The prostate

Question 1

Which zone is where most cancer arises?

Answer 1

Peripheral zone

Question 2

Which zone is where BPH arises?

Answer 2

Transition zone

Question 3

Which zone is palpable on rectal exam?

Answer 3

Peripheral zone

Question 4

Answer 4

Normal Prostate

Question 5

Prostatitis

Answer 5

Acute - due to irritants, infection

Chronic

Granulomatous - d/t prior instrumentation, or bacille Calmette-Guerin therapy for bladder cancer

Question 6

What causes acute prostatitis?

Answer 6

Intraprostate reflux of urine from the posterior urethra or urinary bladder

Pathogens: E. coli, P. aeruginosa, K. pneumoniae

Question 7

What causes chronic prostatitis?

Answer 7

Majority are abacterial

Chronic bacterial infection - d/t recurrent acute prostatitis

Question 8

Clinical findings with acute prostatitis

Answer 8

Fever

Low back, perineal or suprapubic pain

Painful/swollen gland on rectal exam

Dysuria, hematuria

Serum findings = can raise serum PSA above normal (above 4.0 ng/mL)

Question 9

What makes the diagnosis of chronic bacterial prostatitis?

Answer 9

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

Question 10

What is chronic pelvic pain syndrome?

Answer 10

Accounts for 95% of prostatitis

Prostatitis without UTI or positive cultures

Possible organisms – Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis

Question 11

Answer 11

Chronic prostatitis

Question 12

What can cause granulomatous prostatitis?

Answer 12

Infection: tuberculosis (hematogenous), fungal/mycotic (AIDS)

Non-infectious: post-surgical (biopsy site reaction), post-BCG (Bacille Calmette-Guerin), non-specific

Question 14

Answer 14

Granulomatous Prostatitis

Aggregate of histiocytes aka macrophages

Question 15

BPH - Benign Prostatic Hyperplasia

Answer 15

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

Causes BOO, involving urinary frequency, incomplete emptying, nocturia, dysuria

90% prevalence by age 80

Androgen-dependent process – mostly caused by DHT

Question 16

What is mildly elevated in BPH?

Answer 16

Prostate-specific antigen (PSA) – Proteolytic enzyme, increases sperm motility, maintains seminal secretions in the liquid state

PSA usually between 4-10 ng/mL with BPH

Question 17

Answer 17

BPH

Question 19

What is the precursor to invasive cancer?

Answer 19

High grade prostatic intraepithelial neoplasia (HGPIN)

Question 20

Answer 20

High Grade PIN: Large nucleoli

Has not broken through BM

Question 21

How common is prostate cancer?

Answer 21

1 cancer in incidence

Men have a 1 in 6 chance of being diagnosed with prostate cancer in their lifetime

5th leading cause of death in men over age 45

Question 22

What is PSA?

Answer 22

Protease formed by epithelial cells of the prostate

Keeps the semen in a liquefactive form

Is inreased by cancer but also by inflammation and BPH

Used as screen for cancer

Question 23

Who should be screened with a PSA?

Answer 23

Men over the age of 50

High risk men - african american or family history of prostate cancer at age 40

Question 24

What part of the prostate does cancer occur in?

Answer 24

the PERIPHERAL zone – horseshoe-shaped part that is posterior and accessible to rectal palpation (provided the tumor is >0.5 cm)

Question 25

What is the Gleason Grading of prostate cancer?

Answer 25

Patterns of cancer ranging from 1 (well-differentiated) to 5 (poorly differentiated)

Grading starts at 3 because 1 and 2 have the same biological potential

Each prostate cancer on prostatectomy has more than one Gleason grade

Primary grade to the most common pattern

Secondary grade to the least common pattern

The sum of these is the Gleason Score (ranges from 6 - 10)

Question 26

Answer 26

Low grade (3) cancer on biopsy

Question 27

Answer 27

Grade 4 cancer - note fusion of glands

Question 28

Answer 28

Highest grade 5 cancer

Question 29

How does prostatic carcinoma spread?

Answer 29

Spread to the seminal vesicle

Spreads first to external iliac lymph nodes

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