Pathology of the Prostate

Question 1

Prostate pathologies

Answer 1

• Prostatitis
• Benign prostatic hyperplasia
• Adenocarcinoma of the prostate

Question 2

Anatomical components of prostate pathology

Answer 2

• Peripheral zone
• Transitional zone
• Central zone
• Periurethral zone
• Prostatic urethra

Question 3

Histological components of prostate pathology

Answer 3

• Basal layer (low cuboidal epithelium

- Top layer (columnar epithelium)

Question 4

Bacterial prostatitis

Answer 4

• Acute
• Chronic
• Non-specific
• Granulomatous

Question 5

Bacterial prostatitis transmission

Answer 5

• UTI (ascending or descending)
• Reflux (ascending or descending)
• Sexual (ascending or descending)
• Direct extension
• Surgical or procedural manipulation
• Hematogenous
• Lymphatic

Question 6

Clinical (acute) etiological agents of bacterial prostatitis

Answer 6

• E. coli
• Gram + cocci
• STD

Question 7

Symptoms of bacterial prostatitis

Answer 7

• Dysuria
• Chills
• Fever
• Malaise
• Pain

Question 8

Pathological manifestations of bacterial nephroprostitis

Answer 8

• Acute Inflammatory Infiltrate

- Composed of neutrophils in the stroma and glands (Acini)

Question 9

Clinical manifestations of chronic bacterial prostatitis

Answer 9

• Bladder dysfunction from E. coli and gram + cocci

Question 10

Symptoms of chronic bacterial prostatitis

Answer 10

• Dysuria

- Pain (suprapubic, perineal, lower back)

Question 11

Pathological manifestations of chronic bacterial prostatitis

Answer 11

• Chronic Inflammatory Infiltrate composed of mononuclear cells (lymphocytes, macrophages)
• Plasma cells in the stroma
  and glands (Acini)

Question 12

Grnulomatous prostatitis

Answer 12

• Inflammatory infiltrate contains multinucleated giant cells

Question 13

Benign prostatic hyperplasia (nodular hyperplasia)

Answer 13

• Proliferation in glands and stroma

- Increased frequency with age

Question 14

Symptoms of BPH

Answer 14

• Severe abdominal pain and discomfort
• Mild fever
• Required catheterization (2.5 L)

Question 15

Pathology of BPH

Answer 15

• Nodular hyperplasia of the transitional zone (projects upward beneath the urethral mucosa)
• Urethral obstruction

Question 16

Manifestations of BPH

Answer 16

• Increased vigor of the urinary stream
• Increased urinary frequency
• Nocturia
• Incontinence
• Difficulty initiating and stopping urination
• Rectal exam shows firm, nodular prostate

Question 17

Manifestations of BPH if chronic/untreated

Answer 17

• Acute urinary retention
• Bladder hypertrophy, trabeculation, diverticula
• Cystitis, pyelonephritis
• Hydroureter
• Hydronephrosis
• Renal failure

Question 18

Macroscopic pathology of BPH

Answer 18

• Increased weight

- Nodular

Question 19

Microscopic pathology of BPH

Answer 19

• Proliferation of epithelial cells (double layer of cells)
• Proliferation of smooth muscle cells
• Stromal fibroblasts

Question 20

Prostate adenocarcinoma incidence

Answer 20

• 20% in men > 50
• 70% in men 70-80yrs
• Uncommon in Asians
• Frequent among men of African descent

Question 21

Pathogenesis of prostate cancer

Answer 21

• Chromosomal rearrangements
• MYC oncogene
• Tumor suppressor genes (PNET and TP53)
• Hypermethylation defects
• Deletions of RB gene
• Amplification of androgen receptor gene locus

Question 22

Chromosomal rearrangement in prostate CA

Answer 22

• Transcription factor gene (ETS)

- Androgen regulated promoter (TMPRSS2)

Question 23

Prostate CA precursor Lesion (Prostatic Dysplasia)

Answer 23

• Prostatic intraepithelial neoplasia (PIN)
• Nuclear and cellular atypia
• Prominent nucleoli
• Basal layer is identified
• Grades I, II, III

Question 24

Prostate CA pathology

Answer 24

• Adenocarcinoma (95%)

- 70% arise from the peripheral zone

Question 25

Prostate CA clinical manifestation

Answer 25

- Depends upon location and size

Question 26

Pathological diagnosis of prostatic adenocarcinoma

Answer 26

- Clinical laboratory diagnosis | - Prostate specific antigen (PSA) interpretation

Question 27

Prostatic specific antigen (PSA) tests

Answer 27

- PSA Density (serum PSA : prostate volume ratio) - PSA Velocity (Rate of change with time – 0.75ng/ml↑/yr) - Age-Specific Values - Bound to free PSA

Question 28

Age specific reference ranges for PSA (ng/mL)

Answer 28

- 2.5 / 40-49 - 3.5 / 50-59 - 4.5 / 60-69 - 6.5 / 70-79

Question 29

Prostate cancer macroscopic findings

Answer 29

- Firm, gritty, poorly defined, yellow-gray lesion | - Undetectable

Question 30

Prostate cancer microscopic findings

Answer 30

- Differentiation | - Prominent nucleoli

Question 31

Well/moderately differentiated prostate findings

Answer 31

- Lined by a single layer of uniform neoplastic epithelial cells - Loss of basal layer

Question 32

Poorly differentiated prostate findings

Answer 32

- Solid growth | - Tumor growing in a diffuse fashion

Question 33

Microscopic appearance of prostatic carcinoma

Answer 33

- Well-differentiated tumor composed of medium-sized glands - Irregular shape of the glands - Presence of intraluminal basophilic secretion - Contrast with the non-neoplastic glands present in the field is obvious

Question 34

Microscopic prostate CA patterns

Answer 34

- Variability of gland size and configuration - Papillary and cribriform patterns - Solid cords of infiltrating neoplastic cells

Question 35

Prostate CA grading and staging

Answer 35

- Grading = Gleason Score/System and histological evaluation | - Staging = TNM

Question 36

Prostatic adenocarcinoma Gleason System (grading) application

Answer 36

- Grade of predominant pattern - Grade of 2nd most common pattern - 2-6 Well differentiated - 7; Moderately differentiated - 8-10 Poorly differentiated

Question 37

Prostate CA invasion and metastasis (location is important)

Answer 37

- Perineural invasion - Lymphatics - Hematogenous

Question 38

Hematogenous prostate CA invasion and metastasis

Answer 38

- Bone - Liver - Lung