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Learn about prostatitis, infarction of the prostate, nodular hyperplasia, prostatic intraepithelial neoplasia (PIN), and carcinoma of the prostate. Understand causes, symptoms, management, and more for these conditions affecting men's health.
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Prostate Dr. Amitabha Basu MD
Our topic • Prostatitis • Infarction of prostate • Nodular Hyperplasia of prostate • Prostatic intraepithelial neoplasia (PIN) • Carcinoma of prostate.
Prostatitis and infarction • Definition: Inflammation of prostate. • Etiology • 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.
Granulomatous Prostatitis Cause : • Disseminated tuberculosis • Sarcoidosis.
Infarction of prostate • Etiology: • Post oprtative retention of urine. • Prolonged operative hypotension • Smoking and pre-existing cardiovascular disease. • Lab: May increase the serum prostate specific antigen.
Nodular Hyperplasia of prostate (BPH) • Incidence • Etiopathogenesis • Morphology ( gross and micro) • Clinical features • Complications • 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 DHT receptors 5 Alfa reductase Testosterone Dihydrotestosterone (DHT) In older people the DTH receptor increased = result in BPH
Nodulatiry is pronounced in the central & lateral region. Increase in the size of prostate( more that 300g).
Microscopy • Hyper plastic nodule are composed of proliferation of glands and fibromuccular stromaBOTH. • Glands are lined by two layers of cells. • Gland contains corpora amylacea.
Clinical features: Prostatism • Hesitancy • Intermittent interruption while voiding. • And evidence of bladder irritation: • Urgency • Frequency • Nocturia
Complications • MOST FREQUENT CAUSE OF RECURRENT LOWER URINARY TRACT INFECTION in male. • Bladder distention, hypertrophy • Bilateral hydronephrosis
Management - TURP • TRANSURETHRAL RESECTION OF PROSTATE
Carcinoma prostate • General features • Etiopathogenesis • PIN • Morphology of Prostatic carcinoma • Diagnosis • Grading • Management
Carcinoma of prostate : general features • Age : 65-75 yr. • Orchiectomy/ estrogen therapy reduces the tumor size. • Migration: Male migrate from a low risk area to high risk area maintain their low risk of cancer.
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.
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 • Clinically silent • Prostatism: local discomfort and evidence of lower urinary tract obstruction. • 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.
Diagnosis • Digital rectal examination • MRI scan • X- ray in suspected case of bone metastasis ( osteoblastic). • PSA study. ( more than 10 ng/dl) • Needle biopsy • Immunofluroscence staining by Prostatic specific antigen.
Osteoblastic bone lesion in metastasis Prostatic cancer. Which one is normal ?
Self assessment • PIN ( micro) • Diagnosis of Prostatic carcinoma. • Medical management. • Prostatic carcinoma ( gross and micro) • BPH ( gross and micro) • Chronic a-bacterial Prostatitis.