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40 Cards in this Set

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Approx weight of a normal prostate? Of a prostate with BPH?
20 grams. 60-200 grams.
What are the three zones of the prostate?
Transition zone
Peripheral zone
Central zone
What zone in the prostate surrounds the urethra?
The transition zone
What zone in the prostate surrounds the ejaculatory ducts?
The central zone
What cells of the prostate secrete a significant component of the seminal fluid?
The tubulo-alvelor glands.
The tubular-alveolar glands of the prostrate are separated by what?
"An abundant fibromuscular stroma"
What are the two cell types of the tubulo-alveolar glands of the prostate?
Basal cells covered by a layer of columnar mucus secreting cells (epithelial cells).
What are two substances that the epithelial cells of the tubulo-alveolar glands of the prostate produce?
PSA (prostate specific antigen) and PAP (prostate acid phosphatase).
What is a substance that the basal cells of the tubulo-alveolar glands of the prostate produce?
High molecular weight cytokeratin (but not PSA or PAP)
Does the prostate have a true capsule?
No, it is a "peripheral condensation of fibromuscular stroma."
What are the two most common begnign prostatic diseases?
1. Benign prostatic hypertrophy
2. Prostatitis
What is the characteristic morphology of benign prostatic hypertrophy?
Characterized by glandular and stromal hyperplasia resulting in the formation of large nodules in the transition zone.
BPH is extremely common in what demographic?
In men over 60.
What is considered to be the "ultimate mediator of prostate growth"?
Dihydrotestosterone
In what zone of the prostate does BPH occur?
In the transition zone. (The hypertrophy in the transition zone compresses the urethra and the peripheral zone)
BPH: clinical symptoms
Compression of the urethra -->
Trouble emptying bladder
Urinary frequency
Trouble starting and stopping urination
Nocturia

Retention of urine --> distention, hypertrophy of the bladder, infection
BPH: Surgical treatment
Transurethral resection
BPH: Medical treatment
Blocking the action of androgens by preventing conversion to active form
What are the three different classifications of prostatitis?
1. Bacterial prostatitis
2. Nonbacterial prostatitis
3. Granulomatous prostatitis
The types of organisms that cause prostatitis are similar to those that cause what other type of infection?
UTIs
Bacterial prostatitis: clinical symptoms
- Fever and chills
- Lower back and perineal pain
- Dysuria
- Swollen, boggy, tender prostate
Bacterial prostatitis: lab values
- Urine culture positive (gram negative bacteria, 80% E. coli), > or = to 10 WBCs per high powered field.
- Leukocytosis
Bacterial prostatitis: treatment
ABX
Bacterial prostatitis: microscopic presentation
- Neutrophils
- Abcesses

*** for more see page 9
Chronic bacterial prostatitis: clinical presentation
- Recurrent UTIs (cystitis, urethritis)

- Swollen, boggy prostate

- Urine culture positive, > or = to 10 WBCs/high powered field. Leukocytosis.
Chronic bacterial prostatitis: Treatment
ABX
Chronic bacterial prostatitis: microscopic presentation
Lymphocytes in the lumina and epithelium.

Often associated with atrophy.

*** For more, see page 10
Nonbacterial prostatitis: Clinical presentation
- NO recurrent UTIs
- Low back pain, perineal pain
- Dysuria
- Rectal exam may be NORMAL!
- Urine culture NEGATIVE AND > or = to 10 WBCs/high powered field.
Nonbacterial prostatitis: May occasionally find what on urine culture?
Mycoplasma, chlamydia
Nonbacterial prostatitis: microscopic presentation
Microscopic presentation is the same as chronic bacterial prostatitis.
Nonspecific granulomatous prostatitis: Rectal exam
Nodular and hard, suspicious of carcinoma
Nonspecific granulomatous prostatitis: Clinical presentation
Obstructive symptoms
Recurrent infections
Age 50-70
Nonspecific granulomatous prostatitis: Pathogenesis
Duct obstruction --> accumulation of secretions --> rupture --> tissue response to leaked material.

Often associated with hyperplasia
Nonspecific granulomatous prostatitis: granuloma formation
No discrete granuloma formation
Post-transurethral Resection Granulomatous prostatitis: Clinical presentation
May be found in the prostate from 9 days up to 52 months following transurethral resection.

"Not clinically significant"
Post-transurethral Resection Granulomatous prostatitis: Pathogenesis
A reaction to aletered epithelium and stroma from the trauma of diathermic cautery.
Post-transurethral Resection Granuloma of the Prostate: Microscopic findings.
- Central zone of fibrinoid necrosis
- Rim of palisades epithelioid histocytes
- Varied number of multinucleated giant cells
What is BCG used for?
For treatment of superficial urothelial bladder carcinoma (most common cancer of the bladder)

Delays the recurrency of superficial urothelial bladder carcinoma.
What is the reaction of the body if BCG is injected.
Granuloma formation.
Post-BCG Treatment Granulomas of the Prostate: Clinical presentation
- Follows BCG treatment for superficial urothelial bladder carcinoma

- Fever, mild hematuria, urinary frequency

- 40% have abnormal rectal exam
- 55% have abnormal ultrasonographic abnormalities.

- PSA is elevated