Reproduction L08 Prostate

Front 1

What are the 4-zone of the prostate that are clinically important?

Back 1

Peripheral, cnetral, transitional, periurethral

Front 2

What are the 2 major histologic components of the prostate?

Back 2

Glands and stroma

Front 3

Describe the two types of cells found in prostate glands

Back 3

Secretory cells: columnar (face the lumen)… (2) Basal cells: low cuboidal(surrounded by basement membrane)

Front 4

What is the stroma composed of? (hint: muscle)

Back 4

Modified smooth muscle and dense fibrous muscle

Front 5

Where is testosterone converted into DHT? What is the enzyme needed for the conversion? What is DHT?

Back 5

Where is testosterone converted into DHT? Stromal cells of prostate… (2) What is the enzyme needed for the conversion? 5∂ reductase… (3) What is DHT? Most potent androgen, which promotes stromal and androgen growth

Front 6

Name the 3-type of prostatitis

Back 6

Acute bacterial, chronic & non-Bacterial, and Granulomatous prostatitis

Front 7

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated mycobacteria, fungus and BCG?

Back 7

Infectious Granulomatous Prostatitis is associated with mycobacteria, fungus and BCG

Front 8

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated E.coli, other gram netative rods, Enterococci or staphylococci?

Back 8

Acute Bacterial Prostatis and chronic bacterial prostatitis are associated with E.coli, other gram netative rods, Enterococci or staphylococci

Front 9

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated wth inflamation, and infiltration of neutrophils, micorabscesses, and necrosis?

Back 9

Acute Bacterial Prostatitis is associated with inflamation, and infiltration of neutrophils, micorabscesses, and necrosis?

Front 10

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/Postbiopsy/Allergic) Granulomatous, is associated transurethral resection of prostate?

Back 10

Postbiobsy granulomas are seen in pts with a hx of transurethral resection of prostate

Front 11

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated recurrent infection due to harboring pathogens in the prostate?

Back 11

Chronic Bacterial prostatitis is associated recurrent infection due to harboring pathogens in the prostate?

Front 12

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated eosinophilia?

Back 12

Allergic Granulomatous Prostatitis is associated with Eosinophilia (and granulomatous inflammation of other organs)

Front 13

Which prostatitis, Acute bacterial, Chronic Bacterial&Non Bacterial, or (Infectious/Non-specific/postbiopsy/Allergic) Granulomatous, is associated urinary tract infections, inflammatory cells in prostate secretions, fever chills, dysuria, and tender boggy prostrate (w/DRE)

Back 13

Actue bacterial prostatitis is associated urinary tract infections, inflammatory cells in prostate secretions, fever chills, dysuria, and tender boggy prostrate (w/DRE)

Front 14

What is the cause of Non Bacterial prostatitis?

Back 14

unknown

Front 15

What is the cause of Non-specificGranulomatous?

Back 15

unknown

Front 16

Which is the most common Granulomatous prostatitis?

Back 16

Non specific granulomatous prostatitis is most common

Front 17

What ist he disease mechanism of BPH?

Back 17

"Enlargement of the gland Both glandular and stromal involvement --> Leading to formation of nodules --> leading to Large nodules compress urethra → leading to partial/complete obstruction

Front 18

What is the androgen involvement in BPH? What is the evidence for this?

Back 18

" Androgens → ↑ growth… evidence: ↓ 5∂ reducase → ↓ conversion of T → DHT --> improves symptoms

Front 19

What is the Estrogen involvement in BPH? (hint: give the mechanism)

Back 19

"Estrogen also plays a role in BPH --> Aging men have ↑ E -->Increases androgen receptors -->↑sensitivity to DHT

Front 20

What are the zones of involvement of BPH?

Back 20

periurethral and transitional zones are involved in BPH

Front 21

What is the nodular involvement in BPH?

Back 21

"Nodular involvement: compression of surrounding tissue -->pseudocapsule… Urethral walls encroachment by nodules --> leading to obstruction

Front 22

What is the general histology BPH? (hint, what is proliferating, glands or stroma?)

Back 22

Proliferation of both the glands and the stroma of the prostate

Front 23

In the UT obstruction seen with BPH, besides mechanical causes what else causes obstruction with BPH?

Back 23

In BPH, besides mechanical obstruction due to the size of the prostate, there is a DYNAMIC INCREASE IN MUSCLE TONE

Front 24

When are decreased bladder compliance, frequency, nocturia, and urgency seen in BPH

Back 24

Decreased bladder compliance, frequency, nocturia, and urgency are seen in later progression of BPH

Front 25

What are the 5 symptoms associated with BPH?

Back 25

"↓caliber, ↓ force, Hesitancy, Dribbling, Incomplete emptying

Front 26

Why are UTIs seen in BPH?

Back 26

BPH --> urine retention --> UTI

Front 27

What urinary tract sequelae arise from chronic obstruction due to BPH?

Back 27

"In BPH with chronic obstruction: Hydroureter (enlargement)

Front 28

What are the 3 medical Rx of BPH? And what effect do each have?

Back 28

"Rx for BPH: (1) 5 –alpha-reductase inhibitor (finasteride) --> DHT inhibition → ↓ prostate growth… (2) LHRH analogs (leuprolide), transient LH release w/ long term effect... (3) ∂ adrenergic blocker (which relax smooth muscle)

Front 29

Give 4 risk factors for adenocarcinoma of the prostate

Back 29

Family history, Race, increased exposure to androgens, high fat diet

Front 30

How much does having a first degree relative increase the risk to prostate cancer?

Back 30

1° increases a persons risk of developing prostate cancer by 1.5-2.4

Front 31

What effect does blocking androgens have on BPH and carcinoma of the prostrate?

Back 31

Blocking androgens cause involution of BPH and carcinoma of the prostrate?

Front 32

What diet lower one's risk, or raises one's risk, to prostate cancer?

Back 32

What diet lower one's risk: Cereals..., raises one's risk, to prostate cancer? Animal fat

Front 33

Which vitamin/minerals lower one's risk to prostate cancer?

Back 33

Which vitamin/minerals lower one's risk to prostate cancer? Vitamin D, beta-carotene, and Vit-A

Front 34

What is the sensitivity of a combination of DRE + TRUS in detecting prostate cancer?

Back 34

A combination of DRE + TRUS detects prostate cancer in only 1/3 of all cases.

Front 35

Which of the following is incorrect about BPH? Common > 50 y/o… risk increases w/ age… Not always clinical symptoms... increased risk of cancer

Back 35

BPH causes no increased risk of cancer

Front 36

"Which does the following description describe better, the BPH prostate glands or stroma: Fibroblastic/smooth muscle, Small blood vessels, and Myxoid (mucus-like) matrix… or Epithelial tufting & papillary projections into lumen
"

Back 36

With BPH, the composition of the stroma during BPH is composed of Fibroblastic/smooth muscle, Small blood vessels, and Myxoid (mucus-like) matrix… AND: the glands: have epithelial tufting & papillary projections into lumen

Front 37

What are the 3 medical Rx of BPH? And what effect do each have?

Back 37

"Rx for BPH: (1) 5 –alpha-reductase inhibitor (finasteride) --> DHT inhibition → ↓ prostate growth… (2) LHRH analogs:
--> Cause transient release of LH → exerts long-term effects (3) ∂ adrenergic blockers --> relaxes sm muscle
"

Front 38

Left Grade 1:
➢ Well-circumscribed
➢ Glands: compact regular & medium sized

Right: Grade 2:
➢ slightly infiltrated border and
➢ Glands: less regular & less compact, various sizes)

Back 38

Name the Gleason Pattern Grade (1-5) for the left side and right sides of this image (note, they are different grades)

Front 39

Gleason Grade 3:
➢ Infiltrating the stroma & between benign glands
➢ Glands: various shapes & sizes, w/ lumen & they are discrete (not fused)

Back 39

Name the Gleason Pattern Grade (1-5) for this image.

Front 40

Gleason Pattern Grade 5
➢ Solid nests OR individual turmor cells
➢ No glandular formation

Back 40

Name the Gleason Pattern Grade (1-5) for this image.

Front 41

Gleason Pattern Grade 4:
➢ Infiltrating like pattern 3
➢ Glands: less formed, fused and anastamosed

Back 41

Name the Gleason Pattern Grade (1-5) for this image.

Front 42

What is TRUS?

Back 42

TRUS is transrectal ultrasonography used to detect prostate cancer

Front 43

Give the ranges of PSA and what the ramification for these levels:

Back 43

Give the ranges of PSA and what the ramification for these levels: Normal <4 ng/mL… 4-10 ng/mL = 25-35% probablility of prostate carcinoma… >10 ng/mL = 42-64% probability of prostate carcinoma

Front 44

What percentage of PSA survey (where measurement are <4 ng/mL) is a false negative?

Back 44

What percentage of PSA survey (where measurement are <4 ng/mL) is a false negative? 30% are false negative === not great sensitivity

Front 45

What does PSA bind to ?

Back 45

PSA binds ∂-antichymotrypsin in the plasma

Front 46

Which gives greater specificity to prostate cancer, ↑bound PSA w/ ↓ free form → ↑ specificity or ↓bound PSA w/ ↑ free form → ↑ specificity

Back 46

↑bound PSA w/ ↓ free form → ↑ specificity to prostate cancer… which really just means that ↓ free form = improved specificity (greater likelihood of prostate cancer and not a false positive)

Front 47

If DRE, TRUS and PSA all test positive for prostate cancer, how do you confirm it?

Back 47

After (+) DRE, TRUS, and PSA --> Confirmation: transrectal needle biopsy

Front 48

Describe the glands in adenocarcinoma of the prostate: size, general description of gland it self, luminal cells, basal cells, nuclei, nucleoli.

Back 48

Describe the glands in adenocarcinoma of the prostate: size=SMALL-MEDIUM, general description of gland it self=COMPACT, luminal cells: SINGLE LAYER OF CUBOIDAL/LOW COLUMNAR, basal cells=NO BASAL CELLS, nuclei=LARGE+CLUMPY, nucleoli=PROMINENT.

Front 49

What does perineural invasion indicate?

Back 49

In the prostate, perineural infiltration is common in adenocarcinoma and helpful in dagnosis

Front 50

In diagnosis of prostate cancer, what pathology is seen at low and high magnification?

Back 50

Low: small - intermediate sized tumor, decreased stroma, infiltration… HIGH: loss of basal cells, large/clumpy nuclei, prominent nuclei

Front 51

What happens to the basal cells in adenocarcinoma of the prostate?

Back 51

the end up looking like luminal cells, thus it appears like the basal cells are absent.

Front 52

what is meant by infiltration in adenomacarcinoma of the prostrate?

Back 52

Infiltration = large sheets of tumor cells near benign glands of the prostate

Front 53

Match the Gleason pattern with the following description: slighly infiltrated, glands less regular & less compact with various sizes

Back 53

Gleason Pattern 2: slighly infiltrated, glands less regular & less compact with various sizes

Front 54

"Match the Gleason pattern with the following description: Infiltrating like pattern 3, with Glands: less formed, fused and anastamosed

Back 54

Gleason Pattern 4: infiltrating like pattern 3, but with Glands less formed, fused and anastamosed

Front 55

"Match the Gleason pattern with the following description: Solid nests OR individual turmor cells… No glandular formation

Back 55

Gleason Pattern 5: Solid nests OR individual turmor cells… No glandular formation

Front 56

"Match the Gleason pattern with the following description: Well-circumscribed… w/ Glands: compact regular & medium sized

Back 56

Gleason Pattern 1: Well-circumscribed… w/ Glands: compact regular & medium sized

Front 57

"Match the Gleason pattern with the following description: Infiltrating the stroma & between benign glands, w/ Glands: arious shape & size, w/ lumen & are discrete

Back 57

Gleason Pattern 3: Infiltration of the stroma & between benign glands, w/ Glands: arious shape & size, w/ lumen & are discrete

Front 58

Give an example of Gleason Scoring using two scores of 3 and 4

Back 58

Gleason score: 3+4=7/10

Front 59

Which Gleason score has a better prognosis? High or low?

Back 59

Low Gleason scores have a better prognosis

Front 60

"Which of the following are true of PIN (prostatic intraepithelial neoplasm): precancerous lesion, most carcinomas develop from PINs, found in 80% of biopsied carcinomas, no nuclear crowding

Back 60

Which of the following are true of PIN (prostatic intraepithelial neoplasm): frecancerous lesion, most carcinomas develop from PINs, found in 80% of biopsied carcinomas, no NUCLEAR CROWDING… FALSE, YES there is nuclear crowding

Front 61

"Which of the following are true of PIN (prostatic intraepithelial neoplasm): heaped up epithelium lining ducts, doesn't lead to adenocarcinoma of the prostoate, no stromal invasion, no basal cells (no basal cells in invasive carcinoma)

Back 61

Which of the following are true of PIN (prostatic intraepithelial neoplasm): heaped up epithelium lining ducts, doesn't lead to adenocarcinoma of the prostoate-FALSE MOST CARCINOMAS DO DEVELOP FROM PIN, no stromal invasion, no asal cells FALSE - THERE ARE BASAL CELLS with PIN(no basal cells in invasive carcinoma)

Front 62

T/F PSA is only associate with prostate cancer, but is also seen in BPH.

Back 62

TRUE

Front 63

What are the 4 factors of staging for prostate cancer?

Back 63

"1. Amount of prostate involvement (1 lobe vs 2 lobe)… 2. Confined to prostate… 3. Lymph node… 4. Metastasis

Front 64

Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): microscopic, not palpable, confined to prostate

Back 64

Stage A: microscopic, not palpable, confined to prostate

Front 65

Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): palpable tumor, confined to prostate

Back 65

Stage B: palpable tumor, confined to prostate

Front 66

Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): Lymph node of distant metastasis

Back 66

Stage D: Lymph node of distant metastasis

Front 67

Match the following with the appropriate stage of prostatic adenocarcinoma (A,B,C,D): Tumor extending beyond prostatic capsule

Back 67

Stage C: Tumor extending beyond prostatic capsule

Front 68

T/F: Radical prostatectomy is the gold standard for localized adenocarcinoma confined to prostate. What are the complication of Radical prostatectomy

Back 68

True: Radical prostatectomy is the gold standard for localized adenocarcinoma confined to prostate. (2) What are the complication of Radical prostatectomy: incontinence and impotence

Front 69

Is Radical prostatectomy with complete removal curative?

Back 69

Radical prostatectomy with complete removal IS curative.

Front 70

How is Radiation used in prostatic adenocarcinoma?

Back 70

"How is Radiation used in prostatic adenocarcinoma? (1) Alternative to radical prostectomy… (2) Adjunct to radical prostectomy (for residual or aggressive dz)

Front 71

What are the 5 approaches to Hormonal Rx?

Back 71

Orchietomy (castration), Inhibit GnRH, Inhibit androgen synthesis, Inhibit androgen binding to androgen receptor, Inhibit 5∂-reductase

Front 72

Name the 3 drugs used to inhibit GnRH.

Back 72

"GnRH inhibitors: ➢ Estrogen, Leuporlide, LHRH analog

Front 73

Why does hormone induced remission sometimes fail with hormone Rx?

Back 73

Why does hormone induced remission sometimes fail with hormone Rx? Tumor ultimately progresses due to eventual emergence of testosterone insensitive clones.

Front 74

In the past chemotherapy had been unsuccessful with prostatic adenocarcinoma, when is it used?

Back 74

In the past chemotherapy had been unsuccessful with prostatic adenocarcinoma, when is it used? Chemo is used for hormonal refractile metastatic (hormonal resistant cancer)

Front 75

In post-op surveilance, (1) does an increase in PSA indicate re-emergence of a tumor? (2) Which is a better prognosis, short or long interval for PSA rise after surgery. (3) which is a better prognosis, short or long doubling time for PSA?

Back 75

In post-op surveilance, (1) does an increase in PSA indicate re-emergence of a tumor? NOT NECESSARILY CLINICALLY SIGNFICIANT... (2) Which is a better prognosis, short or long interval for PSA rise after surgery. LONG... (3) which is a better prognosis, short or long doubling time for PSA? LONG