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40 Cards in this Set

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list from superior (starting with bladder) to inferior (ending at urethra).
Bladder -> seminal vesicles -> base of the prostate -> apex of the prostate -> urethra
Prostatitis can be inflammatory/infectious; acute/chronic; bacterial/abacterial and are usually extensions from the bladder or urethra. name some common organisms.
Coliforms, GC, TB, Schistosoma (location dependent), Chlamydia, and ureaplasma
BPH is more common in what zone of the bladder?
central zone - reason for urinary problems
Prostatic cancer is found in what zone?
70% found in peripheral zone
describe the feel of BPH.
diffusely enlarged, boggy soft prostate, smooth, no nodules
Describe BPH microscopically.
hyperplasia of both epithelial and stromal elements. can see areas of infarction and squamous metaplasia.
List the clinical symtpoms of BPH.
urinary retention, obstruction, infection, hydroureter, hydronephrosis, renal failure, falls and bone fractures b.c of calcium imbalance
Name some common types of treatments for BPH.
5 alpha reducatase inhibitors (inhibit conversion of testosterone -> DHT); Alpha 1 adrenergic receptor blockers - reduce contraction
Does BPH predispose men to carcinoma?
NO
if prostate cancer were to spread, where would it go?
seminal vesicles, lymph nodes and bone
What grading system is used when staging prostate cancer?
Gleason Scoring System - addresses degree of differentiation and glandular pattern
Describe the Gleason System of grading prostate cancer.
needle biopsy cells have a Score ranging from 2-10 (most common is Grade3); First the cells are assigned a number between 1 and 5 (normal-1, most abnormal=5); then the 2 most common patterns that are seen are added together.
How is prostate cancer diagnosed?
rectal examination, biopsy, alkaline phosphatase (for bone mets), and PSA and bone scans
Typical tumors of a gleason score 2-4 are what?
small tumors, typically incidental
The majority of treatable CA are what Gleason score?
5-7 (I would assume anything <7)
Advanced cancer with an unlikely cure has what type of Gleason score?
8-10
What system is used for staging prostate cancer?
TNM system (Classification of Malignant Tumors); based on how the tumor is found and the extent of spread; T= size or extent of tumor; N=spread to regional lymph nodes; M=distant metastasis
Name the TNM staging. An incidental finding on biopsy.
T1a
Name the TNM staging. Incidental histologic finding in >5% of tissue resected.
T1B
Name the TNM staging. Lesion is localized within the prostate.
T2
Name the TNM staging. Tumor is identified by needle biopsy and was found in 1 or both lobes by needle biopsy but not palpable or visible by imaging.
T1c
Name the TNM staging. Local invasion.
T3
Name the TNM staging. Distant Spread.
T4
Name the TNM staging. No regional lymph node mets.
N0
Name the TNM staging. regional lymph nodes cannot be assessed.
NX - use "X" when not done or can't be done.
Name the TNM staging. mets in regional lymph node or nodes.
N1
Name the TNM staging. Distant mets can't me assessed.
MX
Name the TNM staging. more than 1 site of mets present.
pM1c (a prefix like "p" means that tissue for pathologic examination of a surgical specimen was done)
Name the TNM staging. no distant mets.
M0
Name the TNM staging. distant mets.
M1
Name the TNM staging. Nonregional LN.
M1a
Name the TNM staging. mets to bone.
M1b
Name the TNM staging. mets to other sites.
M1c
What are normal levels of prostate specific antigen?
0-4ng/mL (best way to determine risk is the amount of change or increase in PSA from year to yr)
One of the problems with PSA is that 20-40% of pts. with grade __ prostate cancer have values below 4ng/mL.
T2 (lesion localized within the prostate)
name some proposed modications to make the PSA more sensitive and specific.
use age-related cutoffs; race-specific reference ranges
recently, PSA is being measured in its bound and free forms. what does this tell us?
can tell the difference in mildly elevated PSA from cancer and those with BPH.
The lower the ratio free:total PSA, the _____ the likelihood of cancer.
higher; the risk of CA increases if the free to total ratio is low; the lower the ratio the greater the probability of CA.
A cutoff of ___% maximizes cancer detection and minimizes unnecessary biopsies.
22%