Module 4: Male Genital Pathologies Flashcards
(42 cards)
Starting off with male pathology, what is prostatitis?
- -Dysuria, frequency and urgency
- -low back/pelvic or genital pain
- -loss of sex drive
- –painful erections/ejaculation
- -DRE= enlarged tender prostate
Moving on to Benign Prostate Hyperplasia, what is the etiology?
Most commonly seen in older men
Etiology: Testosterone —- DHT by 5 alpha reductase causes hyperplasia of stroma and glands
–affects central/periurethral and transitional zones
—does NOT affect peripheral zone (prostate cancer) only
What are the pre-disposing factors to BPH?
Testosterone
Age
–importantly not seen in castrated men
Describe the cut section seen on lab slide 2 of BPH as well as histology
Nodular on cut section
–compresses urethra into a slit
Hyperplasia of stoma and glands (tortuous-distended/dilated) due to proliferation
–see two layers: inner columnar and outer basal flat cells
What do patients who have BPH present with?
Increased frequency of urination Increased urgency Nocturia Intermittency Hesitancy Slow flow Terminal Dribbling Compression of urethra to a slit ---- presents with difficulty starting/stopping urination, frequency/dribbling, nocturia and dysuria
On DRE examination what do you find in patients with BPH?
Normal: dont feel anything
–uniform enlargement, firm, smooth and non tender (NOT NODULAR)
(remember that cancer is hard and nodular) and infection would be soft
What are the complications of BPH?
Back up of urine — bilateral hydroureters/hydronephrosis — chronic renal failure —- increased serum calcium —- recurrent kidney and bladder stones/infections
–Trabeculae (diverticuli in the bladder) due to chronic urinary retention
BPH can indirectly lead to bladder cancer :stones can lead to squamous and diverticulum can lead to adeno
Does BPH transition to cancer?
nope never
–patients die from obstructive complications
(again can indirectly lead to bladder cancer)
What is the treatment for BPH?
TURP: transurethral resection of prostate – may lead to impotence
5 alpha reductase inhibitors
Next is adenocarcinoma of the prostate, what are some features?
Most common cancer in men
2nd most common cancer related COD in men
men greater than 50 years old
What are the pre-disposing factors for prostate cancer?
Genetics (KRAS)
Age (over 65)
Blacks (not common in whites or asians)
High fat diet
How does prostate cancer arise?
Arises de novo due to increased sensitivity to dihydrotestosterone – not caused by BPH
Prostate cancer affects which part of the prostate?
Peripheral zone – presents later b/c further away from the urethra and metastasis to CNS via plexus of Batson (Causes back pain)
What is the presentation of prostate cancer?
50% are asymptomatic
- -microscopic hematuria, lower back pain due to osteoblastic (bone forming) lesions (not lytic), weight loss, urinary symptoms
- -urethra obstruction
- -spread by the time they present though (pulmonary symptoms, neuro symptoms and bone pain)
What is felt on DRE in a patient with prostate cancer?
Hard Nodular Irregular Non tender (remember prostatitis is tender)
What is seen on transrectal biopsy in patients with Prostate Cancer?
Malignant glands back to back with little stroma - lined by single layer of cuboidal epithelial cells with atypica
- -columnar — cuboidal with atypica and no basal flat cells
- -positive for cytokeratin
When should men start getting DRE for screening of both prostate and BPH?
over 50
What is the treatment for prostate cancer?
Radical prostatectomy, radiotherapy, hormonal therapy, cryosurgery
What are the complications of prostate cancer?
Mets
lymph — blood – liver, lungs, brain, bones
Urethra obstruction problems (Stricture)
–infection, etc.
Finally what is the Gleason grading for prostate cancer?
Gleason grading:
grade 1 = well differentiated (good)
Grade 5 = poorly differentiated (Bad)
looks at the architecture but remember staging is always better!
PSH is organ, not cancer specific, antigen. What conditions is it falsely increased levels in?
Cancer BPH Prostatitis, infection Ejaculation Extensive Exercise
What is the normal PSH range?
less than 4ng/ml
greater than 10ng/ml = high
PSH results do not provide diagnosis, describe the free PSA, PSA density and PSA velocity
Low percent free PSA (less than 10%) = 50% risk of prostate cancer
–biopsy would be recommended
PAS density (PSAd) = not as accurate as fPSA
–greater than 0.125 = 80% likelihood of detecting caner
PSA velocity= change in serum PSA over time
–high degree of suspicion when the serum PSA increases to greater than 0.75ng/ml/yr
Moving on to Cryptorchidism, first describe spermatogenesis in the seminiferous tubules
Spermatogenesis: sperm cells mature as they migrate towards the center of the lumen
–spermatogonia — spermatocytes — spermatids (in the middle)
