Prostate pathology

intravesical chemotherapy

- Urinary catheter is used to place anticancer drugs directly into bladder to reach cancer cells near the bladder lining but not in the kidneys, urine, and urethra

Treatment of BPH

1. 5-alpha reductase inhibitor - block conversion of T to DHT (takes 6-12 months for results and can cause gynecomastia and sexual dysfunction) 2. Alpha blockers - blocks alpha-1 receptors in prostate to relax smooth muscle and allow urine to flow.(side effects are fatigue, light-headedness, dizziness) this drug can also be used with hypertension 3. Surgery: TURP TUVP TUNA

Symptoms of BPH

1. Dysuria 2. Nocturia 3. Weak stream 4. Urgency 5. Incomplete emptying 6. Frequency 7. Hesitancy 8. Intermittency 9. Drippling

Evaluation of lower urinary tract obstruction due to prostate enlargement include:

1. History 2. Physical exam DRE 3. Urinalysis— to evaluate possible UTI 4. Serum creatinine 5. PSA— prostate specific antigen 6. PVR

Several factors that affect prognosis of TCC:

1. Presence of metastases 2. Depth of invasion 3. Degrees of cellular abnormality

Men should have DRE and PSA level checked starting age____

40

What causes testosterone to become dihydrotesterone?

5-alpha reductase

What weight is an enlarged prostate gland?

50-100g

What demographic do bladder cancer affect the most?

50-80 years old Male in industrialized nations

% of tumor arises in the peripheral zone of the prostate gland posteriorly

70

The median age of bladder cancer at diagnosis is ____

71 yrs

1/3 of prostate cancer is diagnosed in men over___

75

Successful rate of TURP:

80%

What is hydronephrosis?

A condition characterized by excess fluid in a kidney due to a backup of urine. Dilated renal pelves

What is a stromal cell?

A type of cell that makes up certain types of connective tissue (supporting tissue that surrounds other tissues and organs).

How is PVR measured?

Abdominal ultrasound —— preferred method urethral catheterization

The most common type of prostate cancer:

Adenocarcinoma

The risk of prostate cancer increases dramatically with ____

Age

Presenting features of prostate cancer:

Asymptomatic

What are the two important diseases of the prostate?

BPH & prostate carcinoma

What's the most common disorder of the prostate for men over 50?

BPH, half men have it

Treatment for metastatic prostate cancer:

Based on androgen deprivation—> surgical castration Exogenous estrogens Use of LHRH—> inhibit release of pituitary gonadotropins Antiandrogens

What structure do prostate frequently metastasize?

Bone, especially the spine

pathologist use ______ to determine how aggressive the cancer cells are

Cellular differentiation

Treatment for metastatic TCC:

Chemotherapy

Treatment for invasive bladder cancer in men:

Cystoprostatectomy and remove distal ureters

What can detect prostate cancer?

DRE serum PSA level Multiple biopsies with transrectal ultrasound

Benefits of transurethral electrovaporization(TUVP) compare with TURP:

Decreased bleeding Shorter recovery time

What androgen causes BPH?

Dihydrotestosterone

What features in DRE is suspected to have prostate cancer?

Discrete nodule Disffuse hardness to the prostate

Risk factors for developing TCC:

Exposure to chemicals Smoking Urinary tract parasite

What is BPH characterized by?

Formation of large, fairly discrete nodules in the periurethral region of the prostate, compressing the urethral canal to cause partial or complete obstruction of the urethra.

How much low-grade tumors recur?

Half. Requires intravesical chemotherapy

BPH can cause ____ and ____ to develop due to inability to empty bladder

Hydronephrosis Pyelonephritis- kidney infection

What can lead to renal failure?

Hydronephrosis from bladder outlet obstruction Renal calculi—— kidney stone

BPH can cause what secondary change to the bladder?

Hypertrophy of the bladder wall from straining Trabeculation of the mucosa Diverticulum formation

Treatment for bladder cancer in women:

Hysterectomy bilateral salpingo-oophorectomy (BSO) Remove anterior vaginal wall and urethra

Complications of redial prostatectomy:

Impotence—> nerve damage/removal Urinary incontinence Rectal injury

Is the renal damage caused by BPH reversible?

It can be irreversible

What is phylonephritis?

Kidney infection

The spread is the prostate cancer occurs by_____

Local invasion—> into peri prostatic fat, seminal vesicles, and bladder Blood or lymphatic channels—> bones. Lumber spine, proximal femur, pelvis, thoracic spine and ribs

Benefits of TUNA compare with TURP and TUVP

Minimal anesthesia No need for hospitalization Minimum risk of complications like sexual dysfunction and incontinence

Characters bladder tumor:

Mutifocal Accompanied by area of dysplasia Carcinoma in Situ Field effect

Can BPH develop to become malignant?

No

If the pelvic lymph nodes are involved with the prostate cancer, what's the treatment option?

No radial prostatectomy Use radiation Chemotherapy

What is a diverticulum of bladder?

Outpouching of the bladder wall

Classical bladder cancer symptoms:

Painless hematuria —>most common 75% Frequency, urgency and dysuria—> may present sometimes

What is BPH characterized by?

Peri-urethral nodular hyperplasia

What location do prostate cancer arises?

Peripheral zone, posterior of prostate

Which part of the prostate do cancer occur usually?

Periphery of the gland, can be palpated by a digital rectal exam

What part of the prostate increase the most size with BPH?

Periurethral Zone

Which cancer cells behave more aggressively? Poorly differentiated or well differentiated?

Poorly differentiated — meaning looks very different than normal cells

What causes BPH?

Proliferation of the stromal (fibromuscular tissue) and glandular elements in the prostate causes by Dihydrotestosterone

____ is the 2rd leading cause of cancer mortality in men

Prostate cancer

What conditions have PSA increase?

Prostate cancer BPH Some inflammatory condition

What fluid and enzyme prostate secret into the semen that is important for fertility?

Prostatic acid phosphatase

Name the compound that produced by prostate as a marker to diagnose prostate carcinoma:

Prostatic specific antigens—— PSA

If the pelvic lymph nodes are not involved, what treatment option to use?

Radial prostatectomy

What markers after indicates recurrence of prostate cancer?

Rising PSA levels

Side effects of TURP:

Short term: bleeding and UTI around time of surgery Long term: erectile dysfunction, retrograde ejaculation, urethra stricture, bladder neck contracture, incontinence.

What's the size and weight of the prostate?

Size of a walnut, weight 20-40g

What type of bladder cancer takes up most of the cases?

TCC, 90%

What is "field effect" in bladder cancer?

The whole bladder mucosa can be affected by the carcinogenic influence even after lesion has been removed. The rest of the mucosal epithelium is still at risk for development of cancer. Constance surveillance and routine biopsies are needed. Reoccurring at a different site is common.

What is the periurethral zone?

This area surrounds the urethra from the bladder neck to the prostate apex

What is evaluation of Creatinine necessary?

To measure renal function to help understand how long the bladder outlet obstruction has been present.

What is trabeculation of bladder?

Trabeculation of the bladder occurs from repeated obstructions in the urethra. When an obstruction occurs, the muscles walls of the bladder have to work too hard to move urine past the blockage. This leads to a thickening of the muscle walls and a loss of elasticity.

What type of cell lines the inner surface of the bladder and ureters, urethra, and renal pelves

Transitional epithelium

What type of epithelium can give rise to carcinoma that can be flat, papillary, noninvasive or invasive

Transitional epithelium

What can detect an area of prostate to biopsy?

Transrectal ultrasound, multiple areas to biopsy

Treatment for superficial tumors:

Transurethral resection of the tumor

Signs of symptoms of metastatic lesion to the vertebral bone:

Weight loss Diffuse bone pain

The most important prognostic indicator for prostate cancer is____

Whether the pelvic lymph nodes are involved

Where is the prostate gland located?

below the urinary bladder, in front of the rectum. Retroperitoneal organ

What is BPH?

benign prostatic hyperplasia

Mainstays of diagnosis of TCC:

cystoscopy biosy

incomplete emptying of the bladder may result in

infection of bladder—— cystitis

What is Salpingo-oophorectomy?

is the surgery to remove the ovaries and Fallopian tubes

radical retropubic prostatectomy, how it works?

surgical procedure in which the prostate gland is removed through an incision in the abdomen. First examine the pelvic lymph nodes, if the lymph nodes are positive then surgery is abandoned

What is TUNA?

transurethral needle ablation-> low radio frequency causes heat is to destroy the prostate under endoscope