Prostate Pathology: Norton Flashcards
what are the 4 zones of the prostate
- peripheral
- central
- transitional
- anterior fibromuscular stroma
what zone of the prostate is the most common site for carciomas? hyperplasia?
carcinoma: peripheral
hyperplasia: transitional
What are the 2 layers that line the prostate gland
- basal layer of cuboidal epithelium
2. inner layer of columnar secretory epithelium
What separates the prostate glands
fibromuscular stroma
What role does prostatic fluid play
protects and increases motility of sperm
what control growth and survival of prostate cells
testicular androgens
what are 3 pathological processes that occur in prostate
- inflammation
- Benign prostatic hyperplasia (BPH)
- protsatic hyperplasia
What are 4 types of prostate inflammation
acute bacterial prostatitis
chronic bacterial prostatitis
chronic abacterial prostatitis
granulomatous prostatitis
what are common bacteria that cause acute bacterial prostatitis
same as UTI
- E.coli
- other gram -
- enterococci
- staph
clinical features of acute bacterial prostatitis
fever
chills
dysuria
prostate TENDER
what is the urinalysis for acute bacterial prostatitis
positive leucocytes
positive bacteria
clinical features of chronic bacterial prostatitis
mild symptoms back pain dysuria pernieal and suprapubic discomfort asymptomatic
a male with chronic bacterial prostatitis may have a history of what
recurrent UTI
urinalysis for chronic bacterial prostatitis
positive leucocytes
positive bacterial
What is the most common form of prostatitis
chronic abacterial prostatitis
urinalysis of chronic abacterial prostatitis
positive leucocytes
negative bacterial culture
clinical symptoms for chronic abacterial prostatitis
similar to chronic bacterial prostatitis
How can a male get Granulomatous prostatitis
from Bacillus Calmette-Guerin (BCG) instilled into bladder to treat superficial bladder cancer
what is the main prostate hormone
DHT dihydrotestosterone
What converts testosterone to DHT
type 2
5 alpha reductase
What does DHT bind to in prostate
androgen receptors on nuclei of stormal and epithelial cells
What is the etiology of BPH ( benign prostatic hyperplasia)
increased number of epithelial cells and stromal components influenced by DHT
Benign prostatic hyperplasia originates in what part of the prostate
transition zone (periurethral)
What are late and early nodules of prostate in BPH composed of
early: stromal cells
late: epithelial cells/glands
What is a clinical feature for benign prostatic hyperplasia
urethral obstruction causes
- bladder hypertophy and distension
- urine retention
- sudden acute urinary retention
what are some conservative treatment options for benign prostatic hyperplasia
decrease fluids before bedtime
decrease caffeine and alcohol
what are 2 medication options for moderate to severe symptoms of BPH
- alpha blockers
2. 5-alpha reductase inhibitors
How do alpha-blockers help with BPH
decrease smooth muscle tone
how do alpha blockers help with BPH
decrease smooth muscle tone
what is a surgical option for BPH
transurethral resection of prostate
What type of diet can give you a greater risk for prostate adenocarcinoma
high fat diet
What are 3 things that can cause prostate adenocarcinoma
diet
androgens
genetics
What is a precursor lesion to prostate adenocarcinoma
porstate intraepithelial neoplasia (PIN)
prostate intraepithelial neoplasia is seen in what zone
peripheral zone
how do PIN glands differ from prostate adenocarcinoma
- larger than cancer glands with branching/folding
- surrounded by patchy layer of basal cells and intact basement membrane
what is histo for prostate adenocarcinoma
- glands small
- croweded
- no branching/folding
- no stroma
- “back-to-back” glands
What lines the glands in prostate adenocarcinoma
single layer of cuboidal or columnar cells
OUTER BASAL CELL LAYER IS ABSENT
where does prostate adenocarcinoma spread to
periprostatic tissues
seminal vesicles
base of bladder
what are 2 routs of mestastasis for prostate adenocarcinoma
lymphatics
blood
if prostate adenocarcinoma mets via lymph , where does it go
obtruator nodes then to paraaortic nodes
if prostate adenocarcinoma mets via blood, where does it go? what is formed?
bones
- lumbar spine
- proximal femur
- thoracic spine
- ribs
forms osteoblastic lesions
how is prostate adnenocarcinoma scored
adding 1. prominent pattern 2. second most prominent pattern OR 1. prominent pattern 2. highest grade pattern
what is the lowest grade for prostate adnenocarcinoma
gleason 1
what is the highest grade for prostate adnenocarcinoma
Gleason 5
What are 2 methods that detect what is the lowest grade for prostate adnenocarcinoma
- digital rectal exam (DRE)
2. tranrectal ultrasonography
what confirms diagnosis of prostate adenocarcinoma
transrectal needle biopsy
what is clinical feature of local prostate cancer
asymptomatic
- later urinary symptoms
- back pain
for prostate adnenocarcinoma what is most important test for screening
PSA
prostate specific antigen
what is most common treatment for localized prostate adnenocarcinoma
surgery: radical prostatectomy
what are treatment options for prostate adnenocarcinoma
radiation
hormone manipulation
acute surveillance of PSA
