Prostate

Question 1

Describe the location of the prostate.

What is near it and what runs through it?

Answer 1

• Prostate lies inferior and around the neck of bladder.
• Encapsulated
• Posterior surface in contact with rectum (can be palpated)

Urethra runs through it. (prostatic urethra)

Question 2

What runs from the kidney to Bladder

Answer 2

Ureter

Question 3

What is the role of the prostate?

Answer 3

Fibromuscular and glandular accessory organ that provides then, milky, alkaline fluid as a bulking agent to semen and contracting during ejaculation. Ejaculatory duct meets urethra within prostate.

Question 4

What is Benign Prostatic Hyperplasia?

How would CA differ in location and MNFTS?

Answer 4

• Nodular Periurethral enlargement of prostate (both muscle and glands

(CA is peripheral and multi centric, not necessarily urinary complications)

Question 5

Incidence in Men by age?

Answer 5

• Very common as men age
o >40 years ~20% have BPH
o >60 years ~50%
o >80yrs ~90%

Question 6

What is the Etiology of BPH

Answer 6

• Unclear
• Ageing the major risk
o Age related changes in androgen levels??
• Altered Testoterone : Estrogern Balance?
• Genetic, race and diet (higher likelihood)
o Japanese men low/ African high
o Role of yellow vegetables??

Question 7

What is the relationship between testosterone and DHT?

Answer 7

Testes produce testosterone (converted to DHT which impacts accessory oragns)
o T -> 5alpha reductase-> DHT
o DHT acts on prostate cell and supports growth and Fx

Question 8

What is the relationship of Estrogen to DHT

Answer 8

Sensitizes prostate to DHT

Question 9

How does aging lead to prostate enlargement?

Answer 9

Aging leads to T quantitative dec and relative inc estrogen. This Increases significance of estrogen impacts (i.e relative inc) (Androgens have opposing actions) In this case a further sensitization of cells to DHT due to Alteration T:E ratio

o Relative inc in E -> sensitizes prostate to DHT -> enlargement

Question 10

Is growth of BPH in the prostate hypertrophy or hyperplasia?

Where does growth take place?

Answer 10

o Hyperplasia in periurethral tissue -> compresses urethra

o Also hypertrophy of smooth muscle

Note: There is peripheral growth as well (not just periurethral)

Question 11

What is the complication with prostate enlargement?

Answer 11

Impedes urine flow

bladder wall thickens ( normally thin walled, overfill can cause rupture… it’s a compensatory response)

o Trabeculations and diverticula develop in bladder

o Urine stasis (complications- stones, UTI’s, calculi)

NOTE (R/t future kidney notes)

Question 12

What is a further complication once bladder back ups with urine?

Answer 12

o Ureter distention with urine -> hydroureter
o Ureter loop distends downward and creates “fishhook”
o Urine backs up in the kidney causing hydronephrosis
• Distention of renal pelvis and calicies with urine

Question 13

Common MNFTS of BPH

Answer 13

• Frequency (inc)
• Hesitancy (difficulty starting urine flow)
• Weak urine stream (r/t constriction)
• Terminal dribblings (post void dribbling)
• Complete obstruction?

Question 14

What is the major complications from complete urethral obstruction

Answer 14

Eventually pressure prevents filtration of Nitrogenous compounds and kidney failure

Question 15

Dx of BPH

Answer 15

•Hx, MNFTS, Px
• Digital rectum exam (palpation of prostate through rectum)
• PSA (Prostate–specific antigen)
(Normally secreted by prostate in fluid, Inc should be proportional to Prostatic mass
o PSAD and PSAV (density and velocity) (requires size and PSA measure)
• Measure for benign and malignant growth
• BUN and Creatinine (No ischemic damage occurring here)
• Urinalysis (UTI’s?, stones?, hematuria)

Question 16

Tx of BPH

Answer 16

• Often no Tx 
• Based on severity and complications
• Alpha adrenergic antagonists
    o	Act on muscles
    o	Dec obstr -> improves urination
• 5 alpha reductase inhibitor (long term)
    o reduces DHT
• If severe combine both drugs
• TURP (Trans urethral resection of prostate)  or lazer prostatectomy

Question 17

Describe Prostate CA (including Risks)

Answer 17

• Common Ca in Men
• 3rd CA death
• most after age 65
• Risks include: age, diet, ethnicity, familial (1rst and 2* relatives), androgens

Question 18

Pathology of Prostate CA

TYPE, Origin, Spread

Answer 18

• Adenocarcinomas
• Peripheral origin (beneath capsule), multicentric (arise in severeal areas)
• No early mnfts -> delays Dx
• MNFTS appear after invasion or metastasis
• Extension to bladder and Seminal vesical
• Metastasis to bone, liver and lung

Question 19

MNFTS of Prostate CA

Answer 19

• Prostatitis common

* Late hip and back pain (bone metastasis)

Question 20

DX of Prostate CA

Answer 20

• Hx and Px
• Digital Rectal exam (needs to be decently large for effective screening)
• PSA
• Biopsy (US will guide it)

Question 21

Common Non-pharma approach to prostate tx

Answer 21

• Stage, grade and age based
• Non aggressive forms might be put on active surveillance
• If Localized= low risk -> active surveillance

Question 22

Pharma Tx of Prostate CA

Other Tx?

Answer 22

•1st line : antiandrogens (ex. estrogen)
o tumors nurtured by hormones
o radical prostatectomy (remove vesicals)

• Radiation

Question 23

DHT stands for?

Answer 23

Dihydrotestoterone

5 alpha reductase is enzyme

Question 24

What kind cells line the bladder

Answer 24

transitional epithelial cells line bladder for stretch