Prostate
Prostate carcinoma is associated with an increase in acid phosphatases
Treatment at a glance
- Androgen deprivation: GnRH agonist (leuprorelin or goserelin) or orchidectomy
PROSTATE
- Prostatitis: Acute bacterial (2–5%), Chronic bacterial (2–5%), Chronic pelvic pain/nonbacterial ( 90–95% , most common), Asymptomatic inflammatory
- BPH: Androgen-dependent (DHT via 5α-reductase type 2 ); inner transitional zone ; nodules compress urethra; symptoms: hesitancy, weak stream, urgency/frequency/nocturia; Tx = finasteride (5α-reductase inhibitor) or alpha-blockers (tamsulosi
- Prostate Carcinoma: Most common male cancer; outer peripheral zone ; TMPRSS2-ETS fusion , PI3K/AKT mutations; graded by Gleason system ; bone metastases typically osteoblastic ; screened by PSA (imperfect — false +/−)
Read this in Exam Prep: Skin Infections, Psoriasis & Pemphigus
What our notes say
- Prostate carcinoma is associated with an increase in acid phosphatases (bchem EOY 2011 — Past Paper Questions & Answers)
- On physical examination his prostate is diffusely enlarged. (renal pathology — Past Paper Questions & Answers)
- The organ tropism of metastasis is determined by the "seed and soil" hypothesis — specific tumours preferentially metastasise to specific organs (e.g., breast → bone, lung, brain, liver; prostate → bone; colorectal → liver) (Chemical Pathology MCQs: Diabetes, Renal & Liver Disease)
- | Post-renal | Urine cannot leave | Prostate enlargement, stones, schistosomiasis, cervical or prostate cancer, blocked catheter | (Acute kidney injury)
- B—true, serum acid phosphatase (particularly prostatic acid phosphatase) rises in prostate carcinoma, especially with metastasis. (bchem EOY 2011 — Past Paper Questions & Answers)
- Discuss the etiopathogenesis, clinical features, morphology and prognosis of Carcinoma of Prostate. (pathology essays — Past Paper Questions & Answers)
Study material on Prostate
- CLINICAL BIOCHEMISTRY LAQs & SAQs
- Male Reproductive System Pathology
- Penile & Testicular Pathologies: Hypospadias, Tumors, Torsion – Male Reproductiv
- Oncopathology MCQs: Test Your Knowledge on Cancer Pathology
- Exam Prep: Skin Infections, Psoriasis & Pemphigus
- Molecular Basis of Cancer: Cell Cycle, Apoptosis & Angiogenesis
- MALE REPRODUCTIVE SYSTEM PATHOLOGY
- Chemical Pathology MCQs
- Specific Proteins in Clinical Diagnosis
- Cancer Pharmacology: Cell Cycle, Oncogenes & Drug Targets
- Male Reproductive System — Clinical MCQs
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Practice questions on Prostate
A 71-year-old man has difficulty with urination. His urinary retention leads to numerous trips to the restroom per day. On digital rectal examination is prostate is diffusely enlarged. Which of the following represents a pathologic change leading to this man's problem?
- Dysplasia
- Hypertrophy
- Hyperplasia
- Metaplasia
- Neoplasia
Answer: C. Prostatic hyperplasia is an example of pathologic hyperplasia in which prostatic cells become more sensitive to hormonal stimuli for growth. Both glands and stroma can increase in amount. Hyperplasia is an increase in the number of cells. ---
A 55-year-old man with metastatic prostate cancer develops oozing from IV sites, petechiae, and gum bleeding. PT prolonged, PTT prolonged, platelets 28,000, fibrinogen 80 mg/dL, D-dimer markedly elevated. Most likely diagnosis?
- Heparin-induced thrombocytopenia
- Disseminated intravascular coagulation
- Thrombotic thrombocytopenic purpura
- Immune thrombocytopenic purpura
Answer: B. Metastatic cancer + prolonged PT and PTT + low platelets + low fibrinogen + elevated D-dimer = DIC. Unlike TTP, DIC involves the entire coagulation system with consumption of all clotting factors and platelets simultaneously. ---
A 77-year-old man has a routine check-up. The only finding is slight nodularity of his prostate on digital rectal examination. Serum PSA is 6 ng/mL. A prostate biopsy shows prostatic intraepithelial neoplasia (PIN). Which of the following is the best medical care option to offer this man?
- Radical prostatectomy
- Multiagent chemotherapy
- Transurethral prostate resection
- Monitoring PSA levels
Answer: D. PIN is a potential precursor of prostatic adenocarcinoma, but by itself does not warrant therapy. ---
A subset of sexually active 30–45-year-old men are found to have a history of pelvic pain with enlarged, tender prostates on digital rectal examination. However, routine microbiologic cultures from prostatic secretions show no growth. Which of the following infectious agents is most likely to produce this condition?
- Human papillomavirus
- Herpes simplex virus
- Chlamydia trachomatis
- Human immunodeficiency virus
Answer: C. C. trachomatis, the leading cause of non-gonococcal urethritis, is the most frequent form of prostatitis in young adult men. There is typically no history of chronic urinary tract infection. ---
A 95-year-old man has had difficulty with urination for the past 15 years. His prostate is diffusely enlarged. A transurethral resection shows glandular hyperplasia and a focus of grade 1,2 adenocarcinoma. Which of the following is the next most appropriate treatment plan?
- Chemotherapy
- Alpha blocker therapy
- Radiotherapy
- Anti-androgen therapy
Answer: D. A Gleason 1,2 adenocarcinoma is so low grade that it is unlikely to progress. At least half of men his age probably have a focus of prostatic adenocarcinoma. ---
A pathologic study is performed in men aged 50–100 years with PSA levels above 15 ng/mL who underwent prostatectomy. The sites of adenocarcinomas are mapped within the prostate. In which of the following regions are these adenocarcinomas most likely to arise?
- Anterior fibromuscular stroma
- Central zone
- Peripheral zone
- Periurethral zone
Answer: C. Most prostatic adenocarcinomas arise in the peripheral zone posteriorly where they can potentially be palpated by digital rectal examination. ---