Urinary tract diseases II 2024.pptx

Urinary tract disorders - II Overview of prostate diseases BPH Prostate cancer Learning outcomes To understand pathological features of BPH and prostate cancer To explain the main clinical characteristic of BPH and prostate cancer Urinary tract disorders - II Overview of prostate diseases BPH...

Urinary tract disorders - II Overview of prostate diseases BPH Prostate cancer Learning outcomes To understand pathological features of BPH and prostate cancer To explain the main clinical characteristic of BPH and prostate cancer Urinary tract disorders - II Overview of prostate diseases BPH Prostate cancer Prostate A gland that surrounds the bladder neck and proximal urethra; Four zones (central, peripheral, transitional, periurethral) Overview  The prostate is a gland that surrounds the urethra and slowly grows with age  Prostate diseases are very common > age 50  Common prostate diseases: - Benign prostatic hyperplasia - Prostate cancer - Prostatitis - an infection, usually caused by bacteria Urinary tract disorders - II Overview of prostate diseases BPH Prostate cancer Nodular hyperplasia Referred to as benign prostatic hyperplasia (BPH) Non-neoplastic enlargement Common > 60 yrs; symptoms in only 10% Prostate enlarged with nodule formation Histology: − Fibromuscular & glandular hyperplasia. Prostatic hyperplasia BPH Other clinical features: Urinary retention Cystitis Bladder hypertrophy Hydronephrosis, pyelonephritis Pathogenesis: androgens Treatment: Medical: a-blockers antiandrogens Surgical: Transurethral resection (TURP) Pathology: Nodular hyperplasia -fibromuscular -glandular Main symptoms: Hesitancy in initiation of micturition A poor stream Dribbling postmicturition Frequency and nocturia Investigation: Rectal examination for the enlarged prostate BPH - Pathogenesis & pathology Pathogenesis The cause is unknown, but might be related to levels of male sex hormone (testosterone) Pathology Nodular hyperplasia − − Stroma (smooth muscle and fibrous tissue) Glands Hyperplasia (lateral & median lobes) Compression of the urethra Bladder outflow obstruction BPH – Clinical features Main symptoms:  Hesitancy in initiation of micturition  A poor stream  Dribbling postmicturition  Frequency and nocturia BPH – Clinical features Other clinical features:  Urinary retention  Cystitis  Bladder hypertrophy  Hydronephrosis, pyelonephritis BPH - Investigation Digital rectal examination for the prostate (firm, smooth & rubbery) Abdominal examination for an enlarged palpable bladder BPH – Treatment Medical: − a-blockers (relax smooth muscle at the bladder neck) − Antiandrogens (prevent testosterone conversion) Surgical: − Transurethral resection (TURP) New treatment: − Prostate artery embolisation Urinary tract disorders - II Overview of prostate diseases BPH Prostate cancer Prostate cancer Very common, the second most common cancer in men (after lung) accounting for 1/4 of all cancers in men; A disease of elderly men, occurring in 1 in 10 men >70yrs, rare < 55yrs The cause is unknown, but there is a link between androgenic hormones and tumour growth Aetiology -Unknown Hormonal changes, androgens Family history Associated with BPH but no proof Pathology Adenocarcinoma Mostly in peripheral zone, classically posterior location Grading – Gleason classification Treatment:  Surgery – radical prostatectomy  Hormone manipulation – LHRH  Radiotherapy Presentation Symptoms of lower urinary tract obstruction Hard craggy prostate on rectal examination Metastatic disease in the bone; pain Asymptomatic carcinoma, found in autopsies Diagnosis Transrectal ultrasound: size & staging Prostatic biopsy: histological diagnosis & Gleason scoring Prostate-specific antigen (PSA) metastases Prostate cancer - Aetiology The aetiology is unknown, but the hormonal changes that occur with increasing age may be involved Age-dependent hormonal changes; androgens & hypersensitivity of androgen receptor. Family history, a strong hereditary component Often associated with BPH but no proof of causal relationship Prostate cancer - Pathology Histology: adenocarcinoma Mostly arises in the peripheral zone, classically posterior location – palpable on examination Grading − Gleason classification (Grade 1-5 depending on glandular differentiation and architectural patterns) Spread: − Local (floor of bladder & pelvis, other adjacent structures) − Distant metastases (bone, esp. spine, pelvis, femur, ribs; liver & lungs) Prostatic adenocarcinoma Gleason Pattern 3: abundant amphophilic cytoplasm, enlarged nuclei with prominent nucleoli. Prostate cancer - Presentation Symptoms of lower urinary tract obstruction Hard craggy prostate on rectal examination Metastatic disease in the bone; pain Asymptomatic carcinoma, found in autopsies Prostate cancer - Diagnosis  Transrectal ultrasound of the prostate: − Defining the size and staging tumour present  Prostatic biopsy: − Histological diagnosis (essential before treatment) − The Gleason scoring  Prostate-specific antigen (PSA) – metastases EN2: recent discovery by Surrey Team  Further testing: MRI – detailed structure if significant chance of spreading; recent advance: mpMRI Prostate cancer - Treatment Surgery – radical prostatectomy Hormone manipulation − LHRH analogues; orchidectomy Radiotherapy Prognosis depends on the stage Benign prostatic hyperplasia (BPH) is a) A neoplastic enlargement b) Common between 40-60 years old c) Associated with smooth muscle hypertrophy d) A fibromuscular and glandular hyperplasia e) Mainly a glandular hyperplasia Which of the following statements about the prostate carcinoma is TRUE? a) b) c) d) Occurs mainly in elderly men Is histologically an adenocarcinoma Is associated with androgen sensitivity Serum prostate specific antigen level is high e) All of the above