Diseases of the prostate Flashcards
What are the zones of the prostate?
Central zone – an inverted cone with its base forming the base of the prostate and its apex at verumontanum
-ejaculatory ducts pass through central zone
Transition zone – two “lobes” that surround the prostatic urethra laterally and anteriorly
- separated (more or less) by fibrous band from peripheral zone
Peripheral zone – major portion (~70%) of gland, which
surrounds transition zone posteriorly, laterally, and apically
What are the two cell layers of the prostate?
Basal layer of low cuboidal to flattened cells resting on basement membrane
Luminal layer of columnar epithelial cells, which secrete mucus and protease-rich fluid
Corpora amylacea
inspisation of secretions that form as men age
Called prostate sand
Acute prostatitis
acute focal or diffuse suppurative (neutrophilic) inflammation caused by bacterial infection – most common organisms include E. coli or other enterobacteria and S. aureus.
Usually evolves from direct extension of infections of bladder (urine)
a. May be hematogenous
b. May be iatrogenic
Chronic prostatitis
Characterized histologically by aggregates of lymphocytes, plasma cells, and macrophages within the prostatic substance
Etiology unknown – may be due to long-standing bacterial infections or dietary factors
Granulomatous form may occur surrounding “eroded” corpora amylacea
- may also occur with tuberculus infections
Malakoplakia
A peculiar nodular aggregate of histiocytes containing intracytoplasmic calcified inclusions (Michaelis-Gutmann bodies)
Believed to be due to abberrant phagocytic process which leads to retention of bacterial wall fragments that subsequently calcify
What are the clinical symptoms of prostatitis?
Obstructive urinary symptoms due to swelling of gland
Low back pain, dysuria due to infection
Chronic “prostatitis” often asymptomatic – chronic inflammation often present on biopsies
Benign prostatic hyperplasia
Extremely common in men over age 50 – incidence increased with age by “law of 10’s” (e.g. 70% at age 70, etc)
Only 5-10% of affected men require surgical treatment
Usually medical treatment
Androgen: estrogen imbalance
Formation of nodules primarily within the transition zone
that enlarge to compress the urethra as well as the peripheral prostate
Clinical symptoms – difficulty in starting and stopping urination, frequency and Nocturia (lower urinary tract symptoms or LUTS)
Severity not directly related to amount of disease that is present
Medical therapy for BPH
androgen metabolism antagonists and α-blockers is mainstay of therapy
Histology of BPH
- Variable areas of glandular and stromal (often mixed) hyperplasia
- Glands often cystically dilated and thrown into numerous papillary infoldings
- Stromal component involves increased density of spindle cells, vessels and in some cases progressive scarring
How common is prostatic adenocarcinoma?
Most common carcinoma (excluding skin) of adult males in U.S.
Second most common cause of male cancer deaths in U.S.
Significant epidemiologic factors include:
- Age – increases with age after age 50
- Race – Blacks > Whites»_space;> Orientals
- Diet – associations with red meat consumption, Western diet
- Family history
Clinical symptoms of prostatic adenocarcinoma?
Often asymptomatic or similar to those for BPH
Where is the most common place for prostatic adenocarcinoma to appear in the prostate?
peripheral zone
Often multifocal
Histology of prostatic adenocarcinoma
Abnormal collections of atypical glands lined by single layer of malignant cuboidal to columnar cells (lack basal
cells)
a. Increased N:C ratio
b. Prominent nucleoli
How to treat localized vs advanced prostatic adenocarcinoma
Localized disease (prostate confined) usually treated with surgery, external beam radiation, or radioactive “seeds”
Advanced disease (beyond prostate) usually treated with androgen ablation therapy (orchiectomy, anti-androgens, 5-alpha – reductase inhibitors, GNRH inhibitors, etc.) since most tumors are androgen responsive - majority will become androgen refractory with time (Note: does not mean androgen “resistant”)
