B/ 91 Prostatitis, nodular hyperplasia of the prostate

Question 1

General information about prostatitis

Answer 1

Etiology: can be due to a bacterial infection. Often due to E.coli and other gram negative bacteria. Bacteria may reach the prostate through a direct extension from an inflamed urethra and/or urinary bladder. It can also reach the prostate through vascular channels.

Question 2

Morphology of prostatitis

Answer 2

Acute: presence of neutrophilic inflammatory infiltrate, congestion and stromal edema. Neutrophil infiltrate starts within the gland, but can destroy the glandular epithelium and reach the stroma eventually - form micro abscesses.

Chronic: Tissue destruction, fibroblast proliferation, inflammatory cells present

Granulomatous: may be seen in TB, sarcoidosis, fungal infections

Question 3

Clinical presentation of prostatitis

Answer 3

Dysuria, increased urinary frequency, lower back pain, suprapubic or pelvic pain. Prostate may become enlarged and tender.
Fever and leukocytosis.

Question 4

Etiology of Nodular hyperplasia of the prostate

Answer 4

Frequency increases with age. Present in 20% of men at the age of 40.

Question 5

Pathogenesis of Nodular hyperplasia of the prostate

Answer 5

Androgens play an important role. DHT and its metabolite 3alpha-androstenediol binds to nuclear androgen receptors in stromal and epithelial cells. In these cells they stimulate synthesis of DNA/RNA and growth factors leading to hyperplasia.

On the other hand age-related increase in estrogen levels lead to an increased expression of androgen receptors on the parenchyma of the prostate.

Question 6

Morphology of nodular hyperplasia of the prostate

Answer 6

The prostate is divided into zones: central, periurethral, transitional, and peripheral. The nodules are usually most pronounced in the inner areas of the prostate - the central and transitional zones.

The urethra is usually compressed by the proliferating nodules and eventually appears as a slit-like orifice.

Question 7

Mircoscopy of nodular hyperplasia of the prostate

Answer 7

Nodules are composed of varying proportions of glandular elements and stromal elements. The glands are lined by columnar cells and flattened basal cells - in advanced cases the hyperplasia can be associated with infarction and squamous metaplasia.

Question 8

Clinical features of nodular hyperplasia of the prostate

Answer 8

Symptoms are associated with urinary tract obstruction. Frequency, pain during urination, urinary bladder distention, nocturia.