Prostate Prostate

Dr. Amitabha Basu MDDr. Amitabha Basu MD

Our topicOur topic

1.1. ProstatitisProstatitis

2.2. Infarction of prostateInfarction of prostate

3.3. Nodular Hyperplasia of prostateNodular Hyperplasia of prostate

4.4. Prostatic intraepithelial Prostatic intraepithelial neoplasia (PIN)neoplasia (PIN)

5.5. Carcinoma of prostate.Carcinoma of prostate.

Prostatitis and infarction Prostatitis and infarction

1.1. Definition: Definition: Inflammation of Inflammation of prostate.prostate.

2.2. EtiologyEtiology

3.3. Infarction Infarction

Acute bacterial Prostatitis Acute bacterial Prostatitis [ E.coli][ E.coli]

►Patient may have additional infection Patient may have additional infection of urethra or urinary bladder (as a of urethra or urinary bladder (as a source of infection) .source of infection) .

►Presence of Neutrophils in the tissue. Presence of Neutrophils in the tissue.

Chronic ProstatitisChronic Prostatitis

Chronic bacterial Prostatitis : Follow Chronic bacterial Prostatitis : Follow acute Prostatitis.acute Prostatitis.

Chronic abacterial ProstatitisChronic abacterial Prostatitis

[ Prostatodynia] : Chlamydia [ Prostatodynia] : Chlamydia Trachomatis.Trachomatis.

Chronic Prostatitis: lymphocytes and Chronic Prostatitis: lymphocytes and

macrophagemacrophage

Granulomatous ProstatitisGranulomatous Prostatitis

Cause : Cause :

1.1. Disseminated tuberculosisDisseminated tuberculosis

2.2. Sarcoidosis.Sarcoidosis.

Infarction of prostateInfarction of prostate

1.1. Etiology: Etiology: 1.1. Post oprtative retention of urine.Post oprtative retention of urine.2.2. Prolonged operative hypotension Prolonged operative hypotension 3.3. Smoking and pre-existing Smoking and pre-existing

cardiovascular disease.cardiovascular disease.

2.2. Lab: May increase the serum prostate Lab: May increase the serum prostate specific antigen. specific antigen.

Area of Prostatic infarctionArea of Prostatic infarction

Time for Nodular Hyperplasia of Time for Nodular Hyperplasia of prostate prostate

Nodular Hyperplasia of prostate Nodular Hyperplasia of prostate (BPH)(BPH)

1.1. IncidenceIncidence

2.2. EtiopathogenesisEtiopathogenesis

3.3. Morphology ( gross Morphology ( gross and micro)and micro)

4.4. Clinical featuresClinical features

5.5. ComplicationsComplications

6.6. ManagementManagement

Nodular Hyperplasia of prostate Nodular Hyperplasia of prostate (BPH)(BPH)

►AgeAge : Begin at 40 . Frequency : Begin at 40 . Frequency increases to 90 % by eighth increases to 90 % by eighth decade.decade.

►Etiology Etiology : Synergistic role of : Synergistic role of androgen and Estrogen for the androgen and Estrogen for the development of BPH. development of BPH.

Pathogenesis – flow chartPathogenesis – flow chart

Testosterone

Dihydrotestosterone (DHT)

5 Alfa reductase

In older people the DTH receptor increased = result in BPH

DHT receptors

Nodulatiry is pronounced in the Nodulatiry is pronounced in the central & lateral region.central & lateral region.

Increase in the size of prostate( more Increase in the size of prostate( more that 300g).that 300g).

MicroscopyMicroscopy

1.1. Hyper plastic nodule are composed of Hyper plastic nodule are composed of proliferationproliferation of of glands and glands and fibromuccular stromafibromuccular stroma BOTH.BOTH.

2.2. Glands are Glands are lined by two layers of lined by two layers of cells.cells.

3.3. Gland contains corpora amylacea.Gland contains corpora amylacea.

Gland contains corpora Gland contains corpora amylacea.amylacea.

Clinical features: ProstatismClinical features: Prostatism1.1. HesitancyHesitancy

2.2. Intermittent interruption while Intermittent interruption while voiding.voiding.

3.3. And evidence of bladder And evidence of bladder irritation:irritation:

a.a. UrgencyUrgency

b.b. FrequencyFrequency

c.c. NocturiaNocturia

ComplicationsComplications

1.1.MOST FREQUENT CAUSE MOST FREQUENT CAUSE OF RECURRENT LOWER OF RECURRENT LOWER URINARY TRACT URINARY TRACT INFECTION in male.INFECTION in male.

2.Bladder distention, hypertrophy

3.Bilateral hydronephrosis

Management - TURPManagement - TURP

TRANSURETHRAL TRANSURETHRAL RESECTION OF RESECTION OF PROSTATEPROSTATE

Time for carcinoma prostateTime for carcinoma prostate

Carcinoma prostateCarcinoma prostate

1.1. General featuresGeneral features

2.2. EtiopathogenesisEtiopathogenesis

3.3. PINPIN

4.4. Morphology of Prostatic Morphology of Prostatic carcinomacarcinoma

5.5. DiagnosisDiagnosis

6.6. GradingGrading

7.7. ManagementManagement

Carcinoma of prostate : general Carcinoma of prostate : general featuresfeatures

1.1. Age : 65-75 yr.Age : 65-75 yr.

2.2. Orchiectomy/ estrogen therapy Orchiectomy/ estrogen therapy reduces the tumor size.reduces the tumor size.

3.3. Migration: Male migrate from a low Migration: Male migrate from a low risk area to high risk area maintain risk area to high risk area maintain their low risk of cancer.their low risk of cancer.

EtiopathogenesisEtiopathogenesis

A.A. Effect of Androgen Effect of Androgen ( so, ( so, Orchiectomy reduce the tumor size Orchiectomy reduce the tumor size in Prostatic carcinoma patient).in Prostatic carcinoma patient).

B.B. Genetic Genetic ( Chromosome No 1 and 10).( Chromosome No 1 and 10).

C.C. Environmental factors Environmental factors ( common in ( common in Scandinavian countries, Scandinavian countries, uncommon uncommon in Japanin Japan))

Diet rich in animal fat.Diet rich in animal fat.

Prostatic intraepithelial Prostatic intraepithelial NeoplasiaNeoplasia

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

Importance of PINImportance of PIN

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

Prostatic adenocarcinoma ; Prostatic adenocarcinoma ; Presenting featuresPresenting features

1.1. Clinically silentClinically silent

2.2. ProstatismProstatism : : local discomfort and local discomfort and evidence of lower urinary tract evidence of lower urinary tract obstruction.obstruction.

3.3. Bone metastasisBone metastasis : : mainly to mainly to the axial skeleton the axial skeleton ( osteoblastic)( osteoblastic)

Gross of prostate adenocarcinoma ; Gross of prostate adenocarcinoma ; mostly begin (arises) in the mostly begin (arises) in the peripheryperiphery of of

prostate.prostate.Location: Location: posterior lobeposterior lobe..

Yellowish nodules

High power : back to back arrangement of the High power : back to back arrangement of the malignant glands and cells with prominent malignant glands and cells with prominent

nuclei.nuclei.

…………malignant cells with prominent malignant cells with prominent nuclei.nuclei.

Diagnosis Diagnosis

1.1. Digital rectal examinationDigital rectal examination

2.2. MRI scanMRI scan

3.3. X- ray in suspected case of X- ray in suspected case of bone metastasis bone metastasis ( ( osteoblasticosteoblastic). ).

4.4. PSA study. ( more than 10 PSA study. ( more than 10 ng/dl)ng/dl)

5.5. Needle biopsy Needle biopsy

6.6. Immunofluroscence Immunofluroscence staining by Prostatic staining by Prostatic specific antigen.specific antigen.

Osteoblastic bone lesion in Osteoblastic bone lesion in metastasis Prostatic cancer. metastasis Prostatic cancer. Which Which

one is normalone is normal ? ?

Self assessmentSelf assessment

1.1. PIN ( micro)PIN ( micro)

2.2. Diagnosis of Prostatic carcinoma.Diagnosis of Prostatic carcinoma.

3.3. Medical management.Medical management.

4.4. Prostatic carcinoma ( gross and Prostatic carcinoma ( gross and micro)micro)

5.5. BPH ( gross and micro)BPH ( gross and micro)

6.6. Chronic a-bacterial ProstatitisChronic a-bacterial Prostatitis..

Thank youThank you