Prostate

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Prostate

• Dr. Amitabha Basu MD

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Our topic

• Prostatitis
• Infarction of prostate
• Nodular Hyperplasia of prostate
• Prostatic intraepithelial neoplasia (PIN)
• Carcinoma of prostate.

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Prostatitis and infarction

• Definition Inflammation of prostate.
• Etiology
• Infarction

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Acute bacterial Prostatitis E.coli

• Patient may have additional infection of urethra
  or urinary bladder (as a source of infection) .
• Presence of Neutrophils in the tissue.

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Chronic Prostatitis

• Chronic bacterial Prostatitis Follow acute
  Prostatitis.
• Chronic abacterial Prostatitis
• Prostatodynia Chlamydia Trachomatis.

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Chronic Prostatitis lymphocytes and macrophage
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Granulomatous Prostatitis

• Cause
• Disseminated tuberculosis
• Sarcoidosis.

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Infarction of prostate

1. Etiology
2. Post oprtative retention of urine.
3. Prolonged operative hypotension
4. Smoking and pre-existing cardiovascular disease.
5. Lab May increase the serum prostate specific
   antigen.

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Area of Prostatic infarction
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Time for Nodular Hyperplasia of prostate
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Nodular Hyperplasia of prostate (BPH)

1. Incidence
2. Etiopathogenesis
3. Morphology ( gross and micro)
4. Clinical features
5. Complications
6. Management

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Nodular Hyperplasia of prostate (BPH)

• Age Begin at 40 . Frequency increases to 90
  by eighth decade.
• Etiology Synergistic role of androgen and
  Estrogen for the development of BPH.

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Pathogenesis flow chart
DHT receptors
5 Alfa reductase
Testosterone
Dihydrotestosterone (DHT)
In older people the DTH receptor increased
result in BPH
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Nodulatiry is pronounced in the central lateral
region.
Increase in the size of prostate( more that 300g).
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Microscopy

1. Hyper plastic nodule are composed of
   proliferation of glands and fibromuccular stroma
   BOTH.
2. Glands are lined by two layers of cells.
3. Gland contains corpora amylacea.

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Gland contains corpora amylacea.
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Clinical features Prostatism

• Hesitancy
• Intermittent interruption while voiding.
• And evidence of bladder irritation
• Urgency
• Frequency
• Nocturia

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Complications

1. MOST FREQUENT CAUSE OF RECURRENT LOWER URINARY
   TRACT INFECTION in male.
2. Bladder distention, hypertrophy
3. Bilateral hydronephrosis

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Management - TURP

• TRANSURETHRAL RESECTION OF PROSTATE

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Time for carcinoma prostate
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Carcinoma prostate

1. General features
2. Etiopathogenesis
3. PIN
4. Morphology of Prostatic carcinoma
5. Diagnosis
6. Grading
7. Management

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Carcinoma of prostate general features

1. Age 65-75 yr.
2. Orchiectomy/ estrogen therapy reduces the tumor
   size.
3. Migration Male migrate from a low risk area to
   high risk area maintain their low risk of cancer.

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Etiopathogenesis

• Effect of Androgen ( so, Orchiectomy reduce the
  tumor size in Prostatic carcinoma patient).
• Genetic ( Chromosome No 1 and 10).
• Environmental factors ( common in Scandinavian
  countries, uncommon in Japan)
• Diet rich in animal fat.

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Prostatic intraepithelial Neoplasia

• Def A precancerous cellular proliferation found
  in a single acinus or small group of prostatic
  acini.

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Importance of PIN

• The finding of PIN suggests that Prostatic
  adenocarcinoma may also be present.

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Prostatic adenocarcinoma Presenting features

1. Clinically silent
2. Prostatism local discomfort and evidence of
   lower urinary tract obstruction.
3. Bone metastasis mainly to the axial skeleton (
   osteoblastic)

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Gross of prostate adenocarcinoma mostly begin
(arises) in the periphery of prostate.Location
posterior lobe.
Yellowish nodules
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High power back to back arrangement of the
malignant glands and cells with prominent nuclei.
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malignant cells with prominent nuclei.
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Diagnosis

1. Digital rectal examination
2. MRI scan
3. X- ray in suspected case of bone metastasis (
   osteoblastic).
4. PSA study. ( more than 10 ng/dl)
5. Needle biopsy
6. Immunofluroscence staining by Prostatic specific
   antigen.

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Osteoblastic bone lesion in metastasis Prostatic
cancer. Which one is normal ?
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Self assessment

• PIN ( micro)
• Diagnosis of Prostatic carcinoma.
• Medical management.
• Prostatic carcinoma ( gross and micro)
• BPH ( gross and micro)
• Chronic a-bacterial Prostatitis.

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Thank you