Prostate
Dr. Atif Ali Bashir MD
Prostate Pathology
► Prostate
weighs 20 grams in normal adult
► Retroperitoneal organ ,encircling the neck of
bladder and urethra
► Devoid of a distinct capsule
► Four distinct zones
Our topic
1.
2.
3.
4.
Prostatitis
Infarction of prostate
Nodular Hyperplasia of prostate
Prostatic intraepithelial neoplasia
(PIN)
5. Carcinoma of prostate.
Prostatitis and infarction
1. Definition: Inflammation of
prostate.
2. Etiology
3. Infarction
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.
Chronic Prostatitis
Chronic bacterial Prostatitis : Follow acute
Prostatitis.
Chronic abacterial Prostatitis
[ Prostatodynia] : Chlamydia Trachomatis.
Chronic Prostatitis: lymphocytes and
macrophage
Granulomatous Prostatitis
Cause :
1. Disseminated tuberculosis
2. Sarcoidosis.
Infarction of prostate
1. Etiology:
1. Post opertative retention of urine.
2. Prolonged operative hypotension
3. Smoking and pre-existing
cardiovascular disease.
2. Lab: May increase the serum prostate
specific antigen.
Area of Prostatic infarction
Time for Nodular Hyperplasia of
prostate
Nodular Hyperplasia of prostate
(BPH)
1. Incidence
2. Etiopathogenesis
3. Morphology ( gross and
micro)
4. Clinical features
5. Complications
6. Management
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.
Pathogenesis – flow chart
5 Alfa reductase
Testost
erone
Dihydrote
stosterone
(DHT)
In older people the DTH receptor
increased = result in BPH
DHT receptors
Nodulatiry is pronounced in the
central & lateral region.
Increase in the size of prostate( more than
300g).
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.
Gland contains corpora amylacea.
Clinical features: Prostatism
1. Hesitancy
2. Intermittent interruption while
3.
a.
b.
c.
voiding.
And evidence of bladder irritation:
Urgency
Frequency
Nocturia
Complications
1. MOST FREQUENT CAUSE OF
RECURRENT LOWER
URINARY TRACT INFECTION
in male.
2. Bladder distention,
hypertrophy
3. Bilateral hydronephrosis
Management - TURP
 TRANSURETHRAL
RESECTION OF PROSTATE
Time for carcinoma prostate
Carcinoma prostate
1.
2.
3.
4.
5.
6.
7.
General features
Etiopathogenesis
PIN
Morphology of Prostatic carcinoma
Diagnosis
Grading
Management
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.
Etiopathogenesis
A. Effect of Androgen ( so, Orchiectomy
reduce the tumor size in Prostatic
carcinoma patient).
B. Genetic ( Chromosome No 1 and 10).
C. Environmental factors ( common in
Scandinavian countries, uncommon
in Japan)
Diet rich in animal fat.
Prostatic intraepithelial Neoplasia
► Def:
A precancerous cellular
proliferation found in a single acinus
or small group of prostatic acini.
Importance of PIN
► The
finding of PIN suggests that Prostatic
adenocarcinoma may also be present.
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)
Gross of prostate adenocarcinoma ;
mostly begin (arises) in the periphery of
prostate.
Location: posterior lobe.
Yellowish nodules
High power : back to back arrangement of the
malignant glands and cells with prominent nuclei.
……malignant cells with prominent
nuclei.
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.
Osteoblastic bone lesion in metastasis
Prostatic cancer. Which one is normal ?
Self assessment
1.
2.
3.
4.
PIN ( micro)
Diagnosis of Prostatic carcinoma.
Medical management.
Prostatic carcinoma ( gross and
micro)
5. BPH ( gross and micro)
6. Chronic a-bacterial Prostatitis.
Thank you