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1st Repro > Prostate Pathology > Flashcards

Prostate Pathology Flashcards

1
Q

The prostate is broken up into zones

which zone do se wee cancer in?

BPH?

A

Central = Cancer

Transition = BPH

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2
Q

is accessible to palpation on rectal exa m

A

Peripheral Zone (PZ)

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3
Q

Describe normal prostate histology

A

double layer of cells: secreatory and basal

flat nuclie, lie at the edge of gland and these basal cells = normal and healthy basally located cells are absent in prostate cancer

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4
Q

What are the three types of Prostatitis

A

acute

chronic

granulomatous

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5
Q

may be due to prior instrumentation, or bacille Calmette-Guérin therapy for bladder cancer, or a number of other reasons

A

Granulomatous Prostatitis

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6
Q

i. Intraprostate reflux of urine from the posterior urethra or urinary bladder

A

Acute prostatitis

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7
Q

Pathogens involved in Acute Prostatitis

A

Rods

• E. coli, P. aeruginosa, K. pneumoniae

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8
Q

Causes of chronic prostatitis

A

i. Majority are abacterial :Chronic bacterial infection

• Due to recurrent acute prostatitis

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9
Q

Clincal findings of prostatitis

A

a. Fever (occurs in acute prostatitis).
b. Lower back, perineal, or suprapubic pain

c. Painful/swollen gland on rectal examination
d. Dysuria, hematuria

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10
Q

What lab findings are seen in Prostatitis

A

can raise the serum PSA above normal (above 4.0 ng/mL)

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11
Q

Agents responsible for acute prostatitis

A

E. coli

  • Gram negative bacilli
  • Gram positive cocci
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12
Q

•Young Men with low back pain, fever, myalgia and tender swollen prostate

A

Acute Bacterial Prostatitis

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13
Q

•Recurrent with associated urinary tract infections and same organism each culture; they are asymptomatic with calculi

A

Chronic Bacterial Prostatitis

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14
Q

How do you diagnose prostatitis

A

• 10-12 wbc/field in secretions/urine or/and Positive bacterial cultures

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15
Q
  • Accounts for 95% of prostatitis
  • Prostatitis without UTI or positive cultures
A

Chronic Nonbacterial Prostatitis

“Chronic Pelvic Pain Syndrome”

CPPS

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16
Q

Possible organisms of chronic nonbacterial prostatitis and “chronic pelvic pain syndrome”

A
  • Chlamydia trachomatis
  • Ureaplasma urealyticum
  • Trichomonas vaginalis
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17
Q

Non infectious causes of granulomatous prostatitis

infectious causes:

A
  • Infectious: Tuberculosis (hematogenous) and Fungal / mycotic (AIDS)
  • Non-infectious: Post-surgical (biopsy site reaction) and Post-BCG (Bacille Calmette-Guérin) • Non-specific
18
Q

A proliferation of the glands and stroma in the TRANSITION ZONE of the prostate

A

Benign Prostatic Hyperplasia (BPH)

19
Q

Causes bladder outlet obstruction (BOO) involving urinary

frequency, incomplete emptying, nocturia, dysuria

90% prevalence by age 80

A

Benign Prostatic Hyperplasia (BPH)

20
Q

BPH is an ______ process chiefly caused by _______

A

Is an androgen-dependent process

Chiefly caused by dihydrotestosterone (DHT)

21
Q

____ binds the AR with a 5-fold higher affinity than testosterone

The AR will upregulate the transactivation of target genes

A

DHT

22
Q

Role of PSA

A

Proteolytic enzyme

  • Increases sperm motility
  • Maintains seminal secretions in the liquid state
23
Q

PSA levels in BPH

A

ii. PSA is neither sensitive nor specific for BPH.
iii. PSA usually normal (0-4 ng/mL) but BPH can increase it to between 4 and 10 ng/mL, and rarely over 10 ng/mL

24
Q

Treatement option for BPH

A

TURP

trans urethral resection of Prostate; removal of excess tissue

25
Q

High-Grade Prostatic Intraepithelial Neoplasia (HGPIN)

  • -Men who already have elevated serum PSA have ____risk of cancer on repeat biopsy
  • -Additional finding of HGPIN on biopsy increases the risk up to ____

–By itself, does not raise serum PSA

A

20%

25%- 30%

26
Q

Cell lining gland space; have prominent nucleoli, clumpled chromatin; this is noninvasive precursor that can break through the matrix with metaleoproteases

A

High Grade PIN

27
Q
A
28
Q

Prostate Cancer

  • Men have a ______ chance of being diagnosed with prostate cancer in their lifetime.
  • # 1 cancer in incidence, #2 in deaths; 5th leading cause of death in men over age 45
A

1 in 6

29
Q

is a protease formed by the epithelial cells of the prostate and keeps the semen in a liquefactive form
•Is increased by cancer but also by inflammation and BPH and used as a screen for cancer

A

•PSA

30
Q

Who should get screening for PSA

A

PSA blood tests and digital rectal exam and recommended annually for men over age of 50

•Increased Risk Factors Family Hx of Prostate Cancer African-American Men

Those with increased risk should have annual screening start at age 40

31
Q

Prostate cancer occurs (almost entirely) in the _____, a horseshoe-shaped part of the prostate that is posterior and thus is accessible to rectal palpation

A

peripheral zone

32
Q

How does the gleason grading of prostate cancer work?

A

Patterns of cancer range from 1 (well-differentiated) to 5 (poorly differentiated). In current practice we essentially don’t use patterns 1 and 2 because they have the same biologic potential as 3, so grading “starts” at 3.

33
Q

How are grades assigned in the Gleason system

A

Each prostate cancer on prostatectomy has more than one Gleason grade.
We recognize this heterogeneity by assigning a primary grade to the most common pattern and a secondary grade to the least common pattern.

The sum of these is the Gleason score, ranging from 3+3=6 to 5+5=10.

34
Q

Describe features of Grade 3 prostate cancer

A

small glands with infiltrative pattern

loss of double cell layer

glands are seperate, not fused

35
Q

Describe features of grade 4 prostate cancer

A

see prominent nucleoli; loss of glandular seperation

36
Q

What do we see and is concerning in grade 5 prostate cancer?

A

see single cells floating around

37
Q

What is our key consideration when doing prostate staging?

A

Whether the tumor has gotten outside the prostate or not is key consideration for management and prognosis

38
Q

Prostatic Carcinoma Spread

A
  • Has a special propensity to spread to seminal vesicles
  • Spreads first to external iliac lymph nodes (which may or may not be sampled at prostatctomy)
  • Low back/pelvic pain portends bony metastases to vertebra and pelvic bones
39
Q

What is the pattern of prostatic carcinoma spread in bones?

A

•Low back/pelvic pain portends bony metastases to vertebra and pelvic bones

  • Due to spread via the Batson venous plexus
  • Serum prostatic alkaline phosphatase is increased.
  • Due to osteoblastic metastases
  • Serum prostate specific antigen markedly increased
40
Q
A
41
Q

Staging of prostate cancer depends on:

A

spread outside the prostate

42
Q

Grading of prostate cancer depends on

A

glandular architecture

1st Repro (16 decks)

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