DLA 10 Male Genital Tract 1

Prostatic Adenocarcinoma

• It is the most common form of cancer in men in the United States. • Prostate cancer is the second most common cause of cancer-related deaths in men. • Incidence increases in men over 50 years of age

Prostatitis

Inflammation of the prostate gland is known as prostatitis and, can be divided into categories depending on its cause.

Prostatic Adenocarcinoma treatment

Radical prostatectomy and radiotherapy for localized cancers.

Benign Prostatic Hyperplasia (BPH)

• A non-neoplastic enlargement of the prostate gland. • There is stromal and glandular hyperplasia of the prostatic tissue. • Most common form of prostatic enlargement in men over 50 years of age. • An important cause of urinary obstruction in affected men.

Acute bacterial prostatitis Clinical Features

• Fever with chills and dysuria. • Tenderness over the prostate gland on a rectal examination. • Diagnosis can be made clinically with a supporting positive urine culture. • Biopsy is contraindicated, as may cause sepsis

Benign Prostatic Hyperplasia (BPH) morphology

• Gross - the weight of the gland may increase three to fivefold and the hyperplasia involves the transitional zone of the prostate impinging on the urethra to make it slit-like. The hyperplasia is seen in both glandular and fibromuscular stromal elements. • Histology - Each nodules contain cystically dilated glands, which are lined by two layers of cells, inner columnar secretory and outer cuboidal basal epithelial cells. The glands may also show papillary infoldings.

Prostatic Adenocarcinoma clinical course

• Localized prostate cancer is usually asymptomatic, owing to its peripheral location and is usually discovered through elevated levels of prostate-specific antigen (PSA) or on needle biopsies. • It may invade locally to the seminal vesicles and base of urinary bladder and at that stage may cause ureteral obstruction. • Metastatic spread occurs more commonly through the hematogenous route to the axial skeleton (lumbar spine, femur, thoracic spine and ribs). These deposits are osteoblastic (bone-forming), and patients may present with lower back ache as the first symptoms. • The cancer may also spread via lymph to the obturator and para-aortic lymph nodes.

Chronic bacterial prostatitis Clinical Features

• Low back pain, dysuria and perineal or suprapubic discomfort. • Patients may also be asymptomatic. • Diagnosis can be made on history and evidence of leukocytosis in the expressed prostatic secretions. • Urine cultures are positive for bacteria

Benign Prostatic Hyperplasia (BPH) treatment

• Medical treatment with 5-alpha reductase inhibitors (e.g., finasteride) is effective for mild to moderate symptoms. • Surgical resection of prostatic tissue by transurethral approach, is effective for patients with severe symptoms and complications (TURP - Transurethral resection of prostate).

Acute bacterial prostatitis Causes

• Most cases are caused due infection with E. Coli, other gram-negative rods, enterococci and staphylococci. • Organisms reach the prostate by reflux of urine from the posterior urethra or the bladder. • Surgical manipulation of the urethra or the gland e.g., catheterization, cystoscopy or urethral dilatation may cause infection.

Prostatic Adenocarcinoma morphology

• Most cases typically arise in the peripheral zone of the prostate and in a posterior location. • Prostatic intraepithelial neoplasia (PIN) has been recognized as a precursor lesion. • Gross - the enlarged gland may be palpable on a digital rectal examination as a firm to hard mass. On cross-section it appears as a solid area. • Histology - Mass is composed of proliferating neoplastic glands, that are smaller than normal and are lined by a single layer of epithelium. The outer basal layer of glands is absent in malignancy. The nuclei are larger and contain prominent nucleoli.

Chronic abacterial prostatitis Clinical Features

• No history of recurrent urinary tract infections, usually presents with pelvic pain. • More than 10 leukocytes per high filed can be noted in the expressed prostatic secretions. • Urine cultures are negative for bacteria.

Chronic bacterial prostatitis Causes

• Patients have a history of recurrent urinary tract infections either cystitis or urethritis, usually with the same organism. • Since antibiotics do not reach the prostate gland, bacteria from urinary tract may seed there to cause infection.

Benign Prostatic Hyperplasia (BPH) pathogenesis

• Physiologically, dihydrotestosterone (DHT) is the androgenic mediator for prostatic growth, this is usually formed from testosterone in the stromal cells of the prostate in the presence of Type 2 5 α- reductase. DHT binds to the androgen receptors to release growth factors that support proliferation. • In BPH, there is imbalance between the proliferative and inhibitory growth factors, leading to a net increase in proliferation. Estrogens have also been postulated to play a role in upregulating cellular proliferation and causing disease. • Even though the levels of testosterone tend to decrease with increasing age, the increased activity and/ or expression of the DHT receptors is present in the affected men

Prostatic Adenocarcinoma screening and diagnosis

• Serum PSA (prostate-specific antigen) may be raised in cancer; however, this is a nonspecific tool for screening as it is also raised in BPH, prostatitis, urethral or bladder instrumentation and ejaculation. It becomes useful in monitoring response to therapy for prostatic carcinoma. • Needle biopsies are used for confirming diagnosis and the tissue samples are categorized using the Gleason system

Chronic abacterial prostatitis Causes

• The most common form of prostatitis, also known as chronic pelvic pain syndrome. • Usually due to organisms that do not show up on routine cultures e.g., C. trachomatis, U. urealyticum, Trichomonas vaginalis, N. gonorrhoeae, viruses, fungi, and anaerobic bacteria. • Pathogenesis is like chronic bacterial prostatitis.