10. Prostate

Question 1

Diseases of the prostate

Answer 1

1. Benign prostatic hyperplasia

2. Prostatic carcinoma

Question 2

Definition of benign prostatic hyperplasia

Answer 2

Also known as nodular hyperplasia; extremely common condition in men over the age of 50

Question 3

Pathogenesis of benign prostatic hyperplasia

Answer 3

1. Conversion of testosterone in prostatic stromal cells into dihydrotestosterone (DHT) by enzyme 5alpha-reductase
2. DHT then binds to androgen receptors on the prostatic epithelial & stromal cells to induce the production of
   growth factors that:
   - Increase growth rate
   - Decrease death rate
3. Hence progressive hyperplasia of the stromal & epithelial cells of the prostate occurs, forming nodules
   - Most prominent in transitional zone (region of prostate surrounding prostatic urethra)

Question 4

Complications of benign prostatic hyperplasia

Answer 4

1. Urinary tract obstruction due to compression of prostatic urethra, leading to:
   - Bladder distention & hypertrophy (yields a distended bladder with a trabeculated wall)
   - Hydronephrosis
2. Urinary tract infections

Question 5

Treatment of benign prostatic hyperplasia

Answer 5

Transurethral resection of the prostate (TURP)

Question 6

Definition of prostatic carcinoma

Answer 6

Cancer of the prostate, usually occurring in men over 50 years of age; risk of contracting it increases with age

Question 7

Types of prostatic carcinoma

Answer 7

1. Acinar adenocarcinoma (more common)

2. Ductal adenocarcinoma

Question 8

Clinical features of prostatic carcinoma

Answer 8

1. Usually occurs in the peripheral zone of the prostate
   - Hence cannot be resected by TURP
2. Metastatic disease is uniformly fatal
3. Prognosis based on:
   - TMN staging
   - Gleason grading
   ——————————————————————————–
   FYI:
   Gleason grading:
   - Grade 1: well-differentiated tumour, glands are uniform & round in appearance, packed into well circumscribed nodules
   - Grade 5: no glandular differentiation, tumour cells infiltrate stroma in cords, sheets & nests
   - Most tumours contain more than one pattern,
   hence one assigns a score (grade number) to the
   most & second-most frequent patterns
   - The 2 numerical scores are then added to give a gleason score: 2-4 (well-differentiated), 5-6 (intermediate grade), 7 (moderate to poorly differentiated), 8-10 (high grade tumour)