Diseases Of Prostate Flashcards
A young patient comes with fever, chills, dysuria for 6 hrs and exquisitely tender prostate on rectal exam
Positive urine culture :
To gram -ve rods
Acute bacterial prostatitis
How organisms reach the prostate in acute bacterial prostatitis?
- Organisms reach the prostate through reflux of contaminated urine or lymphohematogeneous routes
- Sometimes follow surgical manipulation
What causes acute bacterial prostatitis?
E.coli
Gram negative rods
Enterococcus
Staphylococcus
A patient with history of recurrent UTIs and positive urine culture
Low back pain
Dysuria
Perineal and super pubic discomfort —> though it also may be asymptomatic
Chronic bacterial prostatitis
What is a factor that cause chronic bacterial prostatitis?
Poor antibiotic penetration
A patient comes with low back pain , dysuria , and perineal and Supra;Unix discomfort
No history of recurrent UTIs and bacterial cultures -be
Chronic a bacterial prostatitis
What are the types of granulomatitis prostatitis?
Could be
A. Infectious —. TB, fungal
B. Non-infectious
What is a common cause of granulomatous prostatitis?
Instillation of BCG for treatment of bladder cancer (no clinical significance)
Where is fungal granulomatous prostatitis is typically seen?
It is typically seen in Immunocompromised hosts
What happens in nonspecific granulomatous prostatitis?
Is relatively common and represents a reaction to secretions from ruptured prostatic ducts and acini
Fever , chills , dysuria + many neutrophils
Acute bacterial prostatitis
A patient received intravesical BCG therapy for urothelial carcinoma. A prostate biopsy showed non-caseating granulomas
Granulomatous prostatis after instillation of BCG for treatment of bladder cancer (no clinical significance)
An area of fibrinoid necrosis walled off by a cuff of histiocytes. This is a most likely in response to a previous biopsy
Post-biopsy granuloma
Is the most common benign prostatic disease in men older than age 50 years with histologic eveidence of BPH found in up to 90% of men by age 80
Benign prostate hyperplasia
It is a not premalignant lesion?
Benign prostatic hyperplasia
What happens to the size of prostate in benign prostatic hyperplasia?
The weight of the prostate enlarges 3 to t folds
What is a complication of benign prostatic hyperplasia?
May encroach on the urethra compressing it to a slit like orifice
What is the microscopic features of Benign prostatic hyperplasia?
Nodules contain small to cystic-ally dilated glands separated by stromal cells
Glands still lined by two layers of cells
We could have —> nodule of epithelial and stromal elements
Nodule of stromal cells
We see the corpora —> indicate a benign condition
When we do immunohisyochemistry for the prostate the basal cells are present
What is the major hormonal stimulus for proliferation?
Dihydrotestosterone DHT—> it is an androgen derived from testosterone
What has a central role in generating DHT?
Stromal cells have a central role in generating DHT which is more potent than testosterone
What happens if DHT binds to ARs ?
It stimulates ARs to translocate from the cytoplasm to the nucleus and activate the transcription of androgen-dependent genes, which encode several growth factors and their receptors —> most important are members of fibroblast growth factor (FGF) family and transforming growth factor TGF B
During embryonic prostatic development, FGFs act as paracrine regulators of epithelial growth while TGFB act as an inhibitor for epithelial proliferation
What promotes cell proliferation in Benign prostate hyperplasia?
DHT-induced FGFs promotes epithelial cell proliferation
Estrogen inhibit the inhibitor of proliferation = estrogen —> also helps tip the balance toward cell proliferation
What are symptoms of BPH due to urinary obstruction?
- Bladder hypertrophy and stone formation
- Bladder trabeculation
- Bladder dilation and trabeculation in an autopsy specimen
Symptoms of BPH are due to urinary obstruction:
A. Increased frequency
B. Nocturnal
C. Difficult in starting and stopping the stream of urine
D. Overflow dribbling
E. Dysuria
Sudden acute urinary retention may occur that requires emergency catheterization for relief
Increased resistance to urinary outflow leads to bladder hypertrophy and distention
Inability to empty the bladder completely creates a reservoir of residual urine that is a common source of bacterial infections
How we treat benign prostatic hyperplasia?
Medical treatments:
Alpha Adrenergic blockers
5 alpha reductive inhibitors
Surgical treatments:
Transurethral reaction of the prostate (TURP),
High -intensity focused ultrasound (HIFU)
Laser therapy
Hyperthermia
Transurethral electrovaporization
Radio frequency abalation
