Prostate Cancer

Question 1

What and where is the prostate gland?

Answer 1

Cone shaped solid organ in retroperioneum
Just below bladder
Anterior to rectum
No capsule

Question 2

How much does the prostate gland weight?

Answer 2

20g

Question 3

What does the prostate gland look like histologically?

Answer 3

Branched tubulo acinar glands with fibromuscular stroma

Question 4

How much of seminal fluid does it secrete?

Answer 4

50%

Question 5

How many zones can it be divided into?

Answer 5

4

Question 6

What are 4 of the zones of the prostate?

Answer 6

Transition zone - 5% of tissue - BPH occurs here

• 20% of Pr. Ca
  
  • Surround urethra

Central zone - 25% of tissue -
- Surrounds ejaculatory ducts at base of gland

Peripheral zone - 70% of tissue

  - 75% of PC
  - Pulpable
  - Surrounds central zone

Anterior fibro muscular stroma

Question 7

What is the verumontanum?

Answer 7

Where the ejaculatory ducts from seminal vesicles enter into prostatic urethra

Question 8

Where is benign prostatic hyperplasia most common?

Answer 8

In the transition zone

Question 9

Where is prostate cancer most common?

Answer 9

In the peripheral zone

Question 10

What is the normal architecture of the prostate?

Answer 10

Lobular architecture
Large, irregularly shaped glands
2 cell layers - Epithelial cells + basal cells
Epithelium has folded/papillary appearance
Tall columnar cells with basaly located nuclei
Androgens control growth

Question 11

What are the three main diseases of the prostate?

Answer 11

1) Inflammation (prostatitis)
2) Benign nodular enlargement (BPH) - most common
3) Tumours

Question 12

How common is BPH?

Answer 12

Seen in all men over 50 yrs

Question 13

Why does BPH generally result in lower urinary tract symptoms?

Answer 13

Obstruction and irritation of bladder due to occuring in transitional zone of prostate

Question 14

What are some symptoms of BPH?

Answer 14

Increased pee frequency
Dribbling
Hard to initiate 
Decreased size + strength of stream
Cannot post pone 
Pushing to get it out

Question 15

Where does prostate cancer deaths rate?

Answer 15

3rd most common

Most diagnosed in men

Question 16

What is chance at age 85?

Answer 16

1 in 5

Question 17

What are some risk factors for prostate cancer?

Answer 17

Old age
Family history
Race
High levels of testosterone
Diets high in fat

Question 18

What are symptoms of prostate?

Answer 18

Similar to BPH

Mostly asymptomatic

Question 19

How is PC tested?

Answer 19

Palpation on digital rectal examination
Symptoms
Rectal ultrasound
Tran rectal ultrasound guided biopsy (trusBX)
Serum PSA

Question 20

What is PSA?

Answer 20

Prostate specific antigen

Question 21

What can raise PSA levels?

Answer 21

1) Age
2) BPH
3) Subclinical prostatitis
4) Prostate carcinoma

Question 22

What is disease median age of prostate cancer diagnossi?

Answer 22

67

median age of 80 at death

Question 23

How long is pre-clinical phase of prostate cancer?

Answer 23

10 or 15 years

Question 24

What is the commonest epithelial malignancy of the prostate gland?

Answer 24

Acinar adenocarcinoma (>95%)

Question 25

What are some other types of Epithelial neoplasms associated with PC?

Answer 25

Ductal adenocarcinoma Adenosquamous Carcinoma Small cell carcinoma Sacromatoid carcinoma

Question 26

What are the 4 characteristic histological features of prostate carcinoma?

Answer 26

1) Infiltrative glands - Too small, corwded and clear 2) Absence of basal cell layer 3) Large nuclei 4) Prominent nucleoli

Question 27

What immunohistochemical stain cocktail can demonstrate absent basal cell layer in prostate Ca?

Answer 27

PIN4

Question 28

What is the second most common form of prostate cancer?

Answer 28

Ductal adenocarcinoma

Question 29

Why was ductal adenocarcinoma known as endometrioid adenocarcinoma?

Answer 29

Because it looks look similar to endometrioid adenocarcinoma

Question 30

What is the current internationally accepted grading system for prostate cancer?

Answer 30

The Gleason score

Question 31

What is the Gleason score based upon?

Answer 31

The architectual patterns of the tumour - The more irregularly structured the worse 4x or 10x magnification Not influenced by anything else

Question 32

What are the most common sites of metastasis of prostate cancer?

Answer 32

``` Bone Lung Lymph nodes Liver Brain ``` Metastases often sclerotic on imaging

Question 33

What are the 4 T stages of TNM staging key?

Answer 33

T1 = not palpable, incidentally discovered T2= Organ confined T3=Extends through capsule including seminal vesicles T4= Invades adjacent structures N1 = regional LN metastases M1 = Distant metastases

Question 34

What are the AJCC key components of prostate cancer staging?

Answer 34

TNM Pre op serum PSA Gleason score

Question 35

What are some radical treatments for locally or advanced prostate cancer?

Answer 35

1) External Beam Radiotherapy 2) Radical radiotherapy and androgen deprivation therapy 3) Brachytherapy 4) Radical prostatectomy

Question 36

How is advnaced/metastatic ca treated?

Answer 36

Endocrine therapy - Orchidectomy or administration of LHRH

Question 37

What does the androgen receptor play a role in?

Answer 37

Normal development of prostate Prostate carcinogenesis Progression to metastasis

Question 38

Have AR mutations been linked to PC?

Answer 38

Yes, especially in african american population