SFP: prostate pathology

Question 1

Where is the prostate?

Answer 1

At the base of the bladder on the posterior face and surrounding the urethra

Question 2

What is attached to the prostate?

Answer 2

Seminal vesicles via ejaculatory ducts

Question 3

What are the 3 zones of the prostate?

Answer 3

Central, transition, peripheral

Question 4

What is the purpose of the prostate?

Answer 4

Makes about 50% of sperm volume and balances acidity of the vagina to protect the sperm

Question 5

What are the 3 types of prostatitis?

Answer 5

Acute bacterial, chronic bacterial, and chronic abacterial

Question 6

Describe acute bacterial prostatitis.

Answer 6

Caused by uropathogens associated with UTI

Question 7

Describe chronic bacterial prostatitis.

Answer 7

Recurrent infection caused by pathogens associated with UTI

Question 8

What is granulomatous prostatitis?

Answer 8

A form of chronic bacterial prostatitis associated with BCG treatment of UTI

Question 9

Describe chronic abacterial prostatitis.

Answer 9

The most common form of prostatitis. There is no identifiable pathogen and is associated with chronic pain syndrome

Question 10

What are clinical symptoms of acute prostatitis?

Answer 10

Fever, chills, dysuria

Question 11

What are clinical symptoms of chronic prostatitis?

Answer 11

Painful events with asymptomatic intervals

Question 12

How do we diagnose chronic abacterial prostatitis?

Answer 12

1st 10 ml and midstream urine have no pyuria, prostatic secretions have more than 10 WBC per high power field. This along with no growth of bacteria from prostatic secretions makes diagnosis

Question 13

What is BPH?

Answer 13

Stromal and glandular proliferation of the prostate gland

Question 14

Which zone of the prostate is most impacted by BPH?

Answer 14

The transitional zone or central zone

Question 15

What are clinical symptoms of BPH?

Answer 15

Nocturia, inability to empty the bladder, urinary obstruction

Question 16

What is the pathogenesis of BPH?

Answer 16

DHT produced by prostate stroma impacts growth factor receptors in stroma and epithelium in the prostate.

Question 17

How do we treat BPH?

Answer 17

5a-reductase inhibitors

Question 18

Describe gross pathology of BPH.

Answer 18

Nodular prostate with slit-like urethra

Question 19

What is the histology of BPH?

Answer 19

Epithelial hyperplasia, nodular hyperplasia, papillary infoldings

Question 20

What does BPH do to the bladder?

Answer 20

It becomes trabeculated/hypertrophic and may have bacterial growth, and shape changes due to post-void residual urine

Question 21

What is necessary for the development of prostate cancers?

Answer 21

Androgens

Question 22

What are the first-line therapies of prostate adenocarcinoma?

Answer 22

Androgen receptor inhibitors

Question 23

What is the gross morphology of prostate adenocarcinoma?

Answer 23

“Smoothing out” often seen in the peripheral gland

Question 24

What is the histology of prostate adenocarcinoma?

Answer 24

Loss of basal cells, nuclear enlargement with prominent nucleoli

Question 25

What are clinical findings of prostate adenocarcinoma?

Answer 25

They’re often asymptomatic, but there may be bone mets, invasion into seminal vesicles, bladder, lymph nodes, peri-prostatic soft tissue

Question 26

What is PSA?

Answer 26

Substance made by the prostate epithelium and secreted in semen

Question 27

What is the significance of PSA?

Answer 27

May be elevated in BPH, prostate cancer, prostatitis

Question 28

What is PSA used for?

Answer 28

As a screening test, or as a trend data point

Question 29

What PSA number indicates 50% chance of prostate cancer?

Answer 29

10

Question 30

How do we treat prostate cancer?

Answer 30

Kinda depends on the behavior of the cancer. May just be watched in older patients, localized may need prostatectomy and radiation, where metastatic carcinoma may need androgen deprivation