Male Pathology: Prostate Flashcards Preview

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Flashcards in Male Pathology: Prostate Deck (27)
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1
Q

What are the 4 zones of the prostate?

A
  • Anterior
  • Peripheral
    • Most cancers
    • Palpable on rectal exam
  • Central
  • Transition – BPH, some cancers
2
Q

What does a normal prostate look like on histology?

A
  • Double layer of cells
  • Secretory & basal
  • Double layer is absent in prostate cancer
3
Q

What are the benign conditions of the prostate?

A
  • Acute Prostatitis
  • Chronic Prostatitis
  • Granulomatous Prostatitis
4
Q

**Acute Prostatitis **

Definition

Presentation

Pathogens

A
  • Intraprostate reflux of urine from the posterior urethra or urinary bladder
  • Young men
  • Low back pain, fever, myalgia
  • Pathogens: rods (gram negative bacilli, gram positive cocci)
    • E. coli
    • P. aeruginosa
    • K. pneumoniae
5
Q

**Acute Prostatitis **

Clinical Findings

Serum Findings

A
  • Clinical Findings
    • Fever
    • Lower back, perineal or suprapubic pain
    • Painful/swollen gland on rectal exam
    • Dysuria, hematuria
  • Serum Findings
    • Raised serum PSA above normal
    • >4.0 ng/mL
6
Q

**Chronic Prostatitis **

Definition

Clinical Findings

A
  • Majority abacterial
  • Chronic bacterial infection (recurrent acute prostatitis)
  • Clinical Findings
    • Lower back, perineal or suprapubic pain
    • Painful/swollen gland on rectal exam
    • Dysuria, hematuria
7
Q

**Chronic Prostatitis **

Properties

A
  • Recurrent
  • Associated w/ UTIs
  • Same organism in each culture
  • Asymptomatic
  • Calculi
8
Q

Chronic Prostatitis

Serum Findings

Diagnosis

A
  • Serum Findings
    • Raised serum PSA above normal
    • >4.0 ng/mL
  • Diagnosis
    • 10-12 WBC/field in secretions/urine
    • Positive bacterial cultures
9
Q

What is Chronic Nonbacterial Prostatitis?

“Chronic Pelvic Pain Syndrome”

A
  • 95% of prostatitis
  • Prostatitis w/o UTI or positive cultures
  • Possible organisms
    • Chlamydia trachomatis
    • Ureaplasma urealyticum
    • *Trichomonas vaginalis *
10
Q

**Granulomatous Prostatitis **

Infectious

Non-Infectious

A
  • Infectious
    • Tuberculosis (hematogenous)
    • Fungal/mycotic (AIDS)
  • Non-infectious
    • Post-surgical (biopsy site rxn)
    • Post-BCG (Bacille Calmette-Guérin)
    • Non-specific
11
Q

How does Granulomatous Prostatitis present on histology?

A

Granuloma

  • Aggregate of histiocytes (MΦ)
  • Single to multiple nuclei
  • Chronic inflammation
12
Q

What are the neoplasms of the prostate?

A
  • Benign Prostatic Hyperplasia (BPH)
  • High Grade Prostatic Intraepithelial Neoplasia (HGPIN)
  • Prostatic Adenocarcinoma (Prostate Cancer)
13
Q

What is Benign Prostatic Hyperplasia?

What effect does it have on the bladder outlet?

A
  • Proliferation of glands and stroma in the transitional zone
  • Bladder outlet obstruction (BOO)
    • Urinary frequency, incomplete emptying, nocturia, dysuria
  • 90% prevalence by age 80
  • Androgen-dependent process
  • Chiefly caused by DHT
    • Binds to AR w/ 5X higher affinity than testosterone
14
Q

What is PSA?

How is this affected by BPH?

A
  • PSA can be mildly elevated
  • Proteolytic enzyme
  • Increases sperm motility
  • Maintains seminal secretions in the liquid state
  • PSA is neither sensitive nor specific for BPH
  • PSA is usually normal (0-4 ng/mL) but BPH can increase it to 4-10 ng/mL (rarely over 10 ng/mL)
15
Q
A

Nodular Benign Prostatic Hyperplasia

  • Nodules of hyperplastic glands & stroma
  • Urethra gaping – tissue removal by resection
  • Transurethral resection of nodules
16
Q

How does BPH present in histology?

A

Glandular nodules
Stromal nodule

17
Q

What is High Grade Prostatic Intraepithelial Neoplasia (HGPIN)?

A
  • Precursor to invasive cancer
  • Men w/ elevated serum PSA: 20% risk of cancer on repeat biopsy
  • Additional finding of HGPIN on biopsy increases the risk (25-30%)
  • By itself, _does not raise serum PSA _
18
Q

How does HGPIN present on histology?

A

High grade PIN: large nucleoli

  • Nuclear enlargement
  • Chromatin clumped
  • Prominent nucleoli
19
Q

Prostate Adenocarcinoma (Cancer)

Statistics

Presentation

A
  • Men have 1/6 chance of being diagnosed w/ in lifetime [#1 cancer incidence, #2 cancer deaths]
  • Prostate cancer occurs (almost entirely) in the peripheral zone
    • Horseshoe-shaped part of the prostate
    • Posterior & accessible to rectal palpation
    • Tumor >0.5cm = palpable
20
Q

Prostate Cancer

PSA

Screening

A
  • Prostate Specific Antigen (PSA)
    • Protease formed by epithelial cells of the prostate
    • Keeps the semen in a liquefactive form
    • Increased by cancer, inflammation, BPH
    • Used as screen for cancer
  • PSA Screening
    • PSA blood tests & digital rectal exam recommended annually for men >50 YO
    • Increased risk factors
    • FaHx of prostate cancer
    • African American men
    • Increased risk: start screening at age 40
21
Q

What is the Gleason Grading of Prostate Cancer?

A
  • 1 = well-differentiated
  • 5 = poorly differentiated
  • Primary grade = most common pattern
  • Secondary grade = least common pattern
  • Sum of grades = Gleason score (6-10)
22
Q

Histologic Grades of Prostatic Adenocarcinoma

A
  • Grade 1 = atypical adenomatous hyperplasia (benign)
  • Advised against using (not predictive of prostatectomy)
  • In needle biopsies, grades 3 & 4 the most common
23
Q

What grade of prostate cancer is this?

A

Grade 3

24
Q

What grade of prostate cancer is this?

A

Grade 4

*note fusion of glands

25
Q

What grade of prostate cancer is this?

A

Grade 5

*single cells

26
Q

Whether the tumor has ________ or not is KEY consideration for management & prognosis

A

gotten outside the prostate or not

27
Q

How does Prostate Cancer typically spread?

A
  • Special propensity to spread to seminal vesicles
  • Spreads first to external iliac lymph nodes
    • May or may not be sampled at prostatectomy
  • Low back/pelvic pain portends bony metastases to vertebra & pelvic bones
    • Spread via Batson venous plexus
    • Serum prostatic alkaline phosphatase increased
    • Osteoblastic metastases
    • Serum PSA markedly increased
  • Compression of the spinal cord