PROSTATE

PROSTATEThe most important categories :Infl. Lesions ( prostatitis )Nodular hyperplasia (BPH)Carcinoma

Prostatitis clin. manifestations :Acute-dysuriaChronic-urinary freq. -LBPClinical features -poorly localizedMicroscopic exampelvic painCultur : urine : before - after

PROSTATEINFLAMMATIONSAcute and chronic bacterialChronic abacterial and granulomatous prostatitis

Prostatitis clin. manifestations :dysuriaurinary freq. LBPpoorly localizedpelvic pain

PROSTATEAcute Prostatitis : bacterialcaused by some organismE. coliOther gram - negative

Associated with acute urinary tract inf. (UTI)-direct ext. ( urethra bladder )-vascular channels

PROSTATEChronic Prostatitis : Follow of acute prostatitisDevelop insidiouslyChr. bacterial prost.Chr. a bacterial prost.= prostatodymia : most cases( = non gonococcal urethritis )

Causa : -chlamidya tr.-ureaplasma urealyticum

PROSTATEmorphology : Acute prostatitisneutrophilic inflam., congestion, stromal edema, microabcesses Chronic prostatitislymphoid infiltratetissue destruction, prolif. fibrobl.Granulomatous infl.systemic inflam. (granulomatous)TBC, sarcoidosis, fungal inf.

Normal prostateGlandularStromal surround the urethra

Prostatic parenchyma (anatomically, biologically)PeripheralCentralTransitionalPeriurethral zonesNodular hyperplasia

Important ! : Most hyperplasticTransitionalPeriurethral zonesMost carcinomasPeripheral zonesNodular hyperplasia

Nodular hyperplasia= Gland and stro. hyperplasia := Extremely common abn. of the prostate 20 % of males by 40 years Rise progressively with the age90 % by the eighth decade

prolif : epithelstromal

BPH : Benign Prostatic Hypertrophy

Enlargement (urinary obs.)

Nodular hyperplasia

Causa :androgensestrogens

Before puberty : castrate = BPH (-) = dihydroxytestosteron ( DHT )androgen derived : testosteron

Tx = 5 - reductase inhibitors

Morphology :Most common : periurethral glandSevere cases : 200 gr Surface : multiple, nodulwell circumscribed

Morphology :Microscopically :varying proportions of proliferatingGlandular elemFibromuscular str.

Stroma is always between Hiperplastic glands; lined by : tall, columnar epithelial cells ( crowding, papillary : in some gland )Often : corpora amylacea

Figure 21-33 Nodular prostatic hyperplasia. A, Well-defined nodules of BPH compress the urethra into a slitlike lumen. B, A microscopic view of a whole mount of the prostate shows nodules of hyperplastic glands on both sides of the urethra.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM) 2005 Elsevier

Figure 21-31 Benign prostate gland with basal cell and secretory cell layer.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM) 2005 Elsevier

Figure 21-32 Simplified scheme of the pathogenesis of prostatic hyperplasia. The central role of the stromal cells in generating dihydrotestosterone should be noted.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM) 2005 Elsevier

Clinical features :Manifest only about 10 %Lower urinary tract obstruction.Hesitancy : diff. in start the stream of uriaIntermittenComplete urinary obstructionPainful distention of the bladderhydronephrosis

CARCINOMA OF THE PROSTATEMost common :Visceral cancer in maleRanking as the second : deathmale older than 50 years ( = ca of the lung)Peak incidence : 65 75 yearsLatent cancers : 50 % in men older : 80Causa : unknownExp. Obs :HormonalGenetic ( familial )Environmental factors

Figure 21-30 Adult prostate. The normal prostate contains several distinct regions, including a central zone (CZ), a peripheral zone (PZ), a transitional zone (TZ), and a periurethral zone. Most carcinomas arise from the peripheral glands of the organ and may be palpable during digital examination of the rectum. Nodular hyperplasia, in contrast, arises from more centrally situated glands and is more likely to produce urinary obstruction early on than is carcinoma.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM) 2005 Elsevier

Ad. 1. Male castrated = (-) : < pubertyAndrogen !!Tx : estrogendiethyl stilbestrolAd. 2. Genetic factorsAmerican blacks > white Asian, HispanicsAd. 3. Environmental factorsindustrialsignificant geographic diff. :Scandinavian countries : >>Japan Asian :

Morphology :70 % : peripheral : rectal digital exam : (+)Initial stages : urethral obstr. : (-)

Grossly :cut surface : firm,gray-white to yellowill defined marginsmetastases : pelvic lymph nodes early

Figure 21-34 Adenocarcinoma of the prostate. Carcinomatous tissue is seen on the posterior aspect (lower left). Note the solid whiter tissue of cancer in contrast to the spongy appearance of the benign peripheral zone on the contralateral side.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM) 2005 Elsevier

Microscopically :Most prostatic Ca adeno caGlands : infiltrate the adjacent stromain irregular, back to back, irregular, ragged, papillary, cribiform sheets : in extreme cases.Cells : cuboidal, nucleoli

Figure 21-36 A, Photomicrograph of a small focus of adenocarcinoma of the prostate demonstrating small glands crowded in between larger benign glands. B, Higher magnification shows several small malignant glands with enlarged nuclei, prominent nucleoli, and dark cytoplasm, compared to the larger benign gland (top).Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM) 2005 Elsevier

Figure 21-37 Carcinoma of the prostate showing perineural invasion by malignant glands. Compare to a benign gland (left).Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM) 2005 Elsevier

Figure 21-38 A, Low-grade (Gleason score 1 + 1 = 2) prostate cancer consisting of back to back, uniformly sized malignant glands. Glands contain eosinophilic intraluminal prostatic crystalloids, a feature that is more commonly seen in cancer than in benign glands and more frequently seen in lower grade than in higher grade prostate cancer. B, Needle biopsy of the prostate with variably sized, more widely dispersed glands of moderately differentiated (Gleason score 3 + 3 = 6) adenocarcinoma. C, Poorly differentiated Gleason score (5 + 5 =10) adenocarcinoma composed of sheets of malignant cells.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM) 2005 Elsevier

Figure 21-38 A, Low-grade (Gleason score 1 + 1 = 2) prostate cancer consisting of back to back, uniformly sized malignant glands. Glands contain eosinophilic intraluminal prostatic crystalloids, a feature that is more commonly seen in cancer than in benign glands and more frequently seen in lower grade than in higher grade prostate cancer. B, Needle biopsy of the prostate with variably sized, more widely dispersed glands of moderately differentiated (Gleason score 3 + 3 = 6) adenocarcinoma. C, Poorly differentiated Gleason score (5 + 5 =10) adenocarcinoma composed of sheets of malignant cells.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM) 2005 Elsevier

Figure 21-35 Metastatic osteoblastic prostatic carcinoma within vertebral bodies.Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM) 2005 Elsevier

Morphology :Histologic grading :Gland diff.Architecture of the neopl. glandNuclear anaplasiaMitotic activity - stage-prognosisClinical features :Early stages : silent60 % : > 80 years : autopsy studiesMore extensive prostatism ~ BPH

Metastases : bone :-osteolytic (bone destruction)-osteoblastic (bone-producing)virtually dx.Screening test :PSA : Prostate Specific Antigen : > 4mg/ml (+)-digital rectal exam-transrectal sonography-needle biopsyStaging: clin.,surg.,radiograph.,tu. markerTherapy: surgery, radiation therapy, hormonal ~staging, grading

Staging ( tnm )T ( Tumor primer )T1 : Lesi tidak terabaT2 : Ca teraba, terbatas pd prostatT3 : Perluasan keluar prostat, lokalT4 : Invasi ke organ lain

N ( KGB )N0 : Metastase KGB regional N1 : Metastase 1 KGB diameter < 2 cmN2 : > 2-5 cm atau banyak KGB diameter < 5 cmN3 : KGB diameter > 5 cm

M ( metastase jauh )M0 : Metastase M1 : Metastase +