Prostate cancer Flashcards
Microscopically most cancers are (1) and the (2) is used to help evaluate prognosis. Scores 6 and less are associated with a better prognosis than score 7 and above.
- adenocarcincomas 2. Gleason scoring system
most of these androgen sensitive tumors become resistant to androgen blockade via additional mutations allowing ?
ligand independent activation of androgen receptors
Symptoms of nodular hyperplasia of the prostate are due to obstruction of flow thru the prostatic urethra and thus consist of ?
difficulty in starting the stream of urine or hesitancy and intermittent interruption of urination.
Prostate cancer spreads by (1) and produces firm areas of tumor replacing the normal (2) tissue
- local extension 2. glandular
Unfortunately bony metastasis is not infrequent in prostatic carcinoma and the (1) is a frequent site of involvement where the metastatic deposits are most often (2) in nature
- axial skeleton 2. osteoblastic
Studies of familial cases have identified susceptibility loci on chromosome (1) and in sporadic cases (2) of (3) a known genome caretaker gene has also been identified
- 1 2. hyper methylation 3. glutathione S- transferase p1 (GSPT1)
The incidence is higher in (1) than in whites, Hispanics or Asians. (1) also are prone to develop prostate cancer at an earlier age.
- African Americans
Extreme cases of (1) develop complete urinary obstruction and painful bladder distension and sometimes (2)
- nodular hyperplasia of the prostate 2. hydronephrosis
(1) transcription factor is also involved in the development of Ewing’s sarcoma.
- ETS
Acute bacterial prostatitis is most commonly associated with (1); (2) are thus the most common organisms isolated.
- urethral or bladder infection (urethrocystitis). 2. E.coli and gram negative rods
Granulomatous prostatitis is a type of chronic prostatitis featuring formation of (1) and is due to multiple causes such as (2) and as a reaction following (3) to relieve symptoms of nodular hyperplasia
- granulomas 2. TB, Sarcoid, fungal infections 3. transurethral resection of the prostate
One common genetic change noted in (1) is the chromosomal rearrangement that juxtaposes the sequence of (2) family transcription factor gene (ERG or ETV1) adjacent to the (3), TMPRSS2. This produces (2) over expression in an androgen dependent manner.
- androgen sensitive tumors which become resistance to androgen blockade 2. ETS 3. androgen promoter
Patients with nodular hyperplasia of the prostate are also prone to (1) due to the presence of residual urine in the bladder following incomplete urination.
- urinary tract infections
Males moving from low to high risk countries develop (1) risk in subsequent generation suggesting that (2) factors are also involved in prostatic carcinoma
- intermediate 2. environmental
Nodular hyperplasia of the prostate is a very common condition and is characterized by proliferation of (1) in the (2) zones of the prostate which surround the prostatic urethra. It begins around age 40 and 90% or more of men have it by age 80.
- prostate glands and stroma 2. central and transitional
The overwhelming majority of prostate cancers arise in the (1) zone of the prostate and thus are frequently detected on digital rectal exam. In this location obstruction is a much (more/less) frequent symptom than in prostate hyperplasia
- peripheral 2. less
Chronic abacterial prostatitis in which routine bacteriologic studies are negative is due to nonbacterial agents such as (1)
- Chlamydia and Ureaplasma urealyticum
How should PSA tests be used?
Limited utility for screening, should be used in conjunction with other tests such as DRE, prostate needle biopsy, trans-rectal ultrasound for screening for prostate cancer. However, has great value in following response to treatment of prostate cancer
PSA is secreted by the ?
prostatic acini
T or F. Some cancers (and in particular the more aggressive ones) do not secrete PSA at all.
true
Prostate carcinoma is particularly common though in (1) countries.
- Scandinavian
These organisms reach the prostate by direct extension and cause an acute inflammatory reaction within the prostate with formation of (1). (2) due to chronic infection with these same organisms may follow.
- micro abscesses 2. Chronic bacterial prostatitis
(1) involvement occur in advanced cases of prostate cancer as does invasion of the (2)
- Pelvic lymph node and seminal vesicle 2. urinary bladder.
Clinical features of prostatitis include?
dysuria, urinary frequency, back pain suprapubic or pelvic pain
Age related increases in (1) are also involved in the process of nodular hyperplasia of the prostate, as it increases the expression of DHT receptors in prostatic tissue.
- estrogen
Cancer cells in general produce higher levels of PSA than normal glands but any condition disrupting the prostate glands such as (1) may cause elevation of PSA
- nodular hyperplasia, prostatitis
(1) most likely play a role in the development of prostatic carcinoma as males castrated before puberty do not develop prostate cancer and the growth of prostate cancers is inhibited by orchiectomy or by the administration of (2) therapy
- Androgens 2. estrogen
The mechanism of (1) involves conversion of testosterone by 5α- reductase to dihydrotestosterone (DHT). This binds to androgen receptors in the nucleus and stimulates growth of (2)
- nodular hyperplasia of the prostate 2. prostatic glands and stroma.
Men with inherited germline mutations in (1) (a tumor suppressor gene) have a 20 fold increased incidence in prostate cancer
- BRCA2
(1) and procedures such as (2) can also elevate PSA
- Vigorous exercise, sexual activity 2. sigmoidoscopy and colonoscopy
____, unlike pyelonephritis, rarely causes back pain or AKI, but it does cause frequency, dysuria, urgency, pain and hematuria
Bladder infection
•PE: very TENDER & BOGGY PROSTATE
acute prostatitis
Causative organisms: nongonococcal uretheritis; e.g. Chlamydia and Ureaplasma
Chronic ABACTERIALprostatitis (Prostatodynia).
BPH
•___ of the prostate around the prostatic urethra.
___ and ___ hyperplasia
CENTRAL periurethral zone; GLANDULAR and STROMAL
BPH pathogenesis:
Testosterone is converted to ___ by ____
DHT binds to _____ ; activates DNA and produces cell growth of both glands AND stroma
DHT BY 5-ALPHA-REDUCTASE; nuclear receptors
BPH pathogenesis:
•Age-related decrease in testosterone causes an increase in ___ and increased ____ on cells thus enhancing the effect of DHT (which causes prostate proliferation).
estrogens; DHT receptors
Hydronephrosis and INC. risk of infection due to stasis of urine
Complications of BPH:
•Prostatic Intraepithelial Neoplasia (PIN)
precursor lesion of Prostatic adenocarcinoma
Prostate adeno.
____ (behind the prostate and in front of the rectum) prevents posterior spread to the rectal wall.
Denonvilliers Fascia
•NO NODULES; diffusely involved by proliferative cancer, more solid growth in posterior lobe
Prostatic adenocarcinoma
PSA used as screening tool in conjunction with: (3 things)
DRE, transrectal ultrasound, or needle biopsy sampling.
HALLMARK–> PROMINENT NUCLEOLI
Prostate adenocarcinoma
