Prostate Pathology Flashcards by Kirsten Davis

what is the cause of benign prostatic hyperplasia?

age

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what are the clinical features of BPPH?

Lower Urinary Tract Symptoms
Voiding symptoms
Storage symptoms
Post-micturition: dribbling

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what are the examination findings of BPPH?

Benign prostate will always feel smooth on DGE + PR

* Abdo exam may show palpable bladder

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what are lower urinary tract symptoms?

nocturia, frequency, urgency, post-micturition, dribbling, poor stream/flow, hesitancy, overflow incontinence, haematuria, bladder stones, UTI

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what are obstructive voiding symptoms?

weak or intermittent urinary flow, straining, hesitancy, terminal dribbling and incomplete emptying

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what are the complications of BPPH?

urinary tract infection, retention, obstructive uropathy, stones

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what are the microscopic features of BPPH?

hyperplasia of both the connective (stromal) tissue, and of the glandular (epithelial) tissue

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what is the pathophysiology of BPPH?

Benign nodular or diffuse proliferation of musculofibrous and glandular layers of the prostate – smooth
o Nodules particularly around prostatic urethra = bladder symptoms

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what part of the prostate does BPPH occur in?

transitional zone

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What investigations are done for BPPH diagnosis?

PR exam
PSA
Urine MC+S and dipstick
Bloods: U&E, LFTs
Transrectal US +/ biopsy
Also: Bladder scan, Renal Ultrasound, Cystoscopy, Urine flow analysis, Pressure Study

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what is the management of BPPH?

Lifestyle: avoid caffeine, alcohol, large fluid intakes, avoid constipation, bladder training
Drugs: alpha blockers – tasulosin, alfuzosin, doxazosin
5α reductase – finasteride 5mg/d PO
Surgery

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what is the surgical management of BPPH?

o Transurethral resection of prostate (TURP)
o Transurethral incision of prostate (TUIP)
o Retropubic prostatectomy
o Transurethral laser-induced prostatectomy (TULIP)

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what are the risk factors associated with prostate cancer?

old age, obesity, high fat/low fibre

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what genetic mutations are associated with prostate cancer?

BRCA 1, BRCA 2

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what is the most common kind of prostate cancer?

adenocarcinoma

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what are the other types of prostate cancer?

transitional cell carcinoma (transitional zone), small cell prostatic cancer (neuroendocrine cells)

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which part of the prostate does cancer normally occur?

peripheral zone - basal and luminal cells

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what is the pattern of growth of prostate cancer?

o Pattern of growth starts with local extension through prostatic capsule (seminal vesicles, bladder, rectum, urethra)

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what is the lymphatic spread of prostate cancer?

obturator nodes

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how does prostate cancer metastasise?

o Hemogenic Spread – skeleton

o Perineural invasion along autonomic nerves

what are the clinical features of prostate cancer?

Asymptomatic
Lower Urinary Tract Symptoms
Also: haematuria, haematospermia, incontinence, perineal or suprapubic pain, impotence, rectal pain and tenesmus, UTI
Weight loss +/- bone pain suggests mets

what will a prostate cancer feel like in DRE?

asymmetrical, nodule, fixed craggy mass

what investigations are used for prostate cancer diagnosis?

DRE
PSA
TRUS biopsy
Imaging - xray, bone scan, CT, MRI

how are prostate cancers staged?

MRI - Gleasons scoring and TNM

what is PSA?

prostatic specific antigen is a glycoprotein enzyme reduced by secretory epithelial cells and is involved in liquefaction of semen

what are PSA levels in prostate cancer?

PSA serum level raised

When else might PSA serum levels be raised?

prostatitis, UTI, BPH, DRE

what is the management of prostate cancer confined to prostate?

o Radical prostatectomy – if <70 years o Radical radiotherapy (+/- neoadjuvant & adjuvant hormone therapy) o Hormone therapy o Active surveillance if >70 and no symptoms o Cryotherapy?

What is the management of metastatic prostate cancer?

Hormonal Drugs  LHRH agonists – goserelin  Anti-androgen – cyproterone acetate, bicalutamide  LNRH antagonist – degarelix Also?:bilateral subcapsular orchidectomy, diethylstilboestrol/steroids cytotoxic cryotherapy

what is the mechanism of action of LHRH agonists?

Down regulation of LHRH receptors with subsequent suppression of pituitary LH and FSH secretion + testosterone production (initially can cause raised LH and FSH)

what are examples of LHRH agonists?

busarelin, goserelin, histrelin, leuprolein

what are the side effects of LHRH?

loss of libido, hot flushes + sweats, weight gain, gynaecomastia, anaemia, cognitive changes, osteoporosis

what is the mechanism of action of anti-androgens?

Compete with testosterone and DHT for binding sites on their receptors in prostate cell nucleus, promoting apoptosis + inhibiting CaP growth

What are the two types of anti-androgens?

Steroidal, Non-Steroidal

What are examples of steroidal anti-androgens?

cyproterone acetate

What are examples of non-steroidal anti-androgens?

nilutamide, flutamide, bicalutamide

what are the side effects of steroidal anti-androgens?

loss of libido, erectile dysfunction, gynaecomastia, CVS and hepato toxicity

what are the side effects of non-steroidal anti-androgens?

gynaecomastia, breast pain, flushes, hepatotoxicity | libido maintained

what are the types of prostatitis?

* Acute Bacterial Prostatitis * Chronic Bacterial Prostatitis * Chronic Prostatitis * Asymptomatic Inflammatory Prostatitis

what are the risk factors to developing prostatitis?

Hx of STI, Hx of UTI, Indwelling catheter, Post procedure – e.g. post prostate biopsy, age, Diabetes mellitus, Immunosuppression

what organisms are causes of bacterial prostatitis?

o Gram negative organisms – such as E. coli, enterobacter, serrate, pseudomonas, proteus o Sexually transmitted organisms – neisseria gonorrhoea, chlamydia o Rarely – tuberculosis

what are the non-bacterial causes of prostatitis?

o Increase prostatic pressure o Pelvic floor myalgia o Emotional causes o Infection with unknown organism o Immune reaction to antigen from previous infection o Pelvic nervous system dysfunction o Mechanical issue causing retention of prostatic fluid

what are the clinical features of acute bacterial prostatitis?

UTI like, Retention, Pain | Hamatospermia, Swollen/boggy prostate on DRE, Inguinal lymphadenopathy, Urethral discharge, Systemic

what are the clinical features of chronic bacterial prostatitis?

Symptoms as acute bacterial but >3months More gradual in onset, may be non-specific Prostate exam normal

what are the clinical features of chronic non-bacterial prostatitis?

pain with or without urinary symptoms | Chronic illness with acute exacerbations

what is the diagnostic criteria for chronic non-bacterial prostatitis?

Pelvic discomfort or pain >3 months duration Negative urine and prostatic fluid culture Leukocytes may present in prostatic fluid

what is the management of acute bacterial prostatitis?

Analgesia | Antibiotics – levofloxacin, consider STI cover

what is the management of chronic bacterial prostatitis?

Analgesia | Antibiotics

what is the management of chronic non-bacterial prostatitis?

Analgesia Antibiotics Alpha Blockers Stress management