Prostate Pathology

Question 1

The prostate is broken up into zones

which zone do se wee cancer in?

BPH?

Answer 1

Central = Cancer

Transition = BPH

Question 2

is accessible to palpation on rectal exa m

Answer 2

Peripheral Zone (PZ)

Question 3

Describe normal prostate histology

Answer 3

double layer of cells: secreatory and basal

flat nuclie, lie at the edge of gland and these basal cells = normal and healthy basally located cells are absent in prostate cancer

Question 4

What are the three types of Prostatitis

Answer 4

acute

chronic

granulomatous

Question 5

may be due to prior instrumentation, or bacille Calmette-Guérin therapy for bladder cancer, or a number of other reasons

Answer 5

Granulomatous Prostatitis

Question 6

i. Intraprostate reflux of urine from the posterior urethra or urinary bladder

Answer 6

Acute prostatitis

Question 7

Pathogens involved in Acute Prostatitis

Answer 7

Rods

• E. coli, P. aeruginosa, K. pneumoniae

Question 8

Causes of chronic prostatitis

Answer 8

i. Majority are abacterial :Chronic bacterial infection

• Due to recurrent acute prostatitis

Question 9

Clincal findings of prostatitis

Answer 9

a. Fever (occurs in acute prostatitis).
b. Lower back, perineal, or suprapubic pain

c. Painful/swollen gland on rectal examination
d. Dysuria, hematuria

Question 10

What lab findings are seen in Prostatitis

Answer 10

can raise the serum PSA above normal (above 4.0 ng/mL)

Question 11

Agents responsible for acute prostatitis

Answer 11

E. coli

• Gram negative bacilli
• Gram positive cocci

Question 12

•Young Men with low back pain, fever, myalgia and tender swollen prostate

Answer 12

Acute Bacterial Prostatitis

Question 13

•Recurrent with associated urinary tract infections and same organism each culture; they are asymptomatic with calculi

Answer 13

Chronic Bacterial Prostatitis

Question 14

How do you diagnose prostatitis

Answer 14

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

Question 15

• Accounts for 95% of prostatitis
• Prostatitis without UTI or positive cultures

Answer 15

Chronic Nonbacterial Prostatitis

“Chronic Pelvic Pain Syndrome”

CPPS

Question 16

Possible organisms of chronic nonbacterial prostatitis and “chronic pelvic pain syndrome”

Answer 16

• Chlamydia trachomatis
• Ureaplasma urealyticum
• Trichomonas vaginalis

Question 17

Non infectious causes of granulomatous prostatitis

infectious causes:

Answer 17

• Infectious: Tuberculosis (hematogenous) and Fungal / mycotic (AIDS)
• Non-infectious: Post-surgical (biopsy site reaction) and Post-BCG (Bacille Calmette-Guérin) • Non-specific

Question 18

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

Answer 18

Benign Prostatic Hyperplasia (BPH)

Question 19

Causes bladder outlet obstruction (BOO) involving urinary

frequency, incomplete emptying, nocturia, dysuria

90% prevalence by age 80

Answer 19

Benign Prostatic Hyperplasia (BPH)

Question 20

BPH is an ______ process chiefly caused by _______

Answer 20

Is an androgen-dependent process

Chiefly caused by dihydrotestosterone (DHT)

Question 21

____ binds the AR with a 5-fold higher affinity than testosterone

The AR will upregulate the transactivation of target genes

Answer 21

DHT

Question 22

Role of PSA

Answer 22

Proteolytic enzyme

• Increases sperm motility
• Maintains seminal secretions in the liquid state

Question 23

PSA levels in BPH

Answer 23

ii. PSA is neither sensitive nor specific for BPH.
iii. PSA usually normal (0-4 ng/mL) but BPH can increase it to between 4 and 10 ng/mL, and rarely over 10 ng/mL

Question 24

Treatement option for BPH

Answer 24

TURP

trans urethral resection of Prostate; removal of excess tissue

Question 25

High-Grade Prostatic Intraepithelial Neoplasia (HGPIN) - -Men who already have elevated serum PSA have \_\_\_\_risk of cancer on repeat biopsy - -Additional finding of HGPIN on biopsy increases the risk up to \_\_\_\_ --By itself, does not raise serum PSA

Answer 25

20% 25%- 30%

Question 26

Cell lining gland space; have prominent nucleoli, clumpled chromatin; this is noninvasive precursor that can break through the matrix with metaleoproteases

Answer 26

High Grade PIN

Question 28

Prostate Cancer * Men have a ______ chance of being diagnosed with prostate cancer in their lifetime. * #1 cancer in incidence, #2 in deaths; 5th leading cause of death in men over age 45

Answer 28

1 in 6

Question 29

is a protease formed by the epithelial cells of the prostate and keeps the semen in a liquefactive form •Is increased by cancer but also by inflammation and BPH and used as a screen for cancer

Answer 29

•PSA

Question 30

Who should get screening for PSA

Answer 30

PSA blood tests and digital rectal exam and recommended annually for men over age of 50 •Increased Risk Factors Family Hx of Prostate Cancer African-American Men Those with increased risk should have annual screening start at age 40

Question 31

Prostate cancer occurs (almost entirely) in the \_\_\_\_\_, a horseshoe-shaped part of the prostate that is posterior and thus is accessible to rectal palpation

Answer 31

peripheral zone

Question 32

How does the gleason grading of prostate cancer work?

Answer 32

Patterns of cancer range from 1 (well-differentiated) to 5 (poorly differentiated). In current practice we essentially don’t use patterns 1 and 2 because they have the same biologic potential as 3, so grading “starts” at 3.

Question 33

How are grades assigned in the Gleason system

Answer 33

Each prostate cancer on prostatectomy has more than one Gleason grade. We recognize this heterogeneity by assigning a primary grade to the most common pattern and a secondary grade to the least common pattern. The sum of these is the Gleason score, ranging from 3+3=6 to 5+5=10.

Question 34

Describe features of Grade 3 prostate cancer

Answer 34

small glands with infiltrative pattern loss of double cell layer glands are seperate, not fused

Question 35

Describe features of grade 4 prostate cancer

Answer 35

see prominent nucleoli; loss of glandular seperation

Question 36

What do we see and is concerning in grade 5 prostate cancer?

Answer 36

see single cells floating around

Question 37

What is our key consideration when doing prostate staging?

Answer 37

Whether the tumor has gotten outside the prostate or not is key consideration for management and prognosis

Question 38

Prostatic Carcinoma Spread

Answer 38

* Has a special propensity to spread to seminal vesicles * Spreads first to external iliac lymph nodes (which may or may not be sampled at prostatctomy) * Low back/pelvic pain portends bony metastases to vertebra and pelvic bones

Question 39

What is the pattern of prostatic carcinoma spread in bones?

Answer 39

•Low back/pelvic pain portends bony metastases to vertebra and pelvic bones * Due to spread via the Batson venous plexus * Serum prostatic alkaline phosphatase is increased. * Due to osteoblastic metastases * Serum prostate specific antigen markedly increased

Question 41

Staging of prostate cancer depends on:

Answer 41

spread outside the prostate

Question 42

Grading of prostate cancer depends on

Answer 42

glandular architecture