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Prostatic DiseaseProstatic Disease

ProstatitisProstatitis

Acute bacterialAcute bacterialAscendingAscendingE. coliE. coli

Chronic bacterialChronic bacterialLow back painLow back painDysuriaDysuriaSuprapubic painSuprapubic painCommon bugsCommon bugs

‘‘AbacterialAbacterial’’ChlamydiaChlamydia

Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia

Benign Prostatic HyperplasiaBenign Prostatic HyperplasiaVery commonVery commonAndrogen mediated growth (DHT).Androgen mediated growth (DHT).Central zone proliferatesCentral zone proliferates

Stroma &Stroma &GlandsGlands

Minimal if any increased cancer riskMinimal if any increased cancer risk

BPHBPH

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Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia

Nodular growth patternNodular growth patternSome chronic inflammationSome chronic inflammationGlands always have a double layer of epitheliumGlands always have a double layer of epithelium

Columnar &Columnar &Reserve layerReserve layer

Prostate CancerProstate Cancer

IncidenceIncidenceBlacks &Blacks &WhitesWhitesRare in AsiansRare in Asians

Incidence Incidence increases with increases with age.age.Peripheral zonePeripheral zonePSAPSAFamily historyFamily history

Prostate CancerProstate Cancer

AdenocarcinomaAdenocarcinomaSingle layer of Single layer of epitheliumepitheliumGlandGland--withinwithin--glandglandLN and Bone metsLN and Bone mets

Osteoblastic &Osteoblastic &OsteolyticOsteolytic

TreatmentTreatmentSurgery &Surgery &Hormone Hormone manipulationmanipulation

Prostate CancerProstate Cancer Staging Prostate CancerStaging Prostate Cancer

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Debes, J. D. et al. N Engl J Med 2004;351:1488-1490

Androgen-Dependent and Androgen-Independent Progression of Prostate Cancer Distant Mets, WhereDistant Mets, Where’’s Home?s Home?

Bone MetastasesBone Metastases

Spinal mets Spinal mets -->>PainfulPainfulMay cause lots of May cause lots of reactive bone growth reactive bone growth at the site of the metat the site of the met

OsteoblasticOsteoblastic

May cause bone May cause bone destructiondestruction

OsteolyticOsteolytic

OsteobalsticOsteobalstic (Bone Forming)(Bone Forming)

OsteolyticOsteolytic (Bone destroying)(Bone destroying) Prostate Cancer Can BeProstate Cancer Can Be

Either or BothEither or BothOsteolyticOsteolytic ororOsteoblasticOsteoblastic

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Sexually Transmitted DiseasesSexually Transmitted Diseases

HPVHPVHepatitis BHepatitis BGonorrheaGonorrheaSyphilisSyphilisHIVHIVChlamydiaChlamydia

GonorrheaGonorrhea

NeisseriaNeisseria gonorrheagonorrheaGram negativeGram negativeDiplococcusDiplococcus

MucosaMucosaAcute inflammation!Acute inflammation!Scarring Scarring SterilitySterilityEpididymitisEpididymitis

NeisseriaNeisseria gonorrheagonorrhea SyphilisSyphilisSpirocheteSpirochete

TreponemaTreponemapallidumpallidum

Arteriole is targetArteriole is targetVasculitisVasculitisThree stagesThree stages

Primary: chancrePrimary: chancreSecondary: rashSecondary: rashTertiary: systemicTertiary: systemic

CNSCNSAortaAorta

CongenitalCongenital

TreponemaTreponema pallidumpallidum

SpirocheteSpirocheteInfects arteriolesInfects arterioles

Destroys themDestroys them

RashRashVasovasorumVasovasorum of aortaof aortaCanCan’’t culturet cultureSerologySerology

VDRLVDRLSpecific antibodiesSpecific antibodies

Secondary SyphilisSecondary Syphilis

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Tertiary SyphilisTertiary Syphilis Congenital SyphilisCongenital Syphilis

Infected during Infected during pregnancypregnancy

Third trimesterThird trimester

Virtually all systems Virtually all systems involvedinvolvedPeriosteal Periosteal involvement leads to involvement leads to many skeletal many skeletal deformitiesdeformities

AIDSAIDSHuman immunodeficiency virusHuman immunodeficiency virus

Several strainsSeveral strainsTT--cells infectedcells infected

Antibody regulationAntibody regulationTumor and cell mediated responseTumor and cell mediated response

HIVHIV

HIVHIV

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79 YO Woman with 79 YO Woman with hematuriahematuria

Dilated right Dilated right ureterureterLeft shifted diffLeft shifted diffHematuriaHematuria

Papillary Transitional Cell CaPapillary Transitional Cell Ca 72 YO Man with CHF72 YO Man with CHF

Intractable CHFIntractable CHFLow back painLow back painConfusedConfusedNodular prostateNodular prostateHigh High creatininecreatinineCalciumCalciumAlkAlk PhosPhosPSAPSA

ProstaticProstatic Intraepithelial Intraepithelial NeoplasiaNeoplasia

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Hyperplasia or CancerHyperplasia or Cancer Bone MetsBone Mets

PSAPSA PSAPSA

Age dependentAge dependentSize of glandSize of glandCancerCancerFree or boundFree or bound

Alpha1Alpha1--antichymotrypsinantichymotrypsin

FreeFreeLower with cancerLower with cancer>25% = low risk of ca>25% = low risk of ca

12 YO with Swollen Face12 YO with Swollen FaceIncrIncr BPBPRBC castsRBC castsAzotemicAzotemic

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RBC CastsRBC Casts

Strep InfectionsStrep Infections

ThroatThroatSkinSkin

Toxic changesToxic changesDirect infection Direct infection

50 YO Woman with Weight Gain50 YO Woman with Weight Gain

How sudden?How sudden?ProteinuriaProteinuriaCholesterol = 450Cholesterol = 450Serum Alb = 2.1Serum Alb = 2.1CreatinineCreatinine = 1.3= 1.3Obviously canObviously can’’t be t be kidneykidney

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NephroticNephrotic SyndromeSyndrome

DifferentialDifferentialSLESLEDMDMHepHep BBTumorsTumorsTBTB…………