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40 Cards in this Set
- Front
- Back
list from superior (starting with bladder) to inferior (ending at urethra).
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Bladder -> seminal vesicles -> base of the prostate -> apex of the prostate -> urethra
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Prostatitis can be inflammatory/infectious; acute/chronic; bacterial/abacterial and are usually extensions from the bladder or urethra. name some common organisms.
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Coliforms, GC, TB, Schistosoma (location dependent), Chlamydia, and ureaplasma
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BPH is more common in what zone of the bladder?
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central zone - reason for urinary problems
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Prostatic cancer is found in what zone?
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70% found in peripheral zone
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describe the feel of BPH.
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diffusely enlarged, boggy soft prostate, smooth, no nodules
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Describe BPH microscopically.
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hyperplasia of both epithelial and stromal elements. can see areas of infarction and squamous metaplasia.
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List the clinical symtpoms of BPH.
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urinary retention, obstruction, infection, hydroureter, hydronephrosis, renal failure, falls and bone fractures b.c of calcium imbalance
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Name some common types of treatments for BPH.
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5 alpha reducatase inhibitors (inhibit conversion of testosterone -> DHT); Alpha 1 adrenergic receptor blockers - reduce contraction
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Does BPH predispose men to carcinoma?
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NO
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if prostate cancer were to spread, where would it go?
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seminal vesicles, lymph nodes and bone
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What grading system is used when staging prostate cancer?
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Gleason Scoring System - addresses degree of differentiation and glandular pattern
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Describe the Gleason System of grading prostate cancer.
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needle biopsy cells have a Score ranging from 2-10 (most common is Grade3); First the cells are assigned a number between 1 and 5 (normal-1, most abnormal=5); then the 2 most common patterns that are seen are added together.
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How is prostate cancer diagnosed?
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rectal examination, biopsy, alkaline phosphatase (for bone mets), and PSA and bone scans
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Typical tumors of a gleason score 2-4 are what?
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small tumors, typically incidental
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The majority of treatable CA are what Gleason score?
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5-7 (I would assume anything <7)
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Advanced cancer with an unlikely cure has what type of Gleason score?
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8-10
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What system is used for staging prostate cancer?
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TNM system (Classification of Malignant Tumors); based on how the tumor is found and the extent of spread; T= size or extent of tumor; N=spread to regional lymph nodes; M=distant metastasis
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Name the TNM staging. An incidental finding on biopsy.
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T1a
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Name the TNM staging. Incidental histologic finding in >5% of tissue resected.
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T1B
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Name the TNM staging. Lesion is localized within the prostate.
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T2
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Name the TNM staging. Tumor is identified by needle biopsy and was found in 1 or both lobes by needle biopsy but not palpable or visible by imaging.
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T1c
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Name the TNM staging. Local invasion.
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T3
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Name the TNM staging. Distant Spread.
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T4
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Name the TNM staging. No regional lymph node mets.
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N0
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Name the TNM staging. regional lymph nodes cannot be assessed.
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NX - use "X" when not done or can't be done.
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Name the TNM staging. mets in regional lymph node or nodes.
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N1
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Name the TNM staging. Distant mets can't me assessed.
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MX
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Name the TNM staging. more than 1 site of mets present.
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pM1c (a prefix like "p" means that tissue for pathologic examination of a surgical specimen was done)
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Name the TNM staging. no distant mets.
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M0
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Name the TNM staging. distant mets.
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M1
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Name the TNM staging. Nonregional LN.
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M1a
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Name the TNM staging. mets to bone.
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M1b
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Name the TNM staging. mets to other sites.
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M1c
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What are normal levels of prostate specific antigen?
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0-4ng/mL (best way to determine risk is the amount of change or increase in PSA from year to yr)
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One of the problems with PSA is that 20-40% of pts. with grade __ prostate cancer have values below 4ng/mL.
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T2 (lesion localized within the prostate)
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name some proposed modications to make the PSA more sensitive and specific.
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use age-related cutoffs; race-specific reference ranges
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recently, PSA is being measured in its bound and free forms. what does this tell us?
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can tell the difference in mildly elevated PSA from cancer and those with BPH.
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The lower the ratio free:total PSA, the _____ the likelihood of cancer.
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higher; the risk of CA increases if the free to total ratio is low; the lower the ratio the greater the probability of CA.
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A cutoff of ___% maximizes cancer detection and minimizes unnecessary biopsies.
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22%
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