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45 Cards in this Set
- Front
- Back
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What is benign prostatic hyperplasia?
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nodular enlargement of anterior/periurethral regions of hte prostate, can lead to urinary obstruction and irritative symptoms
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Who gets BPH?
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increases in frequency with age, usually begins in 60s
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What causes BPH?
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increasing age, higher levels of 5 alpha reductase
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Where does BPH occur?
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periurethral transition zone, leads to urinary obstruction
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What compresses the bladder neck and urethra?
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alpha adrenergic activity
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What are the symptoms of BPH?
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reduced caliber and force of urinary stream, hesitancy, dribbling
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How does BPH progress?
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initially the bladder musculature becomes hypertrophic, eventually detrusor decompensates, contributes to incomplete bladder infection
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What are the complications of BPH?
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frequency, nocturia, hydronephrosis, renal insufficiency, acute urinary retention
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What happens after acute urinary retention?
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acute renal failure
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Where does prostate enlargement generally occur?
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generally more central and anterior, harder to detect on rectal exam
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What does BPH look like grossly?
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enlarged, nodular expansion in periurethral zone
can be pink-tan and fleshy to gray and firm |
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What does BPH look like in histologic section?
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mixture of benign glands and fibromuscular stroma, stromal nodules, can have more cells
glands have large elongated profiles, two cell layers of secretory and basal cells eosinophilic strands, mild lymphoid infiltrate |
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What are the indications for treatment of BPH?
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obstructive symptoms, urinary retention,r enal insufficiency
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What is TURP?
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transurethral resection of the prostate, uses fiberoptic transurethral resectoscope and electrocautery
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What is finasteride?
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5 alpha reductase inhibitor, leads to reduction in prostate size, improved urine flow
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What do alpha blockers do?
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improve symptoms, esp irritative symptoms
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Who gets prostate cancer?
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men, esp AAs, North America and Northern Europe
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What gene is linked to prostate cancer?
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1q24-25
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How do hormones affect prostate cancer?
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testosterone may promote it
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From what does prostate cancer in the peripheral zone develop?
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from precursor non-invasive lesions
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How do you diagnose prostate cancer?
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transrectal biopsy, performed because of abnormal rectal exam, elevated PSA, both
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Where does prostate cancer occur most commonly?
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posterior and lateral regions
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Where does prostate cancer usually occur?
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posterior and lateral regions, peripheral zone
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What are normal PSA values?
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0-4 ng/ml
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What ratio of free to total PSA indicates the need for a biopsy?
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low ratio of free to toal and a high PSA
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How is PSA use after treatment?
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serum levels should fall to zero following prostatectomy
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What are the local symptoms of prostate cancer?
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urinary obstruction, hematuria
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To where does prostate cancer metastasize?
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pelvic lymph nodes, bones
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What are osteoblastic mets?
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local bone formation with opaque, radiodense, bone lesions on x-ray
prostate cancer until prove otherwise in elderly male |
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What is the prognosis of most prostate cancer picked up on TURP?
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good, usually transitional zone
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Where is high grade prostatic intraepithelial neoplasm usually found?
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peripheral zone
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What does prostate cancer look like grossly?
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difficult to see, firm, solid tan-gray, yellowish in back of gland
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What does prostate cancer look like in histo?
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small corwded or infiltrating glands with nuclear enlargement, prominent nucleoli
glands lose basal cell layer |
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What stains the basal cell layer of prostate glands?
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high molecular weight keratin
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What is the pattern of invasion in prostate cancer?
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infiltrative, perineural invasion in most high grade cancers
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What does it mean if you have high grade PIN?
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precursor for most prostate adenocarcinomas if the PZ
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What do you see with HGPIN?
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macronucleoli, more common with cancer than not
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How are prostate cancers graded?
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Gleason scale
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Upon what is the Gleason scale based upon?
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histologic architecture or pattern
primary and secondary scales |
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What Gleason score is low grade?
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2-4
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What Gleason score is intermediate grade?
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5-7
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What Gleason score is high grade?
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8-10
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What do you consider when thinking about treatment?
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presence of other illnesses, stage, grade
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How do you treat high grade prostate tumors?
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radical prostatectomy or radiotherapy
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How do you treat metastatic prostate cancer?
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radiotherapy, hormonal treatmetn
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