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
