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Flashcards in Diseases of the prostate Deck (17):

What are the zones of the prostate?

Central zone – an inverted cone with its base forming the base of the prostate and its apex at verumontanum
-ejaculatory ducts pass through central zone

Transition zone – two “lobes” that surround the prostatic urethra laterally and anteriorly
- separated (more or less) by fibrous band from peripheral zone

Peripheral zone – major portion (~70%) of gland, which
surrounds transition zone posteriorly, laterally, and apically


What are the two cell layers of the prostate?

Basal layer of low cuboidal to flattened cells resting on basement membrane

Luminal layer of columnar epithelial cells, which secrete mucus and protease-rich fluid


Corpora amylacea

inspisation of secretions that form as men age

Called prostate sand


Acute prostatitis

acute focal or diffuse suppurative (neutrophilic) inflammation caused by bacterial infection – most common organisms include E. coli or other enterobacteria and S. aureus.

Usually evolves from direct extension of infections of bladder (urine)
a. May be hematogenous
b. May be iatrogenic


Chronic prostatitis

Characterized histologically by aggregates of lymphocytes, plasma cells, and macrophages within the prostatic substance

Etiology unknown – may be due to long-standing bacterial infections or dietary factors

Granulomatous form may occur surrounding “eroded” corpora amylacea
- may also occur with tuberculus infections



A peculiar nodular aggregate of histiocytes containing intracytoplasmic calcified inclusions (Michaelis-Gutmann bodies)

Believed to be due to abberrant phagocytic process which leads to retention of bacterial wall fragments that subsequently calcify


What are the clinical symptoms of prostatitis?

Obstructive urinary symptoms due to swelling of gland

Low back pain, dysuria due to infection

Chronic “prostatitis” often asymptomatic – chronic inflammation often present on biopsies


Benign prostatic hyperplasia

Extremely common in men over age 50 – incidence increased with age by “law of 10’s" (e.g. 70% at age 70, etc)

Only 5-10% of affected men require surgical treatment

Usually medical treatment

Androgen: estrogen imbalance

Formation of nodules primarily within the transition zone
that enlarge to compress the urethra as well as the peripheral prostate

Clinical symptoms – difficulty in starting and stopping urination, frequency and Nocturia (lower urinary tract symptoms or LUTS)

Severity not directly related to amount of disease that is present


Medical therapy for BPH

androgen metabolism antagonists and α-blockers is mainstay of therapy


Histology of BPH

1. Variable areas of glandular and stromal (often mixed) hyperplasia
2. Glands often cystically dilated and thrown into numerous papillary infoldings
3. Stromal component involves increased density of spindle cells, vessels and in some cases progressive scarring


How common is prostatic adenocarcinoma?

Most common carcinoma (excluding skin) of adult males in U.S.

Second most common cause of male cancer deaths in U.S.

Significant epidemiologic factors include:
1. Age – increases with age after age 50
2. Race – Blacks > Whites >>> Orientals
3. Diet – associations with red meat consumption, Western diet
4. Family history


Clinical symptoms of prostatic adenocarcinoma?

Often asymptomatic or similar to those for BPH


Where is the most common place for prostatic adenocarcinoma to appear in the prostate?

peripheral zone

Often multifocal


Histology of prostatic adenocarcinoma

Abnormal collections of atypical glands lined by single layer of malignant cuboidal to columnar cells (lack basal
a. Increased N:C ratio
b. Prominent nucleoli


How to treat localized vs advanced prostatic adenocarcinoma

Localized disease (prostate confined) usually treated with surgery, external beam radiation, or radioactive “seeds”

Advanced disease (beyond prostate) usually treated with androgen ablation therapy (orchiectomy, anti-androgens, 5-alpha – reductase inhibitors, GNRH inhibitors, etc.) since most tumors are androgen responsive
- majority will become androgen refractory with time (Note: does not mean androgen “resistant”)


What is the best clinical marker for prostate adenocarcinoma?

Prostate specific antigen- PSA


Prostatic intraepitelial neoplasia


Tufted, papillary or cribriform proliferations of atypical cells within ducts and acini surrounded by basal cell layer

Natural history variable – probable precursor of some forms of adenocarcinoma

“High grade” PIN associated with adenocarcinomas in a high percentage of cases