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Prostate

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.

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Prostate

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  1. Prostate Dr. Amitabha Basu MD

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

  3. Prostatitis and infarction • Definition: Inflammation of prostate. • Etiology • Infarction

  4. 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.

  5. Chronic Prostatitis • Chronic bacterial Prostatitis : Follow acute Prostatitis. • Chronic abacterial Prostatitis [ Prostatodynia] : Chlamydia Trachomatis.

  6. Chronic Prostatitis: lymphocytes and macrophage

  7. Granulomatous Prostatitis Cause : • Disseminated tuberculosis • Sarcoidosis.

  8. 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.

  9. Area of Prostatic infarction

  10. Time for Nodular Hyperplasia of prostate

  11. Nodular Hyperplasia of prostate (BPH) • Incidence • Etiopathogenesis • Morphology ( gross and micro) • Clinical features • Complications • Management

  12. 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.

  13. Pathogenesis – flow chart DHT receptors 5 Alfa reductase Testosterone Dihydrotestosterone (DHT) In older people the DTH receptor increased = result in BPH

  14. Nodulatiry is pronounced in the central & lateral region. Increase in the size of prostate( more that 300g).

  15. 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.

  16. Gland contains corpora amylacea.

  17. Clinical features: Prostatism • Hesitancy • Intermittent interruption while voiding. • And evidence of bladder irritation: • Urgency • Frequency • Nocturia

  18. Complications • MOST FREQUENT CAUSE OF RECURRENT LOWER URINARY TRACT INFECTION in male. • Bladder distention, hypertrophy • Bilateral hydronephrosis

  19. Management - TURP • TRANSURETHRAL RESECTION OF PROSTATE

  20. Time for carcinoma prostate

  21. Carcinoma prostate • General features • Etiopathogenesis • PIN • Morphology of Prostatic carcinoma • Diagnosis • Grading • Management

  22. 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.

  23. 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.

  24. Prostatic intraepithelial Neoplasia • Def: A precancerous cellular proliferation found in a single acinus or small group of prostatic acini.

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

  26. Prostatic adenocarcinoma ; Presenting features • Clinically silent • Prostatism: local discomfort and evidence of lower urinary tract obstruction. • Bone metastasis : mainly to the axial skeleton ( osteoblastic)

  27. Gross of prostate adenocarcinoma ; mostly begin (arises) in the periphery of prostate.Location: posterior lobe. Yellowish nodules

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

  29. ……malignant cells with prominent nuclei.

  30. 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.

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

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

  33. Thank you

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