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 stroma BOTH.
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 : 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
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