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D&T3 Exam 1 > Prostate-Norton > Flashcards

Prostate-Norton Flashcards

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1
Q

Prostate Adenocarcinoma

Clinical

DRE

A

May detect early prostate cancers as hard nodules

Low sensitivity and specificity

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2
Q

BPH

Tx

Moderate to severe

A

Medical therapies: Dec smooth muscle tone (a-blockers)

5-a-reductase inhibitors inhibit synthesis of DHT to shrink prostate

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3
Q

BPH

Morphology

Early Nodules

A

Composed of stromal cells (pale, gray, tough)

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4
Q

DHT-AR induced growth factor function

A

Inc. proliferation of stromal cells and decrease death of epithelial cells

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5
Q

Where is 5-a-reductive found and what is its function?

A

Found in the stromal cells of the pancreas and works to convert testosterone to DHT

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6
Q

BPH

Morphology

Late Nodules

A

Composed of epithelial cells/glands (pink-yellow, soft, exude milky prostatic fluid)

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7
Q

Prostate Adenocarcinoma

Gleason grading

Totals

8-10

A

High-grade cancer

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8
Q

BPH

Epidemiology

A

20% over 40
70% over 60
90% over 80

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9
Q

Prostate Adenocarcinoma

Gleason grading

Totals

5-6

A

Intermediate grade cancer

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10
Q

Prostate Intraepithelial Neoplasia (PIN)

Gland Morphology

A

Larger than cancer glands with branching and infolding

Surrounded by patchy layer of basal cells and intact basement membrane

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11
Q

MC site of pancreatic carcinomas

A

Peripheral zone

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12
Q

Prostate Adenocarcinoma

MC tx for localized cancer

A

Surgery (radical prostatectomy)

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13
Q

Prostate Adenocarcinoma

Gleason grading

Gleason 5

A

Highest grade

No glandular differentiation, cells infiltrate stroma in cords, sheets, and nests

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14
Q

Prostate Intraepithelial Neoplasia

MC in which zone

A

Peripheral zone (same as cancer)

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15
Q

Prostate Adenocarcinoma

Gleason grading

Totals

7

A

Moderate to poorly-differentiated cancer

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16
Q

Prostate Adenocarcinoma

Clinical

Transrectal US

A

Low sensitivity and specificity

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17
Q

Cause of Acute Bacterial Prostatitis

A

Same as UTI (E. coli, other g(-) rods, enterococcus, staph)

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18
Q

Chronic Bacterial Prostatitis

Pertinent PMH findings

A

Recurrent UTI with same organism

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19
Q

Most common form of cancer in men in US

A

Prostate Adenocarcinoma

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20
Q

Prostate Adenocarcinoma

Grading by what system

A

Gleason system

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21
Q

BPH

Microscopic

A

Nodules are prominent (stromal fibromuscular to fibroepithelial with glands)

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22
Q

Prostate Adenocarcinoma

Histology

A

Glands are small, more crowded, without branching or infolding, separated by little or no stromal material

BACK-TO-BACK glands

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23
Q

MC site of hyperplasia

A

Transitional zone

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24
Q

Chronic Abacterial Prostatitis

Lab findings

A

Prostatic secretions: leukocyte (+)

Culture: Bacteria (-)

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25
Prostate Adenocarcinoma Tx
Surgery (radical prostatectomy) Radiation Hormone manipulation
26
BPH Tx Mild sx
Conservative: Dec fluids before bed, decrease caffeine and EtOH, timed voiding
27
Prostate Adenocarcinoma Prognosis after therapy
>90% can expect to live 15 years
28
Prostate Adenocarcinoma Spread
Local extension is to perprostatic tissues, seminal vesicles, base of bladder
29
Prostate Adenocarcinoma PSA Normal cutoff value and risk level ass. With value
Cutoff for normal serum level is 4.0 ng/ml 25% of men with a PSA 2.5-4.0 ng/ml have prostate cancer
30
BPH Pathogenesis
DHT-AR activation leading to transcription of growth factor genes
31
Prostate Adenocarcinoma Histology Individual cell structure
Hyperchromatic cells with prominent nucleoli Pleomorphism and mitotic figures are UNCOMMON
32
Prostate Adenocarcinoma How to measure response to treatment
Serial PSA measurements
33
Acute Bacterial Prostatitis Clinical findings
Fever, chills, dysuria, prostate TENDER and boggy on dre
34
Prostate Adenocarcinoma MC in... (ethnicity)
African-Americans Uncommon in Asians
35
Chronic Abacterial Prostatitis Clinical
Presents like chronic bacterial prostatitis
36
Chronic Bacterial Prostatitis Clinical
Mild sx: back pain, dysuria, perineal and Suprapubic discomfort or asymptomatic
37
Granulomatous Prostatitis MC cause in US
BCG instilled into bladder to treat superficial bladder cancer (Clinically insignificant if due to BCG)
38
Acute Bacterial Prostatitis What allows spread of bacteria to prostate?
Reflux of urine into prostate
39
Prostate Adenocarcinoma Metastasis via lymphatics
To obturator nodes then paraaortic nodes
40
Chronic Bacterial Prostatitis Lab findings
Expressed prostatic secretions: leukocytes (+)
41
Prostate Adenocarcinoma PSA Specificity
Organ specific but not cancer specific
42
Prostate Adenocarcinoma Clinical Local prostate cancer detection
Asymptomatic, found on DRE or elevated PSA
43
Prostate Adenocarcinoma Histology Gland cell structure
Glands lined by cuboidal/columnar cells with ABSENT OUTER BASAL CELL LAYER
44
Acute Bacterial Prostatitis Urinalysis findings
Leukocytes (+)
45
Prostate Adenocarcinoma PSA Use
Diagnosis and management of prostate cancer Use as screening test is controversial (lacks sensitivity and specificity)
46
Prostate Adenocarcinoma MC in...
Peripheral ducts and acini
47
Prostate Adenocarcinoma Metastasis via blood
To bones (lumbar spine, proximal femur, pelvis, thoracic spine, ribs) to form osteoblastic lesion
48
Prostate Adenocarcinoma Gleason grading How are tumors scored?
Adding most prominent pattern and second most prominent pattern OR Most prominent pattern and highest grade pattern present
49
Acute Bacterial Prostatitis Culture results
Bacteria (+)
50
BPH Morphology
Prostate enlarges to 60-100 g (normal 20 g) Originates in transition zone (periurethral)
51
Prostate Adenocarcinoma Other factors that can elevate PSA
Prostatitis, infarct, instrumentation of prostate, ejaculation,UTI, age, etc. DRE does NOT elevate PSA
52
Chronic Bacterial Prostatitis Culture
Bacteria (+)
53
BPH Clinical Signs of UTI
Bladder hypertrophy and distention Urine retention, residual urine leading to: Frequency, nocturnal, difficulty starting and stopping, overflow dribbling, dysuria Infection
54
BPH Clinical
Urethral obstruction (caused by inc in size of prostate, nodules impinge on urethra, smooth muscle contraction of prostate)
55
What is the main prostate androgen?
Dihydrotestosterone
56
Prostate Intraepithelial Neoplasia (PIN) Morphology
High grade PIN cells look the same as cancer cells PIN glands differ from cancer glands
57
Prostate Adenocarcinoma Possible precursor lesion
Prostate intraepithelial neoplasia
58
MC form of prostatitis
Chronic Abacterial Prostatitis
59
Prostate Adenocarcinoma Etiology
High fat diet may contribute to risk Androgens- induce pro-growth and pro-survival genes in cancer cells as well as normal cells
60
Prostate Adenocarcinoma Gleason grading Gleason 1
Lowest grade Most well-differentiated with uniform round glands in well-circumscribed nodules
61
Where does DHT bind?
Androgen receptors (AR) on nuclei of stromal and epithelial cells
62
How is DHT formed?
Conversion of testosterone by type 2 5-a-reductase found in stromal cells
63
Prostate Adenocarcinoma MC in which zone
Peripheral zone (70%) Classic in posterior area: hard nodule on DRE
64
Prostate Adenocarcinoma Genetics
Men with one first degree relative with prostate cancer: risk is 2X greater Men with 2 first degree relatives with prostate cancer: 5X risk BRCA2: 20X risk
65
Prostate Intraepithelial Neoplasia (PIN) Occurrence
Seen in younger age than cancer Seen more frequently and extensively in prostates with cancer
66
BPH Surgical therapies
Transurethral resection of prostate (TURP)
67
Prostate Adenocarcinoma PSA
Normally secreted into semen, minute amounts circulating in serum Elevated serum levels in localized and advanced prostate cancer
68
Prostate Adenocarcinoma Gleason grading Totals 2-4
Well-differentiated (low-grade) cancer
69
Prostate Adenocarcinoma PSA Refinements to improve PSA screening
PSA density PSA velocity Age specific reference ranges Ratio of bound and free PSA in serum
70
Prostate Adenocarcinoma Clinical What is used to confirm diagnosis?
Transrectal needle biopsy
71
BPH Etiology
Inc. number of epithelial cells and stromal components influenced by DHT

D&T3 Exam 1 (19 decks)

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