Case Study 7.2 – Nodular Hyperplasia and Cancer of Prostate

 

Irving Olson, a 75-year-old man, presented with urinary hesitancy, frequency, and nocturia. A digital rectal examination revealed a large, nodular, and rubbery prostate gland with no hard regions. The serum PSA was 6 ng/mL (reference range 0-4 ng/mL). A transrectal ultrasound examination was performed, and prostatic biopsy specimens were obtained, which were negative for tumor, followed by transurethral resection of the prostate gland (Images 1 and 2).

Fifteen years later, he presented with low back pain of several monthsâ„¢ duration. Further questioning revealed recurrent urinary hesitancy with recent onset of dysuria. A digital rectal examination revealed a hard and irregular prostate gland. Laboratory data included alkaline phosphatase 386 U/L (reference range 38-126 U/L) and PSA 103 ng/mL (reference range 0-4 ng/mL). A transrectal prostate gland biopsy was performed (Images 3 and 4). A radionuclide bone scan revealed widespread hot spots, and a spine x-ray revealed numerous radiodense bony lesions (Image 5). A repeat transurethral resection of the prostate gland and bilateral orchiectomy was performed.

The following images may help guide your discussion:

• Prostate gland, nodular hyperplasia (benign prostatic hypertrophy) – Low power Links to an external site.
• Prostate gland, nodular hyperplasia – Medium power Links to an external site.
• Prostate gland, adenocarcinoma – Low power Links to an external site.
• Prostate gland, adenocarcinoma – High power Links to an external site.
• Spine – Radiograph Links to an external site.
• Prostate gland, nodular hyperplasia – Gross, cut surface Links to an external site.
• Prostate gland, adenocarcinoma – Gross, cut surface Links to an external site.
• Spine, prostate carcinoma metastatic to vertebrae – Gross, cut surface Links to an external site.
• Bone, metastatic prostatic adenocarcinoma – Low powerLinks to an external site.

ALL students will answer Question #1, and Question #8. Then for your INITIAL POST, students with the LAST name beginning with the letter:

• A – C: Will answer Questions 2
• D – F: Will answer Questions 3
• G – J: Will answer Questions 4
• K – O: Will answer Questions 5
• P – T: Will answer Questions 6
• U – Z: Will answer Questions 7

Initial posts and responses must be based on various resources such as textbooks, articles, and journals. Medscape, Up-to-Date, and ePocrates as supplemental resources are acceptable.

Questions:

1. What is the epidemiology of Nodular Hyperplasia and Cancer of the Prostate? (CDC; WHO; other resources).
2. Is nodular hyperplasia found most commonly in the central or peripheral portions of the prostate gland?
3. What hormone causes hyperplasia of the prostate gland? How can the production of this hormone be interrupted biochemically?
4. How do malignant prostatic glands differ from benign prostatic glands in histologic appearance?
5. Is nodular hyperplasia of the prostate gland a risk factor for prostatic carcinoma?
6. What type of cell produces bone in osteoblastic metastases?
7. What symptoms might result from a patient suffering from nodular prostate hyperplasia? Is there a drug that is considered helpful in the treatment of prostatic hyperplasia?
8. What is the Primary Diagnosis?  What are two possible differential diagnoses?  What is the likely outcome of this case?

NB

LAST NAME BEGINS WITH “R”