1.4.3 Prostate Pathology

Question 1

What type of prostatitis?

Answer 1

Chronic

Question 2

What this be?

Answer 2

Prostatic adenocarcinoma

Question 3

Right? Left?

Answer 3

Right: BPH

Left: Normal

Question 4

What yo got, doc?

Answer 4

Prostatic adenocarcinoma

Question 5

What is the current cutoff level for PSA levels? What % of adenocarcinoma is below this level?

Answer 5

4 ng/mL; 20-40%

Question 6

What are the blue and black arrows pointing at?

Answer 6

Blue: benign

Black: malignant

Question 7

Identify the two cell types?

Answer 7

Top: Secretory

Bottom: Basal

Question 8

What symptoms are present in localized prostate cancer?

Answer 8

Asymptomatic

Question 9

What is the most common type of cancer in men?

Answer 9

Prostate

Question 10

What is the incidence in different age groups?

Answer 10

20% in 50s. 70-80% in 70s and 80s

Question 11

What are the histological features of prostatic adenocarcinoma?

Answer 11

Question 12

What other mutations are acquired somatically?

Answer 12

ERG and TMPRSS2 gene fusion

MYC amplification

PTEN deletion

Lost of TP53

Question 13

What age range of men are at risk for BPH?

Answer 13

> 50 y/o

Question 14

What type of infections give rise to granulomatous inflammation?

Answer 14

fungal or mycobacteria

Question 15

What can cause an elevation of PSA?

Answer 15

Cancer, prostatitis, BPH, infarct, instrumentation of prostate, ejaculation

Question 16

What are the black arrows pointing at?

Answer 16

Perineural invasion

Question 17

What are the treatment methods?

Answer 17

active surveillence (low grade), radical prostatectomy (localized), external beam or intersitial radiation therapy (localized), hormonal manipulations

Question 18

What are the three types of treatment available for BPH?

Answer 18

alpha1-adrenergic receptor antagonist

5-alpha-reductase inhibitors

Transurethral resection of the prostate (TURP)

Question 19

What this be?

Answer 19

Metastatic prostatic adenocarcinoma

Question 20

What is the precursor lesion of prostatic adenocarcinoma?

Answer 20

high-grade prostatic intraepithelial neoplasia (PIN)

Question 21

What two stains are important for looking at the prostate?

Answer 21

PSA-ag stain (in secretory cells) and HMW-CK (in basal cells)

Question 22

What is associated with chronic bacterial prostatitis?

Answer 22

Recurrent UTIs

Question 23

What are the symptoms of acute bacterial prostatitis? What is the common bacteria resposible?

Answer 23

Fever, chills, dysuria

E. Coli

Question 24

What has shown to substantially reduce mortality in patients with localized prostatic adenocarcinoma?

Answer 24

Radical prostatectomy

Question 25

What's the diagnosis, doc?

Answer 25

BPH

Question 26

Describe the pathogenesis of BPH

Answer 26

Question 27

Identify the 3 zones?

Answer 27

CZ: central zone TZ: Transurethral zone PZ: Peripheral zone (70% of adenocarcinomas)

Question 28

What are the three ways to detect prostatic adenocarcinoma?

Answer 28

Digital rectal exam (low sensitivity/specificity) Multiparameter MRI Serum PSA level

Question 29

What are the three types of prostate inflammation?

Answer 29

Acute bacterial Chronic bacterial or abacterial Granulomatous

Question 30

What are the two classifications of symptoms that can arise from BPH?

Answer 30

Question 31

What are the factors of prognosis in prostatic adenocarcinoma?

Answer 31

PSA level, Gleason grade, Pathologic stage

Question 32

What this be?

Answer 32

BPH

Question 33

What zones are responsible for BPH?

Answer 33

CZ and TZ

Question 34

What germline mutation is associated with prostate adenocarcinoma?

Answer 34

BRCA2

Question 35

What type of prostatitis?

Answer 35

Acute (note presence of neutrophils)

Question 36

What are the four main complications that arise from BPH?

Answer 36

Urinary retention, bladder hypertrophy and hyperplasia, vesicoureteric reflex, renal dysfunction

Question 37

What this be?

Answer 37

Post-BCG Granulomatous Inflammation

Question 38

What is the treatment for granulomatous inflammation?

Answer 38

BCG Treatment effect