Prostate Pathology

Question 1

What are the 4 glandular compartments of the prostate?

Answer 1

Peripheral Zone (PZ)
Central Zone (CZ)
Transitional Zone (TZ)
Periurethral Gland Region

Question 2

From what part of the prostate do most cancers come from?

Answer 2

Peripheral Zone (PZ) - the part you can feel in a DRE.

Question 3

What does a zoomed-out view of normal prostate glands look like?

Answer 3

Glands follow a curvilinear pattern and originate from the urethra.

Question 4

How many endocrine cells does the normal prostate have? What should normally surround the glands?

Answer 4

“Few endocrine cells”

Glands sit in fibromuscular stroma.

Question 5

3 types of cells in a normal duct-acinar unit?

Answer 5

Secretory cells (cuboidal - columnar)
Basal cells (probs stem cells for secretory cells)
Endocrine/paracrine cells (hard to see normally)

Question 6

What 3 stains should you see on a normal prostate gland?

Answer 6

Keratin in the basal call layer.
Prostate-specific Actin in the epithelial cells.
Smooth muscle actin - illustrating that fibromuscular stroma surrounds the duct.

Question 7

Definition of benign prostatic hyperplasia (BPH): What proliferates? What symptoms?

Answer 7

Nodular prostate enlargement due to proliferation of:
Prostatic glands and stroma
Causes lower urinary tract symptoms (hard to pee).

Question 8

What do we know about BPH etiology?

Answer 8

Not much. Aging and family Hx are risk factors.

T and estrogen may be involved…

Question 9

Tx for BPH? (3 things)

Answer 9

Alpha adrenergic blocker.
5-alpha reducatse inhibitor (blocks T -> DHT).
Surgical.

Question 10

What does BPH look like macroscopically? (quality and location)

Answer 10

Nodules in TZ, submucosal compartment, mostly near proximal prostatic urethra.

Question 11

2 microscopic features of BPH?

Answer 11

Suburethral stromal nodules (i.e. hyperplasia of stromal cells)
Duct proliferation (but the ducts look normal)

Question 12

Where does prostate carcinoma (PCa) rank in terms of prevalence and lethality? (in the US)

Answer 12

Most common cancer in men.

2nd most lethal cancer (after lung cancer)

Question 13

3 risk factors for PCa?

Answer 13

Family Hx.
Increased age.
Diets rich in animal products / red meat?

Question 14

What’s the gold standard for PCa Dx?

Answer 14

Needle biopsy.

Question 15

What makes you want to get a needle biopsy to test for PCa? (2 things)

Answer 15

Increased serum PSA.

Abnormal DRE.

Question 16

What are 3 ways PCa can give you symptoms?

Answer 16

Obstructive bladder symptoms (if in TZ).
Pelvic pain (local extension).
Bone pain (metastases).

Question 17

What’s the traditional PSA serum level that merits needle biopsy?

Answer 17

4 ng / ml

it really has poor diagnostic value, though

Question 18

What is PSA actually? What does it do?

Answer 18

A serine protease that liquifies semen and enhances sperm motility.

Question 19

What was the “number needed to treat” at best for PSA screening? Conclusion?

Answer 19

need to screen 1000 to prevent 1 PCa death.

Risk from dealing with false positives outweighs benefit.

Question 20

PCa macroscopic features?

Answer 20

Hard, dense, yellow to yellow-tan, lacks necrosis / hemorrhage, infiltrative.

Question 21

What is PCa grading based on?

Answer 21

Architectural features of ducts seen in histology.

Question 22

What do nuclei look like in PCa?

Answer 22

Enlarged, open chromatin, nucleoli.

Question 23

What do malignant lumenal secretions look like?

Answer 23

Amorphous or crystalline eosinophilic.
Blue mucin (on H&E) also bad.

Question 24

What’s a luminal secretion that is more suggestive of a benign process?

Answer 24

Corpora amylacea (lamellar eosinophilic depositions)

Question 25

Collagenous micronodules: good or bad?

Answer 25

Bad.

Question 26

What are the 5 steps in Gleason grading?

Answer 26

1: Tightly packed, well-formed glands.
2: More space between well-formed glands.
3: Haphazard, irregular glands.
4. Cribiform plates, sheets with glandular lumens
5. Sheets of cells without any gland formation

Question 27

What are the numbers in the Gleason grade?

Answer 27

Primary (majority) grade + secondary (minority) grade.

5-6 has pretty good prognosis. Stuff over 7 is getting pretty bad.

Question 28

What are the American Joint Committe on Cancer PCa staging guidelines? (What do T1 - T4 mean?)

Answer 28

T1: Incidental (it exists…. but not a big deal)
T2: Confined to prostate
T3: Extending out of capsule / to seminal vesicle
T4: Invading adjacent structures

Question 29

What are the 3 subdivisions of T2?

Answer 29

T2A: 1/2 of one lobe or less
T2B: more than 1/2 of one lobe, not still in just one lobe
T2C: in more than one lobe.

Question 30

Most common cytogenic alteration in PCa?

Answer 30

Loss of chromosome 8p.

Question 31

Most common amplifications seen in PCa? (name 3)

Answer 31

MYC
NCOA2
AR (androgen receptor)

Question 32

Most common deletions seen in PCa? (name 2-3)

Answer 32

PTEN
P53
RB1
(and more….)