Prostate.pdf

Diseases of Prostate Histology of Prostate Three zones: o Transition zone: Common site of nodular hyperplasia o Central zone: Large irregular ducts o Peripheral zone: Common site of prostate CA (carcinoma) Two layers of cells: o Secretory (luminal cells): Release prostate specific antigen (PSA), pro...

Diseases of Prostate Histology of Prostate Three zones: o Transition zone: Common site of nodular hyperplasia o Central zone: Large irregular ducts o Peripheral zone: Common site of prostate CA (carcinoma) Two layers of cells: o Secretory (luminal cells): Release prostate specific antigen (PSA), prostate acid phosphate(PAP) o Basal cells: Release high molecular weight keratin, p63 Lower Urinary Tract Symptoms (LUTS) pathogenesis Static: increase in prostate size obstructs bladder Dynamic: increased smooth muscle tone Compensatory changes: Bladder hypertrophy Decompensated: residual urine, Obstructive symptoms Benign Prostate Hyperplasia (BPH) and Lower Urinary Tract Symptoms (LUTS) LUTS: increase in prostate size BPH: Hypertrophy; increase in size of glandular portion of prostate o Not a malignant process Benign Prostate Hyperplasia (BPH) Increase Risk o High fat diet o Lots of red meat o IM testosterone replacement (NOT transdermal) o Meds § Narcotics § Antihistamines § Anticholinergic § Sympathomimetic drugs (ex. pseudoephedrine) Diagnosed via PSA release by secretory cells What is PSA? o Prostate-specific antigen (PSA) o Kallikrein related serine protease produced by secretory epithelium o Elevated serum levels seen in prostatic adenocarcinoma Digital Rectal exam (DRE): assesses size, consistency, irregularity of prostate BPH treatment o Observation o Medical § Alpha 1 adrenergic blockers § 5-alpha reductase inhibitors § PDE-5 inhibitors o Surgical Prostatitis Infection/inflammation of the prostate Causes of prostatitis o Gram negative bacilli – coliform bacteria (80%) § E. Coli § Klebsiella o Sexual transmitted bacteria – less common § Neisseria gonorrhea § Chlamydia trachomatis Complications of Prostatitis o Bladder outlet obstruction o Urinary retention o Abscess (immunocompromised patients) o Infertility o Recurrent cystitis o Pyelonephritis o Renal damage o Sepsis 4 types: o Acute Bacterial: Gram negative bacteria o Chronic Bacterial: Chronic urogenital symptoms o Chronic prostatitis/chronic pelvic pain syndrome: > 90% of all prostatitis; for at least 3 months out of 6 o Asymptomatic inflammatory prostatitis Acute Bacterial Prostatitis diagnosis o Urinalysis: positive gram stain o DRE: Boggy, tender, enlarged prostate Chronic Bacterial Prostatitis o Gram negative (similar to acute prostatitis) o E. Coli – 75-80% (most common) o Presentation § Intermittent dysuria § Intermittent obstructive LUTS § Recurrent UTI § No systemic symptoms o Diagnosis of Chronic Bacterial § Fractional urinary studies (not a urinalysis) § 4 glass urine eval - V1: Initial void (urethral) - V2: Midstream void (bladder specimen) - EPS: Expressed prostatic fluid (prostate specific), same bacteria as first specimen - V3: Post prostatic massage void, same bacteria as first specimen o Treatment: Fluoroquinolone 4-6 weeks Chronic inflammatory prostatitis/pelvic pain syndrome o Most common type o Pelvic pain or discomfort o More than 3 of the previous 6 months WITHOUT documented urinary tract infections from uropathogens