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Reproductive Pathology > Hyperplasia and Carcinoma of the Prostate > Flashcards

Hyperplasia and Carcinoma of the Prostate Flashcards

1
Q

Describe a normal prostate gland?

A
  • In adult, normal weight is 20g
  • Retroperitoneal organ
  • Encircles the bladder and urethra
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2
Q

The prostate gland is divided into what zones anatomically?

A

Peripheral
Central
Transitional

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3
Q

Describe the histological regions that make up the prostate gland?

A
  1. fibromuscular stroma

2. glandular component

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4
Q

Describe the histology of the glandular component?

A

Compound tubuloalveolar glands lined by two layers

  1. Basal layer
  2. cuboidal epithelium
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5
Q

What controls the growth of the prostate gland?

A

Testicular androgens

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6
Q

Enlargement of the prostate is characterised by?

A

hyperplasia of the stromal and glandular epithelial cells

- benign process

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7
Q

Describe the epidemiology of benign prostate hyperplasia?

A

Common disorder in men over 50 yrs

- Hyperplastic process starts in young age

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8
Q

What zone does BPH usually affect?

A

transitional zone

- periurethral region

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9
Q

What forms as a result of BPH?

A

large, discrete nodules

- With resultant urethral obstruction in severe disease

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10
Q

What is the cause of BPH?

A

Dihydrotestosterone (DHT)

- metabolite of prostate is the mediator of prostatic growth

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11
Q

Describe the aetiopathogenesis of BPH?

A
  1. testosterone is converted to dihydrotestosterone by 5 alpha reductase enzyme in prostate stromal cells
  2. DHT binds to nuclear androgen receptors and signals transcription of growth factors
  3. DHT 10X potent in causing hyperplasia than testosterone
    - can stay bound to androgen receptors for longer
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12
Q

Describe the pathological state of a BPH prostate?

A
  • Can weigh more than 100g

- Composed of nodules of variable sizes

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13
Q

What are the nodules formed by BPH?

A
  1. Initial nodules are entirely of stromal cells
  2. Later epithelial nodules develop
  3. Mixed nodules (stroma and glandular)
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14
Q

What do these nodules do to surrounding structures?

A

Urethra compressed into slit like lumen with subsequent obstruction

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15
Q

Describe the pathology of glandular proliferation?

A
  • Small to large to cystically dilated glands with intact basal cells and basement membrane
  • Small areas of infarction present
  • With surrounding foci of squamous metaplasia present
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16
Q

What are the secondary changes in the bladder?

A
  1. Hypertrophy
  2. Trabeculations
  3. Diverticular formation
17
Q

Describe the clinical presentation of BPH?

A
  1. secondary changes in bladder
  2. Hydronephrosis
    - excess fluid in the kidneys due to back up of urine
  3. Urinary tract infections
    - due to stagnation of urine
18
Q

What are the clinical symptoms of BPH?

A
  1. Difficulty to pass urine: starting the flow and stopping
  2. Overflow dribbling
  3. Dysuria
  4. Frequency
  5. Nocturia
  6. Acute urinary retention
  7. Prone to urinary tract infections
19
Q

Describe the treatment of BPH?

A
  1. 5α-reductase inhibitors
    - Inhibit 5α-reductase hence blockin production of DHT
  2. α- adrenergic inhibitors:
    - Inhibit α- adrenergic receptors in prostate smooth muscle thereby reducing the muscular tone allowing urine to pass
  3. Surgical correction
20
Q

What is the most common form of carcinoma of the prostate?

A

adenocarcinoma of the prostate

- slow growing

21
Q

Describe the epidemiology of adenocarcinoma of the prostate?

A

men >50

22
Q

Which zone is most commonly affected by adenocarcinoma of the prostate?

A

peripheral zone

23
Q

How does adenocarcinoma of the prostate come to our attention?

A
  1. Sometimes comes to attention with metastatic disease

2. Discovered through screening: Prostate specific antigen (PSA)

24
Q

What are the risk factors of carcinoma of the prostate?

A
  1. Older age
  2. Positive family history
  3. Race
    - commoner in blacks than white
    - Rare in asians
  4. Hormone levels
  5. Environmental factors: eg diet(fats)
25
Q

What is a preneoplastic carcinoma of the prostate?

A

Prostatic intraepithelial neoplasia (PIN)

26
Q

Describe the aetiopathogenesis of prostatic carcinoma?

A
  1. Androgens are believed to play a role in pathogenesis
    - Evidenced by reduction in disease burden by orchidectomy
  2. Androgen gene receptor mutation
  3. Germline mutations of prostate cancer susceptibility genes
27
Q

Describe the pathology of carcinoma of the prostate?

A
  • 70% arises in peripheral aspects thus palpable on rectal examination
  • Cut surface: firm and gritty, if diffusely infiltrative may be difficult to see macroscopically
  • Does not form nodules like of BPH
  • Irregular glands, lack basal layer and basement membrane is disrupted
28
Q

Describe the course of the metastases of carcinoma of the prostate?

A
  1. Local to adjacent structures
  2. Haematogenous - to bone and other organs
  3. Lymph - to regional and distant metastases

Reproductive Pathology (8 decks)

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