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Repro. Med 2 > Prostate > Flashcards

Prostate Flashcards

1
Q

Glandular tissue comprises ___% of the prostate

A

30%

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2
Q

How is the glandular tissue of the prostate organized?

A

stratified epithelium lined with a layer of cuboid or columnar cells

“arranged like a tree”

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3
Q

____ is a collagen elastic and fibrous tissue that supports glandular tissue.

It comprises ___% of the prostate

A

Stroma

70%

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4
Q

___ is the smallest structure in the glandular component of the prostate and is surrounded by stroma

A

Acini

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5
Q

The proliferation of acini can lead to ____

A

BPH

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6
Q

What is BPH influenced by?

A

A decrease in testosterone

Increases of estrogen and adipose

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7
Q

What are the glandular zones of the prostate?

A

Periurethral zone
Peripheral zone
Central zone

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8
Q

The ___ contains mucosal glands

A

Periurethral zone

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9
Q

Changes of the ___ elements contribute to urethral pressure along with ____ zone changes that cause BPH

A

Stromal

Transitional

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10
Q

The ___ zone is the origin of 70% prostate adenocarcinomas

A

Peripheral

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11
Q

The majority of prostatic glandular tissue (70%) is in what zone?

A

Peripheral

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12
Q

What is the epidemiology of BPH?

What population if BPH more severe in?

A

50% of men by 60 y/o
90% by 80 y/o
*normal part of aging

More severe in African Americans

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13
Q

Testosterone –> 5 reductase –> ____, which binds to nuclear receptors in the prostate gland leading to hyperplasia

A

DHT

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14
Q

Where are A1 receptors?

A

In the muscle of the stroma, in the capsule of the prostate, and in the bladder neck, which causes smooth muscle contraction and contribute by worsening urinary sxs –> LUTs (lower urinary tract sx)

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15
Q

What are the prostate areas that are involved in BPH?

What is occurring in these area(s)?

A

Transition and periurethral zones

Epithelium proliferation (acini proliferation)
Smooth muscle proliferation
Stromal support changes
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16
Q 
What LUTS (lower urinary tract sx) occur w/ BPH? (x3)
What are examples of each?
A

Obstructive urinary sx (weak stream, hesitancy, incomplete emptying, double voiding)

Irritative urinary sx (urgency, frequency, nocturia)

Urinary incontinence (“paradoxcial” overflow incontinence, hx of UTI, sx worse w/ cold medications)

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17
Q

Sx of BPH are classified as either ___ or ___

A

Voiding (obstructive)

Storage (irritative)

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18
Q

What are some special work-up tools you may use to dx BPH? (5)

A

Post-void urinary residual (PVR) –> bladder sonogram

Uroflow –> measure urine flow rate/ pattern

Transrectal U/S

Cystoscopy

Upper tract imaging –> (US or CT) stones, CKD, hematuria

19
Q

What medications can be used to tx BPH?

How do they work to tx BPH?

A

Open up the gland by relaxing the smooth muscle
Nonselective alpha-blockers: doxazosin, terazosin
selective alpha-blockers: tamsulosin, silodosin

Shrink the gland
5-alpha reductase inhibitors: finasteride, dutasteride

Antimuscarinics: oxybutynin

20
Q

What are surgical options for BPH? (x4)

A

TUMT (microwave treatment)
TUNA (insert hot wire under direct vision) ( = coagulative necrosis)
TURP (resect the obstructing tissue)
PVP (vaporize the obstructing tissue)

21
Q

What are the indications for surgical tx of BPH? (x6)

A 
Refractory sxs to medications
Urinary retention
Cannot tolerate medical therapy
Prefers surgical therapy
Recurrent UTI attributable to BPH
Impaired renal function attributed to BPH
22
Q

What other dx can mimic BPH? (x8)

A 
UTI
Prostatitis 
Neurologic dz (CVA/TIA, Parkinson’s, MS)
Dietary indiscretion (caffeine, alcohol, etc.)
Diabetes (polyuria)
Timing of diuretics
OSA (“Does he snore?”)
Advanced CA of the prostate (rare)
23
Q

What is the epidemiology of prostate CA?

A

Most common non-skin CA in men in the US

2nd leading cause of cancer death in men in the US

24
Q

What prostate CA screenings are available?

A

Prostate specific antigen (PSA)

Digital rectal exam (DRE)

25
Q

What is PSA? What is it’s sensitivity for dx prostate CA?

A

PSA is an enzyme that liquifies ejaculate

21% sensitivity (nonspecific)
50% for high-grade CA

26
Q

What is the sensitivity and specificity for detecting prostate CA using DRE?

A

sensitivity: 59%
specificity: 94%

27
Q

Who needs to have an annual prostate screening?

A

Men > 50 y/o (<50 y/o if 1st degree relative)

African American men >40 y/o

28
Q

What is the normal range for PSA?

A

0.0-4.0 ng/mL

29
Q

Other than prostate CA, what can cause PSA to increase?

A 
BPH
Prostatitis 
trauma
instrumentation
ejaculation
30
Q

T/F DRE can significantly increase PSA levels?

A

False; DRE has minimal effect on PSA value (increases 0.26-0.4 ng/mL)

31
Q

What medications can alter PSA values?

A

5-ARI (finasteride, dutasteride)

32
Q

What is a limitation of using DRE to detect prostate CA?

A

Only 85% of CA arise peripherally (palpable)

33
Q

How does prostate CA present?

A

Screening: elevated PSA, nodular prostate

Constitutional sx: wt loss, night sweats, and bony metastatic sx

34
Q

T/F Urinary sx are rare in prostate CA?

A

True

Usually only when advanced

35
Q

How is a prostate needle bx performed?

A

Pt awake
Local anesthetic
Use transrectal US guidance

36
Q

Where does prostate CA metastasize?

A

Lymph nodes

Bone

37
Q

What is a risk of prostate needle bx?

A

Significant risk of prostatitis

Self-limited bleeding (urine, stool, semen)

38
Q

How many locations are prostate samples taken from during a needle bx? Where are they taken from?

A

6

  • right apex, mid, base
  • left apex, mid, base
39
Q

What is the scoring method called used for prostate CA? Describe it.

A

Gleason scoring

Creates a score by assigning all observed CA cell types a score of 1-10, w/ two most common types receiving a final combined score

40
Q

(Grading/Staging) is determining the type of CA and how aggressive

(Grading/Staging) is determining how much CA there is and where

A

Grading

Staging

41
Q

What is used in the staging w/u of prostate CA?

A

CXR
Labs: CBC, LFT
Bone scan if PSA >20 ng/mL
CT of pelvis

42
Q

What are the tx options for a pt w/ prostate CA?

A

Radical retropubic prostatectomy (RRP)
Radiotherapy
Androgen suppressive therapy
Active surveillance

43
Q

___ are radiated and implanted in the prostate and remain even after radiation has degraded for ~60 days

What type of CA is this tx best for?

A

Brachytherapy

Best for localized, contained CA

Repro. Med 2 (12 decks)

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