Lecture 8: Prostate Pathology Flashcards by Hao-Hua Wu

What is the function of the prostate gland?

It is the exocrine compound tubule-alveolar gland
Function is to secrete a slightly ALKALINE fluid (to counter acidic vagina)
Milky, or white in appearance
Usually constitutes 20-30% of semen volume along with spermatozoa and seminal vesicle fluid
Sprematozoa that is expelled in prostatic fluid have better motility, longer survival and better protection of DNA

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What is the McNeal Anatomic model for prostate?

Glandular Compartments

2. Non-glandular compartments

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What are in the GLANDULAR compartments for the Mcneal Anatomic model for the prostate?

Peripheral Zone (PZ)
Central Zone (CZ)
Transitional Zone (TZ)
Periurethral gland Region (PU)

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What are in the non-glandular compartments?

Anterior fibromuscular stroma

2. Preprostatic Sphincter

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What is the “lobe” classification of prostate used in?

Used for anatomy NOT for pathology
Anterior lobe (isthmus) = part of transitional zone
Posterior lobe = peripheral zone
Lateral lobe spans all zones
Median lobe = part of central zone

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What does PUGR stand for?

Periurethral gland region

One of the 4 zones

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What does PU stand for? Significance?

Prostatic urethra

Used by McNeal as key anatomic landmark

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What does UP stand for?

Proximal prostatic urethra

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What does UD stand for?

Distal prostatic urethera

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What does SV stand for?

Seminal vesicle

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Where do the ejaculatory ducts pass?

The central zone

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What are the key characteristics of the peripheral zone?

Approximately 70% of normal gland in young men
Sub-capsular portion of the POSTERIOR aspect of the gland that surrounds the distal urethra
70-80% of prostatic cancers originate from the peripheral zone

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What is the key characteristics of Central zone?

25% of normal gland
Surrounds the ejaculatory duct
Secondary involvement in prostatic cancers

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What are the key characteristics of the transition zone?

5% of normal gand
Responsible for BENIGN PROSTATIC HYPERPLASIA
10-20% of prostate cancers
Surrounds proximal urethra

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What are the key characteristics of the anterior fibro-muscular zone?

5%
Devoid of glandular components
Composed only of muscle and fibrous tissue

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What part of the prostate is responsible for benign prostatic hyperplasia (BPH)?

Transitional zone (TZ)

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What are the two layers of cells in the prostate?

Basement membrane

2. Epithelial layer

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What does the normal microscopic anatomy of prostate look like?

branching tubuloalveolar system
originate from urethra in curvilinear pattern
apical and basal layer in glands
FEW endocrine cells
glands sit in fibromuscular stroma

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What types of cells in prostate?

secretory cells
Basal cells
Endocrine-paracrine cells

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What does PSA stand for?

Prostate specific antigen
…could also be misconstrued as prostate-specific
actin

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What is the definition of BPH?

Nodular prostate enlargement due to cellular proliferation of prostatic glands and stroma associated with lower UTI symptoms
LUTS = lower urinary tract symptoms

What is the etiology of BPH?

Pathophysiology remains poorly understood

Perhaps hormonal alterations play a major role (accumulation of testosterone?)

What are risk factors of BPH?

Aging
Family history
Estrogen

What is the prevalence of BPH?

50% of men in 50s

80% men in their 80s

What is the most common cause of non cancerous rise in PSA?

BPH | PSA – prostate-specifc antigen

What is the significance of LUTS features?

Without lower urinary tract symptoms, glandular and stromal proliferation is NOT BPH

What is the hallmark of BPH?

Nodular prostatic enlargement Hyperplastic nodules -mainly centered on proximal prostatic urethra -involve transition zone and submucosal compartment

When do you biopsy patients who are asymptomatic??

Increased serum PSA Abnormal digital rectal exam Peripheral zone is enlarged (posterior) This is prostate carcinoma

What is PCA?

Prostate carcinoma

What is DRE?

Digital Rectal exam

What is the epidemiology of PCA?

6th most common cancer in world PCA is the MOST COMMON malignancy in men Affects AFRICAN-AMERICANS much more 2nd most lethal cancer after lung cancer

What are risk factors for PCA?

``` Red meat Animal products (heterocyclic amine content?) ```

What are the two types of PCA?

1. Asymptomatic | 2. Symptomatic

What are the characteristics of Symptomatic Prostate carcinoma?

1. Obstructive bladder symptoms - transition zone cancer therefore may have had cancers before 2. Pelvic pain - local extension 3. Bone pain - bone metastasis

What does the term PCA include?

1. acinar adenocarcinoma 2. ductal adenocarcinoma 3. adenosquamous and squamous cell carcinoma 4. basaloid and adenoid cystic carcinoma 5. small cell carcinoma 6. sarcomatoid carcinomas

What produces prostate specific antigen? Purpose?

It is synthesized by secretory cells of the epithelium Increased diffusion into serum when basement membrane is breached by PCA Liquefies semen and increases motility

What are the macroscopic features of PCA?

Lack of necrosis or hemorrhage No sharp borders Indurated yellow mass

Is there a PSA cut off at which a man can be guaranteed to be free from prostate cancer?

Where do PCA usually arise from?

Peripheral zone (75-80%) Tranistional zone responsible for 15-25% 50% are multifocal

What are the categories of microscopic features of PCA?

1. Architectural featuers 2. Nuclear and cytoplasmic features 3. Intraluminal features 4. Pathognomic features

What are the pathognomonic features of PCA?

1. Circumferential perineural invasion 2. collagenous micronodules 3. glomerulations 4. growth within adipose tissue

What is corpora amylacea?

Prostatic concretions…suggests benign cancer Hyaline masses of unknown significance found in prostate gland, neuroglia and pulmonary alveoli -derived from secretions and increase with age

What is the verumontanum?

AKA seminal colliculus An important landmark near the ENTRANCE of the seminal vesicles Means mountain ridge in Latin

What is Gleason Grade 1?

Tightly cohesive nodule of WELL FORMED glands

What is Gleason Grade 2?

Loosely cohesive nodule of well formed glands

What is Gleason Grade 3?

Haphazard infiltration of irregular glands

What is Gleason Grade 4?

Large cribriform plates and small sheets of cells with glandular lumens No space where the glands should be..

What is Gleason Grade 5?

Sheets of cells WITHOUT any gland formation

What is the gleason score?

GS 5-6 = lower progression rates GS 7-10 = worse prognosis Predictive value of GS enhanced when combined with PSA level and DRE findings

What are the genes implicated in prostate cancer?

``` Deletions in 8p PTEN P53 RB1 ```