Gu Path - 2 - Prostate

Front 1

Know the structure of the prostate

Back 1

Robbins Text book

Front 2

Three main zones of the prostate

Back 2

Transitional – surrounds the urethra and extends anteriorly to the apex. Normally 20% of prostatic volume, but it can be 70% in BPH
Peripheral zone- posterior and lateral to the urethra. It is 60-65% of the prostate and is the site of most prostate cancer
Central zone – is superior, close to bladder base and is 5-10% of the prostate volume surrounding the urethra

Front 3

Glands from which 98% of prostate cancer develops ?

Back 3

Acinar Adenocarcinoma from acini (glands). There are two types of cells – inner secretory cell and outer basal cell layer

Front 4

Immunostains for basal cells, normal, hyperplastic and neoplastic prostate ?

Back 4

P63 and HMW-CK for basal cells
PSA and PSAP (phosphatase)for rest
IS for basal cells are used to differentiate b/w benign prostatic lesions that seem to mimic PC, however PSA and PSAP are used to determine prostate cancer, whether primary or metastatic

Front 5

Why are only 6 sextant biopsies taken in PC ?

Back 5

Because anything more than that influences the false negative rate based on the number of biopsy cores and length of needle core

Front 6

Prostatitis – risk factors

Back 6

BPH, bladder catheterization and prior invasive GU procedures. Usually no need to send for biopsy

Front 7

What is the prostatitis usually due to in old men ?

Back 7

Hyperplasia of the prostate causes urinary obstruction and stasis, predisposing them to UTIs from gram negative bacteria, enterococci or staph

Front 8

Itis Sx

Back 8

Symptoms -Fever, perineal pain, urgency, dysuria
Signs – Painful, swollen gland

Front 9

Chronic prostatitis ? Treatment ?

Back 9

Difficult to diagnose and treat. It can develop de novo or after bouts of bacterial infection.
It may or may not be symptomatic

Front 10

Granulomatous prostatitis

Back 10

It is non specific, and can occur in reaction to prostatic secretions in leaky prostatic ducts and acini. It can also occur in patients treated w/ intravesicle BCG for superficial bladder cancer – usually incidental finding here.

Front 11

When can infectious granulomatous prostatitis occur ?

Back 11

Exposure to TB or fungi in immunocompromised patients

Front 12

BPH or adenomyofibromatous hyperplasia (AFH) or nodular hyperplasia (NH) – Age,Risk factors, Causative agent, prevention

Back 12

20% of men above 40 yrs, 90% above 70
Dihydrotestosterone w/ some estrogens
BPH is not a risk factor for PC
Prepubertal castration

Front 13

Treatment for BPH ?

Back 13

Anti-androgens like Finasteride(Procar) and Alpha 1 adrenergic blockers (reduce SM tone of bladder)

Front 14

Gross, Micro for BPH ?

Back 14

Gross – pink yellow or gray nodules of various sizes in the transitional zone
Micro – Circumscribed nodules of medium to large closely packed glands with benign histology. Bland necrosis is seen in the infarcted areas and sometimes Squamous metaplasia is present between necrotic and viable tissue

Front 15

Atypical adenomatous hyperplasia

Back 15

A benign glandular proliferation that can histologically mimic cancer if sampled on needle biopsy. Occurs on the ednge of hyperplastic nodules. Acini are small, and may have only a patchy basal cell layer. Nuceli and Nucleoli are benign appearing and acini are clustered, not infiltrative

Front 16

Prostate cancer – epidemiology

Back 16

Most common non skin cancer and number 2 cause of cancer deaths in american men. Incidence increases with age. Less than 2% are <50 yrs. Peak is 65-76yrs.

Front 17

How do genetics, Environment and hormonal factors affect prostate cancer ?

Back 17

Genetics – first degree family hx, loss of cancer suppressor genes
Environmental factors – Low to high risk areas remains low risk only for that generation
Hormonal factors – androgen ablation causes tumor regression, prepubertal castration

Front 18

Tests for PC screening

Back 18

Serum PSA, DRE and TRUS – all three have less than optimal specificty and sensitivity. PSA can be elevated in variety of pathologies, and therefore modified versions of the PSA are being used for greater accuracy

Front 19

What are the findings suggestive of prostatic adenocarcinoma ?

Back 19

Intraluminal crystalloids and blue tinged mucus

Front 20

Precursor ?

Back 20

Prostatic intraepithelial neoplasia

Front 21

High grade PIN at low power and high power

Back 21

At low power they do not have infiltrative pattern, whereas at high power the cells resemble those of prostatic adenocarcinoma

Front 22

Gleason 1-2:

Back 22

Neoplastic acini are larger and only slightly infiltrative

Front 23

Gleason 3:

Back 23

Neoplastic acini are smaller, more infiltrative

Front 24

Gleason 4:

Back 24

Neoplastic acini are ragged and fused

Front 25

Gleason 5:

Back 25

More solid nests and sheets of tumor, comedo necrosis may be present

Front 26

Staging T1

Back 26

Tumor found incidentally on TURP specimen or on prostate bx for elevated PSA

Front 27

Staging T2

Back 27

Tumor confined to prostate gland, based on prostatectomy findings

Front 28

T3

Back 28

Tumor invades beyond the prostate, either extraprostatic extension or seminal vesicle involvement

Front 29

T4

Back 29

Direct extension of tumor to pelvic wall , bladder or rectum

Front 30

N0/N1

Back 30

When prostate cancer metastsizes to LN it usually goes to the pelvic nodes first

Front 31

M0/M1

Back 31

Hematogenous spread of prostate cancer is often to bones and typically axial skeleton with multiple osteoblastic lesions

Front 32

A man presents with osteoblastic bone metastasis, what cancer is it empirically ?

Back 32

Prostate

Front 33

Ductal Adenocarcinoma

Back 33

High grade cancer cells growing in and filling larger ductal spaces. There may be necrosis. It is in contrast to acinar adenocarcinoma in that it grows in a patter of very small glands.

Front 34

What about PSA is DA different about ?

Back 34

The PSA is released into the prostatic instead of the prostate stroma. Hence serum PSA is not elevated

Front 35

Urothelial carcinoma

Back 35

This can involve the prostate by direct extension from the urinary bladder. Involvement can also be from Carcinoma in Situ (CIS). We can prove that this cancer is not of prostatic origin by checking for PSA immunostain