Pathology of the Prostrate Gland

Question 1

Prostatitis

Answer 1

Inflammation and swelling of the prostate gland

Four types / categories:
Acute bacterial prostatitis
Chronic bacterial prostatitis
Chronic non-bacterial prostatitis / chronic pelvic pain syndrome (IIIa inflammatory. IIIb non-inflammatory)
Asymptomatic inflammatory prostatitis

Question 2

Prostatitis – Acute bacterial

Answer 2

Common among men over 50 years of age esp. if immunocompromised (i.e. HIV/AIDS, diabetes)
Consider STD in younger man

Causes:
Ascending infection (bacteria from urine refluxing into prostate or ascending urethral infection)
Direct extension or lymphatic spread from rectum
Haematogenous
Post-procedure (biopsy, catheter)

S&S:
Severe prostatitis symptoms
Urinary frequency, urgency, and dysuria
Urinary retention
Acute UTI
Systemic infection

Question 3

Prostatitis – Chronic bacterial

Answer 3

Chronic bacterial prostatitis
Primary voiding dysfunction problem (structural or functional)
Recurrent UTI (same bacterium) for typically more than 3 months 

S&S:
Intermittent dysuria
Intermittent lower urinary tract symptoms
Recurrent UTI with same organism

Question 4

Prostatitis – CPPS

Answer 4

Chronic non-bacterial prostatitis / chronic pelvic pain syndrome (CPPS)
Chronic pelvic pain syndrome diagnosed based on pain with negative UTI
Sexual dysfunction, pelvic pain, and persistent voiding issues for > 3 months
Can be inflammatory or non-inflammatory depending on presence / absence of leukocytes in prostatic secretions

Question 5

Prostatitis – Asymptomatic inflammatory prostatitis

Answer 5

Inflammation of prostate but no genitourinary symptoms

Often only diagnosed following examination of prostate tissue (i.e. biopsy)

Question 6

Cysts

Answer 6

Usually incidental finding
Asymptomatic
Aetiological factors include chronic prostatitis (lateral cyst) and congenital disease (midline cyst; Mullerian duct cyst, prostatic utricle cyst)

Question 7

Calcifications

Answer 7

Incidental finding
Usually associated with inflammation or post trauma / injury / biopsy

S&S:
Most often asymptomatic
May have haematuria / dysuria / pelvic or peroneal pain
Obstruction – may even pass one!

Question 8

Benign Prostatic Hyperplasia (BPH)

Answer 8

AKA benign prostatic enlargement and benign prostatic hypertrophy (old term, please forgive me if I use it!)
Sometimes referred to as prostatomegaly, but prostates can be enlarged for other reasons
Benign, very common
Transitional zone enlargement, compresses PZ & CZ
Incidence increases with age after 40 years: by 60 years, 50% of men have BPH; by 90 years, 90% have BPH

S&S:
Difficulty voiding
Weak urine stream
Dribbling urine once you have stopped urinating
Constant feeling of having to urinate
Nocturnal urgency
Increase in UTIs
Bladder or kidney calculi

Question 9

TURP

Answer 9

Trans-urethral resection of the prostate

Removes hyperplastic tissue around prostatic urethra to relieve compression

Question 10

Prostate Malignancies

Answer 10

Most primary prostate cancers are adenocarcinomas
Other cancers that originate in the prostate include neuroendocrine carcinomas (incl small cell carcinomas), transitional cell carcinomas, and sarcomas – rare
Most start in PZ; <20% start in TZ
Slow growing
Can spread to adjacent tissues (bladder, rectum)
Can metastasise (LNs, bone)

S&S:
Painful or burning sensation on urination or ejaculating
Increased freq urination, esp nocturnal
Difficulty stopping or starting urination
Sudden erectile dysfunction
Haematuria, haematospermia
Palpable hard lump on rectal examination (Stage II onward)

Question 11

Seminal vesicle pathology

Answer 11

Seminal vesicle enlargement
Seminal vesiculitis
Seminal vesicle cyst
Seminal vesicle calcifications

Question 12

Laboratory tests

Answer 12

Semen analysis:
the volume of semen
the macroscopic appearance
the semen viscosity (thickness)
sperm concentration,
total number of sperm
sperm motility (the percentage that are able to move, as well as how vigorously and straight the sperm move)
the number of normal and abnormal (defective) sperm
coagulation and liquefaction (the time it takes the semen to go from a gel to a liquid state)
fructose level (a sugar in semen)
pH (acidity)
the number of immature sperm

Semen analysis:
Positive correlation between prostatic calcifications and haematospermia following a prostate biopsy
If referral says haematospermia, ask if the patient has had a prostate biopsy!
Blood test:
Prostate-specific antigen (PSA) – protein produced by both normal and malignant cells in the prostate.
PSA is elevated when malignancy is present but also with benign prostatic hyperplasia and prostatitis