Prostate Flashcards
Glandular tissue comprises ___% of the prostate
30%
How is the glandular tissue of the prostate organized?
stratified epithelium lined with a layer of cuboid or columnar cells
“arranged like a tree”
____ is a collagen elastic and fibrous tissue that supports glandular tissue.
It comprises ___% of the prostate
Stroma
70%
___ is the smallest structure in the glandular component of the prostate and is surrounded by stroma
Acini
The proliferation of acini can lead to ____
BPH
What is BPH influenced by?
A decrease in testosterone
Increases of estrogen and adipose
What are the glandular zones of the prostate?
Periurethral zone
Peripheral zone
Central zone
The ___ contains mucosal glands
Periurethral zone
Changes of the ___ elements contribute to urethral pressure along with ____ zone changes that cause BPH
Stromal
Transitional
The ___ zone is the origin of 70% prostate adenocarcinomas
Peripheral
The majority of prostatic glandular tissue (70%) is in what zone?
Peripheral
What is the epidemiology of BPH?
What population if BPH more severe in?
50% of men by 60 y/o
90% by 80 y/o
*normal part of aging
More severe in African Americans
Testosterone –> 5 reductase –> ____, which binds to nuclear receptors in the prostate gland leading to hyperplasia
DHT
Where are A1 receptors?
In the muscle of the stroma, in the capsule of the prostate, and in the bladder neck, which causes smooth muscle contraction and contribute by worsening urinary sxs –> LUTs (lower urinary tract sx)
What are the prostate areas that are involved in BPH?
What is occurring in these area(s)?
Transition and periurethral zones
Epithelium proliferation (acini proliferation) Smooth muscle proliferation Stromal support changes
What LUTS (lower urinary tract sx) occur w/ BPH? (x3) What are examples of each?
Obstructive urinary sx (weak stream, hesitancy, incomplete emptying, double voiding)
Irritative urinary sx (urgency, frequency, nocturia)
Urinary incontinence (“paradoxcial” overflow incontinence, hx of UTI, sx worse w/ cold medications)
Sx of BPH are classified as either ___ or ___
Voiding (obstructive)
Storage (irritative)
What are some special work-up tools you may use to dx BPH? (5)
Post-void urinary residual (PVR) –> bladder sonogram
Uroflow –> measure urine flow rate/ pattern
Transrectal U/S
Cystoscopy
Upper tract imaging –> (US or CT) stones, CKD, hematuria
What medications can be used to tx BPH?
How do they work to tx BPH?
Open up the gland by relaxing the smooth muscle
Nonselective alpha-blockers: doxazosin, terazosin
selective alpha-blockers: tamsulosin, silodosin
Shrink the gland
5-alpha reductase inhibitors: finasteride, dutasteride
Antimuscarinics: oxybutynin
What are surgical options for BPH? (x4)
TUMT (microwave treatment)
TUNA (insert hot wire under direct vision) ( = coagulative necrosis)
TURP (resect the obstructing tissue)
PVP (vaporize the obstructing tissue)
What are the indications for surgical tx of BPH? (x6)
Refractory sxs to medications Urinary retention Cannot tolerate medical therapy Prefers surgical therapy Recurrent UTI attributable to BPH Impaired renal function attributed to BPH
What other dx can mimic BPH? (x8)
UTI Prostatitis Neurologic dz (CVA/TIA, Parkinson’s, MS) Dietary indiscretion (caffeine, alcohol, etc.) Diabetes (polyuria) Timing of diuretics OSA (“Does he snore?”) Advanced CA of the prostate (rare)
What is the epidemiology of prostate CA?
Most common non-skin CA in men in the US
2nd leading cause of cancer death in men in the US
What prostate CA screenings are available?
Prostate specific antigen (PSA)
Digital rectal exam (DRE)
