Professional Documents
Culture Documents
Prostate
Acute prostatitis. Clin. Manifest.
Organisms implanted in the prostate by
intraprostatic reflux of bladder urine,
lymphohematogenous route or surgical
manipulation on the urethra (catheter),
bladder or prostate.
Kidney
Prostate
Acute prostatitis. Pathology
Neutrophilic infil. Into glandular spaces.
Edema, congestion
Abscess of varying size
The lesion may subside completely or leave
fibrous scar or calcification.
Prostate
Chronic bacterial prostatitis. Pathology
Lymphs, plasma cells, PMN, macrophages.
Chronic bacterial prostatitis. Clin manifest
Low back pain, dysuria, perineal or
suprapubic discomfort
History of UTI. Disease appears insidiously
without obvious provocation.
Prostate
Chro. abacterial prostatitis. Clin. Manifest
Similar to chronic bacterial prostatitis. No
history of recurrent UTI.
Usually affect sexually active men:
Chlamydia trachomatis, ureaplasma
urealyticum
Prostate
Prostatitis. Lab findings
No pyuria in the premassage sample.
Pyuria in prostate secretion specimen
obtained by transrect. prost. Massage:
PMN, macrophages.
Bacte count by cult. is significant higher in
the EPS than in the urine.
Prostate
HIV-related prostatitis
15% of AIDS patients
Most often opportunistic organisms
HIV virion have been detected in prostate
epithelial cells.
Prostate
Nodular hyperplasia: Central zone
20% of men 40 years of age
70% by age 60
90% by the eighth decades of life
TURP(transurethral resection of prostate):
Whites 6.72: 1,000. Blacks 6.58:1,000.
Prostate
Nodular hyperplasia. Etiology
DHT which is synthesized in the stromal
cells by the action of 5-reductase binds to
nuclear receptors (stromal, glandular)
cell proliferation
Estradiol increases and sensitizes the
prostate to growth promoting effects of
DHT.
Prostate
Nodular hyperplasia. Path. Gross
60-100 g. Discrete nodules in periurethral
area compressing urethra.
Nodules: Proliferation of glands, stromal or
muscle cells with predominance of one or
more than one components.
Prostate
Nodular hyperplasia. Path. Micro
Stromal nodule
Muscle nodule
Glandular nodule
Nodule composed of varying combination
of stroma, muscle and glands
Prostate
Prostate
Nodular hyperplasia. Clin. Manifestations
Difficulty in starting and stopping of the
urine stream, dribbing, dysuria, nocturia.
Sudden acute urinary retention of unknown
cause
30% of patients older than 50 are
symptomatic.
Symptomatic Rx of BPH
Prostate
Nodular hyperplasia. Complications
Bladder hypertrophy, trabeculation
(hypertrophy of detrusor in some areas),
diverticulosis (weakening of the wall in
others).
UTI
Hydronephrosis
Renal failure.
Prostate cancer
Epidemiology
Incidental finding in autopsy and prostate
removed for other reasons.
20% in fifth decade of life.
70% in eighth decade of life.
Prostate cancer
Epidemiology
Genetic: Different rate in different race.
Hong Kong Chinese: 1:100,000
Japanese 3:100,000. Higher for Japanese
in USA.
Whites: 60:100,000. Blacks: Higher.
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Prostate cancer
Pathology
Gross: Peripheral and transitional zone,
Yellow, firm and gritty.
Micro: Most frequently adenocarcinoma
Glands lined by a single layer of cells with
enlarged nuclei with prominent nucleoli with
pale or eosinophilic cytoplasm. Crystalloids
Absence of basal layer.
Prostate cancer
No evidence of invasion
Stage T3
T3a: Extraprostatic extension
T3b: Seminal vesicle invasion
Stage T4: Invasion of the urinary bladder
and or colon
T1a:
Most do not progress with 10 years of
follow up
5-25% will develop local spread or
metastasis
T1b: 30-50% will progress with fatality rate
of 50%
Prostate carcinoma
Clinical evaluation
Rectal digital examination
Transrectal ultrasonography for early
detection and assessment of local spread.
CT scan and MRI for evaluation of lymph
nodes.
PSA and PAP.
Prostate carcinoma
Clinical evaluation
PAP is increased in cases tumor extending
beyond the capsule and metastasis.
PSA in localized, advanced disease,
hyperplasia and infarct. With a given
volume cancerous tissue yields higher level
than other diseases probably because
greater diff. from M. acini to stromal BV.
Prostate cancer
Clinical evaluation
Elevated PAS after prostatectomy indicates
disseminated disease.
Elevated PAS after initial control indicates
recurrence disease.
Prostate cancer
Treatment
Surgery
Radiotherapy
Hormonal therapy:
Orchiectomy
Agonists of LHRH
Synthetic LHRH
PSA
Digital rectal examination
Transrectal sonography: Cancer may be
hypoechoic.
: 3.5 ng/m
60-69
: 4.5 ng/ml
70-79
: 6.5 ng/ml
25 % of prostate Ca: No of PSA