Prostate old age 60 70

Benign prostatic nodular hyperplasia

Pathogenesis
prostate is highly exposed to effect of

Testosterone 5 reductase enzyme

Dihydrotestosterone
stimulates growthfactors

viabindingto Androgen receptors

SO proileferation Mitosis
of Epithelial
Stromalcells

Distribution
Periurethral BPH early manifestations
Peripheral usuallyProstaticcarcinoma Latediagnosis

clinical
caliber force ofstream
Trouble starting hesitancy stopping
Post voiddribbling
retention incontinence
Urgency frequency
Nocturia dysurea
elevation in PSA prostatespecificAg
Diagnosis

Usually longmL
Gross
multiple nodules bulge in C S cystic spaces
grey yellow colour
compressed prostatic urethra
Trabeculations in mucosa wall hypertrophy Urolithiasis

M'S
Epithelialhyperplasia stromal hyperplasia
variable sizes dilated glands
Fibromuscular
Lined by Basal secretory cells
papillary Infoldings projections Cysts
often contain corpora amylacae secretions
Sometimes calcification

Complications
Bladderhypertrophy outletobs Resisting compensatoryhypertrophy

high intra
luminal
Iliffe
pressure in bladder
I'me protrudes
yq
fromMslayer
obstructive uropathy

i.it iii iiiietinii.i.Y i effectE

chronicpyelonephritis
Stones stasis Inf stone

Treatment
5 α reductase inhibitor
α Block sm.ms relaxation
If severe Transurethral resectionof prostate TURP
Prostatic adenocarcinoma

Etiology Androgen dependent

Gross ill defined firm Yellow mass

arises in postaspect of peripheral zone
Late manif
Presented
bymetastasis
Mostcommonspread Bone
osteosclerotic Notosteolytic
Irritatesosteoblasts Newboneformation

Mis Graded with the Gleason system

scores glandular differentiation Arrangement

Crowded small circularglands infiltrating b w benignglands

Nucleienlarged prominent large nucleoli
No basal cells
Normally Lined 183,619T
by 2 Layersofepith r fattened

clinical
often silent No obstruction
vertebral column
metastasis Lumbarspine Lower back Pain

Late stage urinary tract obstruction

Diagnosis Triad
Digitalrectal exam Induration NormallyNotpalpable

Serum PSA ProstaticSpecificAntigen

transrectal US biopsy

alkalinephosphatase

Obturator Pelvic LN metastases

Treatment
Prostatectomy radiation

If Metastatic Orchiectomy astestes secreteandrogens

estrogens
HRH agonists anti androgens

monitored with PSA levels