PATH - Male General

Question 1

Benign prostatic hyperplasia

BPH

Answer 1

Common in men > 50 years old

Characterized by smooth, elastic, firm nodular enlargement (hyperplasia not hypertrophy) of periurethral
(lateral and middle) lobes, which compress the
urethra into a vertical slit

Not premalignant

presents with INC frequency of urination, nocturia, difficulty starting and stopping urine stream, dysuria.

May lead to distention and
hypertrophy of bladder, hydronephrosis, UTIs

INC free prostate-specific antigen (PSA).

TX: α1-antagonists (terazosin,

tamsulosin) , which cause relaxation of smooth muscle; 5α-reductase inhibitors (eg,
finasteride) ; tadalafil.

Question 2

Prostatitis

Answer 2

Dysuria, frequency, urgency, low back pain

Warm, tender, enlarged prostate.

Acute: bacterial (E coli)
Chronic: bacterial or abacterial

Question 3

Prostatic adenocarcinoma

Answer 3

Common in men > 50 years old

Arises most often from *posterior lobe (peripheral zone) of prostate gland and is most frequently diagnosed by INC PSA and subsequent needle core biopsies

Prostatic acid phosphatase (PAP) and PSA are useful tumor markers (INC total PSA, with DEC fraction of free PSA)

Osteoblastic metastases in bone may develop in late stages, as indicated by lower back pain
and INC serum ALP and PSA.