NEOPLASMS OF THE

PROSTATE GLAND
Dr.dr. Didit Pramudhito, Sp.U
Departemen Bedah RSMH/FK UNSRI

Dr.dr.Didit Pramudhito Sp.U

Dr.dr.Didit Pramudhito Sp.U
 Benign
Benign Prostatic Hyperplasia
 Malignant
Carcinoma of the Prostate

Dr.dr.Didit Pramudhito Sp.U

Dr.dr.Didit Pramudhito Sp.U
BPH
(Benign Prostatic Hyperplasia)
 Uniformly originates in the transition zone
 Most common benign tumor in men
 Autopsy study ,ages 41-50 : 20 %
ages 51-60 : 50 %
Over 80 : 90 %
obstructive voiding
age 55 : 25 %
age 75 : 50 %

Dr.dr.Didit Pramudhito Sp.U

 Risk factor: poorly understood
 Some study have suggested : a genetic
predisposition and racial differences
 Etiology: endocrine
 The prostate is composed of both stromal
and epithelial element can give
hyperplastic nodules
 Stroma: collagen and smooth muscle

Dr.dr.Didit Pramudhito Sp.U

Dr.dr.Didit Pramudhito Sp.U
 Theories for the cause of BPH
Theory Cause Effect
Dihydrotestosteron  5- reductase and Epithelial and stromal
hypothesis androgen receptors hyperplasia

Oestrogen-testosteron  Oestrogens Stromal hyperplasia

imbalance  Testosteron

Stromal-epithelial  Epidermal growth Epithelial and stromal

interactions factor/fibroblast hyperplasia
growth factor
 Transforming growth
factor 

Reduced cell death  Oestrogens  Longevity of stroma

and epithelium

Stem cell theory  Stem cells Proliferation of transit

cells

Dr.dr.Didit Pramudhito Sp.U

Clinical Findings

 Symptoms
Obstructive and irritative
 Obstructive: hesitancy, decrease force and
caliber of stream, sensation kof incomplete
bladder emptying, double voiding, straining
to urinate, post voiding dribling
 Irritative: urgency, frequency and nocturia
 AUA/IPSS
Dr.dr.Didit Pramudhito Sp.U
International Prostate Symtoms
Scores
 Incomplete emptying (0-5)
 Frequency (0-5)
 Intermittency (0-5)
 Urgency (0-5)
 Weak Stream (0-5)
 Straining (0-5)
 Nocturia (0-5)

Dr.dr.Didit Pramudhito Sp.U

 Sign
A physiccal examination, DRE
DRE: size and consistency of the prostate
(smooth,firm, elastic enlargement)
Does not correlatte with severity of
symptoms or degree of obstruction.

Dr.dr.Didit Pramudhito Sp.U

 Symptoms score 0-7  mild
 Symptoms score 8-19  moderate
 Symptoms score 20-35 severe

Dr.dr.Didit Pramudhito Sp.U

Differential Diagnosis

 Urethral stricture
 Bladder neck contracture
 Bladder stone
 Carcinoma of the prostate

Dr.dr.Didit Pramudhito Sp.U

Treatment

 Watchfull waiting
Mild symptom score (0-7)

Dr.dr.Didit Pramudhito Sp.U

Treatment

 Medical Therapy
1. Alpha blockers: prazosin, terazosin,
doxazosin, tamsulosin.
2. 5 alpha reductase inhibitor: finasteride
3. Combination therapy:
terazosin+fenasteride
4. Phytoterapy: Pygeum afrocanum,
echinacea
purpura, hypoxis rooperi
Dr.dr.Didit Pramudhito Sp.U
Alpha receptor

Dr.dr.Didit Pramudhito Sp.U

 Conventional Surgical Therapy
1. Transurethral Resection of the
Prostate(TURP)
Symptom score and flow rate improvement
with TURP is superior to that of any
minimally invasive therapy.

Dr.dr.Didit Pramudhito Sp.U

2. Transurethral incision of the prostate
Small prostate.
3. Open simple prostatectomy
Prostate over 100 g , can be done with
either asuprapubic or retropubic approach.

Dr.dr.Didit Pramudhito Sp.U

 Minimally Invasive Therapy
1. Laser therapy
2. Transurethral electrovaporization of the
prostate.
3. Hyperthermia
4. Transurethral needle ablation of the
prostate

Dr.dr.Didit Pramudhito Sp.U

Dr.dr.Didit Pramudhito Sp.U
Dr.dr.Didit Pramudhito Sp.U
5. High intensity focused ultrasound.
6. Intraurethral stents
7. Transurethral ballon dilation of the
prostate.

Dr.dr.Didit Pramudhito Sp.U