Student’s name:
Disorders of the prostate.
Group: 2
PROSTATITIS
DEFINITION
Prostatitis is an inflammation of the prostate gland, that is caused by infectious agents(bacteria, fungi and mycoplasma) or other conditions including urethral stricture, prostatic hyperplasia.
CLASSIFICATION OF PROSTATITIS
Acute Bacterial (Type 1)
Chronic Bacterial (Type 2)
Chronic prostatitis or chronic pelvic pain syndrome. CP/CPPS (Type 3)
Asymptomatic inflammatory prostatitis (Type 4)
CONT.
Both Acute and Chronic Bacterial prostatitis, generally result from organisms reaching the
prostate gland by one of the following routes:
Ascending from the urethra(upward)
Descending from the bladder (downwards) and invasion via the blood stream or the lymphatic channels.
Common organisms are such as:
Escherichia coli
Klebsiella
Pseudomonas
Enterobacter
Proteus
Neisseria gonorrhoea and group D streptococci
CONT.
Chronic Bacterial prostatitis involves recurrent episodes of infection.
CP/CPPS is a new term that describes the syndrome with prostate and urinary pain in the absence of an obvious infectious process.
The etiology of CP/CPPS is unclear. It may be associated with STDs.
CONT.
Asymptomatic inflammatory prostatitis is usually diagnosed in individuals who have no symptom, but are found to have an inflammatory process in the prostate.
CLINICAL MANIFESTATION
Perineal discomfort
Burning, urgency and frequency
Pain with ejaculation
Prostatodynia (pain in the prostate gland)
Sudden fever, chills and perineal, rectal and low back pain in acute bacterial prostatitis
URINARY SYMPTOMS
Dysuria, frequency, urgency and nocturia may occur some patients do not have a symptoms.
(BPH) Benign Prostatic Hyperplasia
The prostate gland is the
male organ most
commonly afflicted with either benign or malignant neoplasms
25
%
70%
5 %
BENIGN PROSTATIC HYPERPLASIA
BPH is the most common benign tumor in men, and its incidence is age
related
Risk factors unknown, supposedly hereditary
Age 41-50
Age 51-60
Age 80+
20%
50%
80%
Epidemiology
Who is most affected : men > 45 years old
The prevalence :
8 percent in men aged 31 to 40
40 to 50 percent in men aged 51 to 60
More than 80 percent in men older than age 80
PATHOPHYSIOLOGY
1. Obstructive
component of the
prostate: a.
mechanical b.
dynamical
2. Response of
the bladder to the
outlet resistance
CLINICAL FINDINGS
SYMPTOMS
–
Obstructive
hesitancy
decreased force and caliber of stream
sensation of incomplete bladder emptying
straining
to urinate
postvoid dribbling
Irritative
urgency
Frequency
nocturia
CLINICAL MANIFESTATIONS
Asymptomatic
LUTS
SYMPTOMS
Score ranges from
0-35 0-7 mild
8-19 moderate
20-35 severe
SIGNS
A physical examination, DRE, and focused neurologic examination are performed on all patients.
The size and consistency of the prostate is noted.
BPH usually results in a smooth, firm, elastic enlargement of the prostate.
Induration, if detected, must alert the physician to the possibility of cancer and the need for further evaluation (ie, prostate-specific antigen [PSA], transrectal ultrasound [TRUS], and biopsy).
IMAGING
CYSTOSCOPY
Cystoscopy is not routinely recommended to determine the need for treatment but may assist in choosing the
surgical approach in patients opting for invasive therapy.
If BPH is associated with hematuria, then cystoscopy is mandatory to rule out other bladder pathology.
(BPH), or benign prostatic hyperplasia
CARCINOMA OF THE PROSTATE
INCIDENCE AND EPIDEMIOLOGY
INCIDENCE AND EPIDEMIOLOGY
RISK FACTORS
PATHOLOGY
More than 95% of the prostate cancers are adenocarcinomas.
Nonadenocarcinoma variants can be categorized into two groups based on the cellular origin: epithelial and nonepithelial.
ri Epithelial variants consist of endometrioid, mucinous, signet-
ng, adenoid cystic, adenosquamous, squamous cell, transitional cell, neuroendocrine, and comedocarcinoma.
Nonepithelial variants include rhabdomyosarcoma, leiomyosarcoma,
osteosarcoma, angiosarcoma, carcinosarcoma, malignant
lymphoma, and metastatic neoplasms among others.
PATHOLOGY
hype• The cytologic characteristics of CaP include rchromatic, enlarged nuclei with prominent nucleoli
Cytoplasm is often abundant; thus, nuclear-to-
cytoplasmicratios are not often helpful in making a diagnosis of CaP, unlike their usefulness in diagnosing many other neoplasms.
Cytoplasm is often slightly blue tinged or basophilic,
which may assist in the diagnosis.
CLINICAL FINDINGS
SYMPTOMS
The large majority of patients with early-stage CaP are asymptomatic.
The presence of symptoms often suggests locally advanced or metastatic disease.
Obstructive or irritative voiding
complaints.
Metastatic disease to the bones may cause bone pain.
Metastatic disease to the vertebral
column may be associated
with symptoms of cord compression, including paresthesias and weakness of the lower extremities and urinary or fecal incontinence.
SIGNS
A physical examination, including a DRE, is needed.
Induration or nodularity, if detected, must alert the
physician to the possibility of cancer and the need for
further evaluation (ie, PSA, TRUS, and biopsy).
Locally advanced disease with bulky regional
lymphadenopathy may lead to lymphedema of the lower
extremities.
Specific signs of cord compression
P R O S T A T E – S P E C I F I C O T H E A N T I G E N A N D
R T U M O R M A R K E R S
A “normal” PSA has traditionally been defined as ≤4 ng/ mL, and the positive predictive value of a serum PSA
between 4 and 10 ng/mL
(20–30%).
For levels in excess of 10 ng/mL, the positive predictive value increases from 42% to 71.4%.
DIAGNOSIS AND EVALUATION
PROSTATE BIOPSY
Prostate biopsy should be considered in men with an elevated serum PSA, abnormal DRE, or a combination of the two, depending additionally on patient’s other factors.
Biopsies are taken throughout the peripheral zone of the prostate, with optional additional sampling of any abnormal areas on DRE and/or TRUS.
Traditionally, six (sextant) biopsies were taken along a parasagittal line between the lateral edge and the midline of the prostate at the apex, midgland, and base bilaterally.
References
Abstracts from USCAP 2020: Genitourinary Pathology (860-1046). Mod Pathol 33, 1002–1163 (2020). https://doi.org/10.1038/s41379-020-0472-9
Alibhai, S., Zukotynski, K., Walker-Dilks, C., Emmenegger, U., Finelli, A., Morgan, S. C., Hotte, S. J., Tomlinson, G. A., & Winquist, E. (2017). Bone Health and Bone-Targeted Therapies for
Nonmetastatic Prostate Cancer: A Systematic Review and Meta-analysis. Annals of internal medicine, 167(5), 341–350. https://doi.org/10.7326/M16-2577
Cianferotti, L., Bertoldo, F., Carini, M., Kanis, J. A., Lapini, A., Longo, N., Martorana, G., Mirone, V., Reginster, J. Y., Rizzoli, R., & Brandi, M. L. (2017). The prevention of fragility fractures
in patients with non-metastatic prostate cancer: a position statement by the international osteoporosis foundation. Oncotarget, 8(43), 75646–75663. https://doi.org/10.18632/oncotarget.17980
Eskra, J.N., Rabizadeh, D., Mangold, L. et al. A novel method for detection of exfoliated prostate cancer cells in urine by RNA in situ hybridization. Prostate Cancer Prostatic Dis (2020).
https://doi.org/10.1038/s41391-020-00272-6
Krieger, J. N., Riley, D. E., Cheah, P. Y., Liong, M. L., & Yuen, K. H. (2003). Epidemiology of prostatitis: new evidence for a world-wide problem. World journal of urology, 21(2), 70–74.
https://doi.org/10.1007/s00345-003-0329-0
Nickel, J. C., Downey, J., Hunter, D., & Clark, J. (2001). Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom
index. The Journal of urology, 165(3), 842–845
Smith, M. R., McGovern, F. J., Zietman, A. L., Fallon, M. A., Hayden, D. L., Schoenfeld, D. A., Kantoff, P. W., & Finkelstein, J. S. (2001). Pamidronate to prevent bone loss during androgen-
deprivation therapy for prostate cancer. The New England journal of medicine, 345(13), 948–955. https://doi.org/10.1056/NEJMoa010845
Wagenlehner, F. M., van Till, J. W., Magri, V., Perletti, G., Houbiers, J. G., Weidner, W., & Nickel, J. C. (2013). National Institute
s of Health Chronic Prostatitis Symptom Index (NIH-CPSI) symptom evaluation in multinational cohorts of patients with chronic prostatitis/chronic pelvic pain syndrome.
European urology, 63(5), 953–959. https://doi.org/10.1016/j.eururo.2012.10.042
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