Diseases of the Prostate PDF

‫حيم‬$‫&ا‬$‫بسما'ا‬ Diseases of the prostate Modified 2024-2025 Faculty of Medicine - AAUP Dr. Malik Khamaysi - M.D 2023/2024  Adult Prostate ⑧n -Central zone centree ③...

‫حيم‬$‫&ا‬$‫بسما'ا‬ Diseases of the prostate Modified 2024-2025 Faculty of Medicine - AAUP Dr. Malik Khamaysi - M.D 2023/2024  Adult Prostate ⑧n -Central zone centree ③ ① ② & 554.ss Cancers  Benign prostate gland * * O-septas & basal fibromascular stroma  PROSTATITIS Acute bacterial prostatitis Chronic bacterial prostatitis Chronic abacterial prostatitis  ACUTE BACTERIAL PROSTATITIS Etiology Same organisms that cause UTI E coli , proteus, other gnr Pathogenesis UTI s8 Organisms ascend from urethra and urinary bladder Rarely, hematogenous spread  Case Study: Acute Prostatitis Patient Information: A 50-year-old male presents to the clinic with a 4- day history of fever (39°C/102.2°F) accompanied by chills, perineal and lower back pain, dysuria, and urinary urgency. He also reports a weak urinary stream, hesitancy, and a sense of incomplete bladder emptying. The patient denies hematuria but mentions Acute bacterial prostatitis fatigue and malaise. He has no prior history of urinary tract infections or chronic diseases but reports unprotected sexual activity with a new partner two weeks ago. Question: What is the most likely diagnosis? A. Urinary Tract Infection (UTI) B. Acute Prostatitis C. Bladder Stones D. Pyelonephritis Correct Answer: B. Acute Prostatitis Explanation: Morphology Acute Prostatitis is supported by the combination of systemic symptoms (fever, chills, malaise) and localized urinary symptoms (dysuria, Acute inflammation, especially in the glands, with weak stream, perineal pain). A history of unprotected sexual activity also raises suspicion for infection. UTI (A): Although it can cause cavity containing pus dysuria and frequency, systemic symptoms and microabsesses perineal pain are less typical. Bladder Stones (C): These usually cause localized pain and hematuria but not systemic necrotic plasma A - symptoms. tissue protein Congestion, edema Pyelonephritis (D): Typically involves flank pain rather than perineal pain and is more associated with kidney infection signs like costovertebral angle tenderness. Clinical course J& zes Dysuria, frequency, low back pain, pelvic pain. Enlarged, exquisitely tender # +/- Fever ,chills or leukocytosis -I ↑ WBC Usually resolves with ab rx is  Acute prostatitis inflamation in gland - sig! O 0 -> antibiotic & 9%.  CHRONIC PROSTATITIS Etiology Chronic' 655. II, acutes 51. May follow acute prostatitis May develop insidiously Culture positive (bacterial) Same organisms that cause ap Culture negative (abacterial) May be related to Chlamydia trachomatis Ureaplasma urealyticum Trichomonas Most common form of cp  CHRONIC PROSTATITIS Morphology Lymphocytic infiltrate mononucular cell Neutrophils and macrophages Some evidence of tissue destruction Clinical course Similar to ap Less acute symptoms -...5 le More resistant to ab rx , so we give then long term ab I 5. long term antibiotic;g's Cbp often associated with recurrent uti  Stroma infeltration monocyt Glau Hand - # urethre  Proliferative lesions of the prostate - Periurethral and transitional zones Urethra Peripheral Zone Normal prostate Sis ⑤ jig sli Nodular hyperplasia - Carcinoma -  Nodular hyperplasia Other terms used Glandular and stromal hyperplasia Benign prostatic hypertrophy (hyperplasia) Epidemiology Occurs in 20% of men over 40 Occurs in 70% of men over 60 Occurs in 90% of men over 70 5.35- 5. Age so Risk  Pathogenesis of nodular hyperplasia Proliferation of both epithelial and stromal -- elements ↳s 1) Both androgens and estrogens may play a role testisterono,j - Not seen in males castrated before puberty hyperplasians 1.210* -> ↳ Inhibitors of testosterone metabolism useful in treatment Relative increase in estrogens in older men may increase dht receptors in prostate i  Pathogenesis of prostatic hyperplasia - 25S.s 25. si riceptors See,: - S sir ass epithelials'.  Nodular prostatic hyperplasia Periurethral nodules nodule Nodular prostatic hyperplasia: well differentiated The microscopic view of a whole mount of the nodules compressing the urethra into a slit-like prostate shows nodules of hyperplastic glands on lumen, which causes urinary tract obstruction both sides of the urethra.  - the prostateglan here is 6 am enlarge very - - * ‫‪d‬‬ ‫↑‬ ‫عند التكبير العالي‪ ،‬تعاني البروستاتا ا‪3‬تضخمة من تضخم غدي‪.‬‬ ‫من الناحية ا‪3‬جهرية‪ ،‬يمكن أن يشمل تضخم البروستاتا الحميد ك^ من‬ ‫الغدد متمايزة جيًدا و‪ D‬تزال تحتوي على بعض السدى ا‪3‬تداخلة‪.‬‬ ‫الغدد والسدى‪ ،‬على الرغم من أن ا‪W‬ولى عادة ما تكون أكثر بروًزا‪.‬هنا‬ ‫ُتعرف الكتل الوردية الصغيرة ا‪3‬صفحة داخل التجويف الغدي باسم‬ ‫تظهر عقدة كبيرة مفرطة التنسج من الغدد‬ ‫الجسم ا‪W‬ميلي‬  Clinical course of nodular hyperplasia Symptoms occur in only 10% of men with nodular hyperplasia(urethral obstruction & narrowing ) recedancy -> it's - Hesitancy · 25.25 D,5 Urinary retention Urgency, frequency, nocturia, uti Treatment Medical - ,551, 5 Surgical Common cause for elevated prostate specific antigen (psa)  Association of BPH and Prostate Carcinoma may turn or cause cancer notpremalegmant & by Both are related to advanced age and androgens. Both may respond to androgen deprivation. Carcinoma occurs 10-15 yr after BPH. 10% of BPH cases contain incidental carcinoma. BPH is not a premalignant condition and is not precursor of carcinoma.  Carcinoma of the prostate Epidemiology Most common visceral cancer in male - => > About 70/100,000 men in us 20% are lethal 15. Second most common cause of cancer death in men Peak incidence of clinical cancer is 65-75 yo  Carcinoma of the prostate 5:11j8 It is diseae of elderly men prostate cancer.. 1$;8/ps i's s 10% at 50 yr of age (autopsy studies ) => -> 80% at 80 yr of age (autopsy studies ) - Latent ca is even more prevalent >50% in men > 80 yo there are many undiagnosed or asymptomatic cases of cancer  ‫‪Carcinoma of the prostate‬‬ ‫‪ Pathogenesis‬‬ ‫اخت‪-‬ل التوازن الهرموني‪:‬‬ ‫‪.1‬‬ ‫يؤدي الع‪-‬ج با=ستروج‪ 9‬إلى زيادة مستويات هرمون ا=ستروج‪ 9‬مقارن ًة بهرمونات الذكورة‬ ‫‪ Hormonal factors‬‬ ‫)ا‪V‬ندروجينات( مثل التستوستيرون‪.‬هذا قد يحفز مستقب‪-‬ت ا=ستروج‪ 9‬في البروستاتا‪ ،‬مما‬ ‫تكاثرا غير طبيعي للخ‪-‬يا وزيادة خطر ا=صابة بالسرطان‬ ‫ً‬ ‫يسبب‬ ‫ ‬ ‫‪Orchiectomy and/or estrogen treatment inhibits growth‬‬ ‫‪-99‬‬ ‫‪Is.‬‬ ‫‪-‬‬ ‫‪-‬‬ ‫عند استئصال الخصيت‪ ،9‬يتوقف إنتاج‬ ‫التستوستيرون ا‪V‬ساسي في الجسم‪ ،‬مما يؤدي إلى‬ ‫ ‬ ‫‪ Genetic factors‬‬ ‫انخفاض حاد في هذا الهرمون‪.‬ومع ذلك‪ ،‬قد تتطور‬ ‫بعض الخ‪-‬يا السرطانية في البروستاتا لتكون مقاومة‬ ‫لهذا ا‪m‬نخفاض‪.‬بعض ا‪V‬ورام السرطانية في‬ ‫ ‬ ‫‪Increased risk in first order relatives‬‬ ‫زيادة ا‪3‬خاطر لدى أقارب الدرجة ا‪W‬ولى‬ ‫البروستاتا قد تظل تعتمد على هرمونات أخرى أو قد‬ ‫تطور طرقًا بديلة للبقاء نشطة‪ ،‬حتى في غياب‬ ‫التستوستيرون‬ ‫ ‬ ‫)‪Blacks > whites (symptomatic ca‬‬ ‫>=‬ ‫>‬ ‫‪ Environmental factors‬‬ ‫ ‬ ‫‪Geographic differences in incidence of clinical cancer (not‬‬ ‫‪of‬‬ ‫)‪latent ca‬‬ ‫⑤‬ ‫‪-‬‬ ‫>=‬ ‫ ‬ ‫‪Change in incidence with migration‬‬ ‫‪18 (il‬‬ ‫‪..2 esssir gis;els prostates.‬‬ ‫=‬ ‫‪Cancer‬‬ ‫‪prostate‬‬ ‫‪cancer‬‬ ‫↓‬ ‫‪2!!" S$2‬‬ ‫*‬  Prostatic Carcinoma Clinical features: Often clinically silent. Urinary obstructive symptoms. Diagnosis is made in one of the following instances: Routine surveillance in men over 40 yr. Incidental finding in TURP. X, lsse4.98s,y 15 8. s Adenocarcinoma with unknown primary. => prostatID? 9. Rarely, rectal or perirectal mass. -> sss - ↳is  Carcinoma of the prostate Clinical course GRE Digital rectal exam (dre) PR Prostate specific antigen (psa) > 4 ng/ml In peripheral blood - & Free psa < 25% -prostats, s small portion is free Transrectal ultrasound Needle biopsy Metastases Osteoblastic 3 Treatment- surgery, radiation, hormones, chemo I 2 4  Prostatic carcinoma Pathology Yellow-white hard multifocal foci with‫أبيض‬-‫بؤر متعددة البؤر صلبة ذات لون أصفر‬ predilection for peripheral zones..‫( ميل للمناطق الطرفية‬Parieheral) Haphazard small irregularly shaped invasive glands with abortive lumens. - - ‫غدد غازية صغيرة عشوائية الشكل غير‬ ‫منتظمة الشكل ذات تجويف فاشل‬ - Glands lack basal cell layer. Cells contain prominent nucleoli. Perineural invasion. for nerve  - Loss of convelusion no papillary  Prostate specific antigen (PSA) Specific for prostate tissue. Not For screening: PSA should be cancer specific. used in combination with digital - or ultrasound exam. - Normal level < 4ng/ml. - Psa can be used for : Elevated in 51 - prostat Monitoring success of gis3,8 Carcinoma Sis il prostatectomy. Urethra's Bph Detecting early relapses - J. I acute Prostatitis Schronic - s 4.19 ‫خرى‬W‫ورام الخبيثة ا‬r‫التشخيص التفريقي ل‬ Differential diagnosis of other malignancies. Psa velocity & density. Prostatic Intraepithelial Neoplasia within PIN proliferation infettrate Lymphocyte  ‫‪n‬‬ ‫*‬ ‫‪fe‬‬ ‫*‬ ‫>‪-‬‬ ‫‪165.‬‬ ‫‪prostar‬‬ ‫‪-‬‬ ‫]‪-‬‬ ‫!‪56‬‬ ‫ُترى نوى بارزة في نوى سرطان البروستاتا‬ ‫الغدي‪.‬هذه النوى ا‪3‬تضخمة هي سمة‬ ‫مميزة‪D.‬حظ أن هذا السرطان الغدي له‬ ‫درجة مجهرية أعلى‪W ،‬نه ‪ D‬يوجد سوى عدد‬ ‫قليل من اللمعان الغدي غير ا‪3‬تشكل في‬ ‫طبقة من الخ^يا الورمية ا‪3‬زدحمة‬ Mitotic figures are structures observed during cell division (mitosis). They are visible under a microscope and represent various stages of cell division. Mitosis is the process by which a single cell divides to produce two genetically identical daughter cells. Mitotic figures are crucial for normal growth, development, and tissue repair. Increased or abnormal mitotic figures may be indicative of uncontrolled cell division, which can be a characteristic feature of cancer when observed in tissues under a microscope. Mitotic figures are often assessed in pathology to evaluate the proliferative activity of cells. ‫ضافة إلى أشكال انقسامية‬y‫ يظهر سرطان البروستاتا الغدي ضعيف التمايز خ^يا ورمية ذات نويات بارزة با‬،‫عند التكبير العالي‬  hestological grade, 2,91Isprostats) 8%, [es:-), s s E $84. - is poor (well :1 5555.9 I's:s 6 +2 erg?"s,I! sigg grad pour s - - :15 stromen fibromascular margen is stroma glasse very poor ‫تكشف هذه ا‪3‬قاطع من البروستاتا التي تمت إزالتها عن طريق استئصال البروستاتا الجذري عن عقيدات صفراء غير منتظمة‪ ،‬معظمها في الجزء الخلفي )ُيرى‬ ‫هنا بشكل علوي(‪.‬ثبت أن هذا سرطان غدي في البروستاتا‪ D.‬تتضخم بالضرورة غدد البروستاتا التي تحتوي على سرطان غدي‪.‬قد يتعايش السرطان الغدي‬ ‫ضا مع تضخم‪.‬ومع ذلك‪ ،‬فإن تضخم البروستاتا ليس آفة سابقة للسرطان‪.‬يعتمد تحديد مرحلة سرطان البروستاتا الغدي على مدى اتساع الورم‪.‬‬‫أي ً‬ Sam Metastatic osteoblastic prostatic carcinoma