cancer
dysplastic epithelial proliferation (prostatic intraepithelial neoplasia) = PIN -> cancer
PIN lesions = pre-malignant => adenocarcinoma
desdcribe PIN development
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
why is PIN considered pre-malignant lesion
PIN + invasive prostate cnacer = peripheral zone
cytologic similarity + certain markers are found in both
more frequent in prostates that contain cancer
describe postatic adenocarcinoma
mostly in peripheral zone
acinar = cuboidal cells arranges in acini
ductal = columnar cells in papillary or cribriform pattern
elevated serum prostate-specific antigen levels
what are the macroscopic features o of prostatic adenocarcinoma
someotimes not visible = needle biopsy
different colour
asymmetrical prostate
nodules
prostate cancer clinically
earlt = asymptomatoc advances = obstructive voiding, intermittent urinary stream, nocturia, haematuria + haematospermia , renal failure
describe the progression of prostatic adenocarcinoma
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
what factors affect prognosis of prostate cancer
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)
general treatment for prostate cancer
radiotherapy = local lesions
hromone therapies = androgen deprivation therapy
chemotherapy - metastasis
surgery
describe androgen deprivation therapy as a targeted treatment
apoptosis of prostate cells
can tagrget testosterone production at leydig cells in testicles or hypothalamic-pituitary gonadal axis
prevention of prostate cancer
digital rectal examination = palpate peripheral prostate for abnormalities
prostate-specific antigen blood test = controversial
prostate imaging
