prostate Flashcards
4 zones of the prostate
TZ = transitional zone
CZ = central zone
PZ = peripheral zone
anterior fibromuscular stroma
TZ
transitional zone surrounds the urethra and is the part of the prostate predominantly affected by nodular hyperplasia
only 20% of prostate carcinomas occur here
PZ
peripheral zone is the zone that is palpable on rectal examination
75% of prostate carcinomas occur here
3 common conditions affecting the prostate gland
- nodular hyperplasia (benign prostatic hyperplasia BPH)
- neoplasms of the ports tae
inflammatory conditions (prostates, (acute, chronic, bacterial, bacterial, granulomatous))
nodular hyperplasia
benign prostatic hyperplasia BPH
common after age 50
uncommon before 40
seen in most older males but only clinically significant in some
cause of nodular hyperplasia
unknown
theory - imbalance of oestrogen/testosterone/dihydrotestosterone
nodular hyperplasia affects
TZ
compresses the urethra causing difficulty passing and storing urine
symptoms of nodular hyperplasia
frequency, nocturne, urgency and incontinence
slow and weak stream, difficulty initiating and stopping flow, dribbling
histology of nodular hyperplasia
proliferation of epithelial cells of the glands and ducts
proliferation of the smooth muscle cells and fibroblasts within the stroma
complications of nodular hyperplasia
chronic obstruction - hypertrophy of the bladder, urinary stasis, recurrent urinary tract infections
backpressure if obstruction is prolonged causing hydrometer, hydronephrosis, renal failure and death
prostatic adenocarcinoma
all other tumours of the prostate are rare (TCC, SCC, sarcomas, lymphoma)
risk factors for prostate cancer
- increasing age
- ethnicity - rare in asian males, common in African males,
- family history
- genetic factors - BRCA1 and 2, Lynch syndrome
- dietary factors - obesity, diet high in fat
diagnosis of prostate cancer
most men with early age prostate cancer have no symptoms
- urinary frequency, urgency, nocturne and hesitancy - difficult to seperate from symptoms of nodular hyperplasia
haematuria/haematospermia
- bone pain - when carcinoma metastasises
usually diagnosis is made after biopsy for elevated PSA (marker in the blood)
PSA
marker in the blood
protein made only in the prostate
produced by secretory cells of the prostate glands, and also by prostate ca cells
PSA rises with
rises with age - should be compared to the norm of that age group
PSA in cancer
production is increased and tissue barriers between prostate glands and capillaries are dirupted, releasing more into the blood stream
causes of elevated PSA
- nodular hyperplasia
- prostate carcinoma
- prostates
- perineal trauma (cyclists)
approach to PSA screening
some organisations are agianst PSA screening due to high rate of false positives
some organisations recommend a discussion with a health care provider before PSA test
acinar adenocercinaom
glandular
most common type
small crowded glands with no basal cell layer
clear with large nuclei and prominent nucleoli
Gleason score
given number 3, 4, or 5 based on the pattern
Gleason score = sum of the most predominant pattern + worst pattern in core biopsy
other things in the pathology report of prostate cancer
- type
- size
- grade - Gleason score
- Stage (TNM)
- extraprostatic extension, lymph node status, distant metastases
perineurial invasion
margins
treatment options for prostate cancer
- active surveillance
- surgery
- radiation
- hormone
- chemotherapy
treatment go localised prostate cancer
- active surveillance - for small volume, lower grade tumours eg. Gleason score of 6 (men who are older or have other illnesses
- surgery, radial prostatectomy
- radiation therapy
treatment of locally advances prostate cancer
radiation therapy combined with hormone therapy
surgery (radial prostatectomy) and radiation therapy
