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D&T3 Exam 1 > Prostate-Norton > Flashcards

Prostate-Norton Flashcards

1
Q

Prostate Adenocarcinoma

Clinical

DRE

A

May detect early prostate cancers as hard nodules

Low sensitivity and specificity

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2
Q

BPH

Tx

Moderate to severe

A

Medical therapies: Dec smooth muscle tone (a-blockers)

5-a-reductase inhibitors inhibit synthesis of DHT to shrink prostate

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3
Q

BPH

Morphology

Early Nodules

A

Composed of stromal cells (pale, gray, tough)

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4
Q

DHT-AR induced growth factor function

A

Inc. proliferation of stromal cells and decrease death of epithelial cells

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5
Q

Where is 5-a-reductive found and what is its function?

A

Found in the stromal cells of the pancreas and works to convert testosterone to DHT

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6
Q

BPH

Morphology

Late Nodules

A

Composed of epithelial cells/glands (pink-yellow, soft, exude milky prostatic fluid)

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7
Q

Prostate Adenocarcinoma

Gleason grading

Totals

8-10

A

High-grade cancer

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8
Q

BPH

Epidemiology

A

20% over 40
70% over 60
90% over 80

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9
Q

Prostate Adenocarcinoma

Gleason grading

Totals

5-6

A

Intermediate grade cancer

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10
Q

Prostate Intraepithelial Neoplasia (PIN)

Gland Morphology

A

Larger than cancer glands with branching and infolding

Surrounded by patchy layer of basal cells and intact basement membrane

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11
Q

MC site of pancreatic carcinomas

A

Peripheral zone

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12
Q

Prostate Adenocarcinoma

MC tx for localized cancer

A

Surgery (radical prostatectomy)

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13
Q

Prostate Adenocarcinoma

Gleason grading

Gleason 5

A

Highest grade

No glandular differentiation, cells infiltrate stroma in cords, sheets, and nests

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14
Q

Prostate Intraepithelial Neoplasia

MC in which zone

A

Peripheral zone (same as cancer)

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15
Q

Prostate Adenocarcinoma

Gleason grading

Totals

7

A

Moderate to poorly-differentiated cancer

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16
Q

Prostate Adenocarcinoma

Clinical

Transrectal US

A

Low sensitivity and specificity

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17
Q

Cause of Acute Bacterial Prostatitis

A

Same as UTI (E. coli, other g(-) rods, enterococcus, staph)

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18
Q

Chronic Bacterial Prostatitis

Pertinent PMH findings

A

Recurrent UTI with same organism

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19
Q

Most common form of cancer in men in US

A

Prostate Adenocarcinoma

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20
Q

Prostate Adenocarcinoma

Grading by what system

A

Gleason system

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21
Q

BPH

Microscopic

A

Nodules are prominent (stromal fibromuscular to fibroepithelial with glands)

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22
Q

Prostate Adenocarcinoma

Histology

A

Glands are small, more crowded, without branching or infolding, separated by little or no stromal material

BACK-TO-BACK glands

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23
Q

MC site of hyperplasia

A

Transitional zone

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24
Q

Chronic Abacterial Prostatitis

Lab findings

A

Prostatic secretions: leukocyte (+)

Culture: Bacteria (-)

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25
Q

Prostate Adenocarcinoma

Tx

A

Surgery (radical prostatectomy)

Radiation

Hormone manipulation

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26
Q

BPH

Tx

Mild sx

A

Conservative: Dec fluids before bed, decrease caffeine and EtOH, timed voiding

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27
Q

Prostate Adenocarcinoma

Prognosis after therapy

A

> 90% can expect to live 15 years

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28
Q

Prostate Adenocarcinoma

Spread

A

Local extension is to perprostatic tissues, seminal vesicles, base of bladder

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29
Q

Prostate Adenocarcinoma

PSA

Normal cutoff value and risk level ass. With value

A

Cutoff for normal serum level is 4.0 ng/ml

25% of men with a PSA 2.5-4.0 ng/ml have prostate cancer

30
Q

BPH

Pathogenesis

A

DHT-AR activation leading to transcription of growth factor genes

31
Q

Prostate Adenocarcinoma

Histology

Individual cell structure

A

Hyperchromatic cells with prominent nucleoli

Pleomorphism and mitotic figures are UNCOMMON

32
Q

Prostate Adenocarcinoma

How to measure response to treatment

A

Serial PSA measurements

33
Q

Acute Bacterial Prostatitis

Clinical findings

A

Fever, chills, dysuria, prostate TENDER and boggy on dre

34
Q

Prostate Adenocarcinoma

MC in… (ethnicity)

A

African-Americans

Uncommon in Asians

35
Q

Chronic Abacterial Prostatitis

Clinical

A

Presents like chronic bacterial prostatitis

36
Q

Chronic Bacterial Prostatitis

Clinical

A

Mild sx: back pain, dysuria, perineal and Suprapubic discomfort or asymptomatic

37
Q

Granulomatous Prostatitis

MC cause in US

A

BCG instilled into bladder to treat superficial bladder cancer

(Clinically insignificant if due to BCG)

38
Q

Acute Bacterial Prostatitis

What allows spread of bacteria to prostate?

A

Reflux of urine into prostate

39
Q

Prostate Adenocarcinoma

Metastasis via lymphatics

A

To obturator nodes then paraaortic nodes

40
Q

Chronic Bacterial Prostatitis

Lab findings

A

Expressed prostatic secretions: leukocytes (+)

41
Q

Prostate Adenocarcinoma

PSA

Specificity

A

Organ specific but not cancer specific

42
Q

Prostate Adenocarcinoma

Clinical

Local prostate cancer detection

A

Asymptomatic, found on DRE or elevated PSA

43
Q

Prostate Adenocarcinoma

Histology

Gland cell structure

A

Glands lined by cuboidal/columnar cells with ABSENT OUTER BASAL CELL LAYER

44
Q

Acute Bacterial Prostatitis

Urinalysis findings

A

Leukocytes (+)

45
Q

Prostate Adenocarcinoma

PSA

Use

A

Diagnosis and management of prostate cancer

Use as screening test is controversial (lacks sensitivity and specificity)

46
Q

Prostate Adenocarcinoma

MC in…

A

Peripheral ducts and acini

47
Q

Prostate Adenocarcinoma

Metastasis via blood

A

To bones (lumbar spine, proximal femur, pelvis, thoracic spine, ribs) to form osteoblastic lesion

48
Q

Prostate Adenocarcinoma

Gleason grading

How are tumors scored?

A

Adding most prominent pattern and second most prominent pattern

OR

Most prominent pattern and highest grade pattern present

49
Q

Acute Bacterial Prostatitis

Culture results

A

Bacteria (+)

50
Q

BPH

Morphology

A

Prostate enlarges to 60-100 g (normal 20 g)

Originates in transition zone (periurethral)

51
Q

Prostate Adenocarcinoma

Other factors that can elevate PSA

A

Prostatitis, infarct, instrumentation of prostate, ejaculation,UTI, age, etc.

DRE does NOT elevate PSA

52
Q

Chronic Bacterial Prostatitis

Culture

A

Bacteria (+)

53
Q

BPH

Clinical

Signs of UTI

A

Bladder hypertrophy and distention

Urine retention, residual urine leading to:

Frequency, nocturnal, difficulty starting and stopping, overflow dribbling, dysuria

Infection

54
Q

BPH

Clinical

A

Urethral obstruction (caused by inc in size of prostate, nodules impinge on urethra, smooth muscle contraction of prostate)

55
Q

What is the main prostate androgen?

A

Dihydrotestosterone

56
Q

Prostate Intraepithelial Neoplasia (PIN)

Morphology

A

High grade PIN cells look the same as cancer cells

PIN glands differ from cancer glands

57
Q

Prostate Adenocarcinoma

Possible precursor lesion

A

Prostate intraepithelial neoplasia

58
Q

MC form of prostatitis

A

Chronic Abacterial Prostatitis

59
Q

Prostate Adenocarcinoma

Etiology

A

High fat diet may contribute to risk

Androgens- induce pro-growth and pro-survival genes in cancer cells as well as normal cells

60
Q

Prostate Adenocarcinoma

Gleason grading

Gleason 1

A

Lowest grade

Most well-differentiated with uniform round glands in well-circumscribed nodules

61
Q

Where does DHT bind?

A

Androgen receptors (AR) on nuclei of stromal and epithelial cells

62
Q

How is DHT formed?

A

Conversion of testosterone by type 2 5-a-reductase found in stromal cells

63
Q

Prostate Adenocarcinoma

MC in which zone

A

Peripheral zone (70%)

Classic in posterior area: hard nodule on DRE

64
Q

Prostate Adenocarcinoma

Genetics

A

Men with one first degree relative with prostate cancer: risk is 2X greater

Men with 2 first degree relatives with prostate cancer: 5X risk

BRCA2: 20X risk

65
Q

Prostate Intraepithelial Neoplasia (PIN)

Occurrence

A

Seen in younger age than cancer

Seen more frequently and extensively in prostates with cancer

66
Q

BPH

Surgical therapies

A

Transurethral resection of prostate (TURP)

67
Q

Prostate Adenocarcinoma

PSA

A

Normally secreted into semen, minute amounts circulating in serum

Elevated serum levels in localized and advanced prostate cancer

68
Q

Prostate Adenocarcinoma

Gleason grading

Totals

2-4

A

Well-differentiated (low-grade) cancer

69
Q

Prostate Adenocarcinoma

PSA

Refinements to improve PSA screening

A

PSA density

PSA velocity

Age specific reference ranges

Ratio of bound and free PSA in serum

70
Q

Prostate Adenocarcinoma

Clinical

What is used to confirm diagnosis?

A

Transrectal needle biopsy

71
Q

BPH

Etiology

A

Inc. number of epithelial cells and stromal components influenced by DHT

D&T3 Exam 1 (19 decks)

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