The prostate Flashcards
Which zone is where most cancer arises?
Peripheral zone
Which zone is where BPH arises?
Transition zone
Which zone is palpable on rectal exam?
Peripheral zone
Normal Prostate
Prostatitis
Acute - due to irritants, infection
Chronic
Granulomatous - d/t prior instrumentation, or bacille Calmette-Guerin therapy for bladder cancer
What causes acute prostatitis?
Intraprostate reflux of urine from the posterior urethra or urinary bladder
Pathogens: E. coli, P. aeruginosa, K. pneumoniae
What causes chronic prostatitis?
Majority are abacterial
Chronic bacterial infection - d/t recurrent acute prostatitis
Clinical findings with acute prostatitis
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)
What makes the diagnosis of chronic bacterial prostatitis?
10-12 wbc/field in secretions/urine and/or positive bacterial cultures
What is chronic pelvic pain syndrome?
Accounts for 95% of prostatitis
Prostatitis without UTI or positive cultures
Possible organisms – Chlamydia trachomatis, Ureaplasma urealyticum, Trichomonas vaginalis
Chronic prostatitis
What can cause granulomatous prostatitis?
Infection: tuberculosis (hematogenous), fungal/mycotic (AIDS)
Non-infectious: post-surgical (biopsy site reaction), post-BCG (Bacille Calmette-Guerin), non-specific
Granulomatous Prostatitis
Aggregate of histiocytes aka macrophages
BPH - Benign Prostatic Hyperplasia
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
What is mildly elevated in BPH?
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
BPH
What is the precursor to invasive cancer?
High grade prostatic intraepithelial neoplasia (HGPIN)
High Grade PIN: Large nucleoli
Has not broken through BM
How common is prostate cancer?
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
What is PSA?
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
Who should be screened with a PSA?
Men over the age of 50
High risk men - african american or family history of prostate cancer at age 40
What part of the prostate does cancer occur in?
the PERIPHERAL zone – horseshoe-shaped part that is posterior and accessible to rectal palpation (provided the tumor is >0.5 cm)
What is the Gleason Grading of prostate cancer?
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)
Low grade (3) cancer on biopsy
Grade 4 cancer - note fusion of glands
Highest grade 5 cancer
How does prostatic carcinoma spread?
Spread to the seminal vesicle
Spreads first to external iliac lymph nodes
Low back/pelvic pain portends bony metastases to vertebra and pelvic bones
