““The only gracious way to The only gracious way to accept an insult is to ignore it. accept an insult is to ignore it. If you can’t ignore it, top it. If you can’t ignore it, top it.

If you can’t top it, laugh at it. If you can’t top it, laugh at it. If you can’t laugh at it,If you can’t laugh at it,

it’s probably it’s probably deserveddeserved...!...!” ”

–Joseph Russell Lynes

Pathology of Pathology of Prostatic EnlargementProstatic Enlargement

Dr. Venkatesh M. ShashidharDr. Venkatesh M. ShashidharAssociate Professor of Pathology

Fiji School of Medicine

IntroductionIntroduction

Anatomy – 5 lobes.Median/Posterior – (BPH/Cancer)Function ?Hormone response – Estrogen likeEnlargement – Inflammation / growthNeoplastic / Non neoplastic growth.BPH / Cancer.

Male Male Urogenital Urogenital SystemSystem

Male Male Urogenital Urogenital SystemSystem

Enlargement of Prostate:Enlargement of Prostate:

BPH – Benign Prostatic HyperplasiaInflammations – infectionsNeoplasms – Carcinoma.

IntroductionIntroduction

Common non-neoplastic lesion.Involves peri urethral zone.BPH is common as men age.75% among men aged 70-80yearsOver 90% in people aged over 90yRare before the age of 40y.? Physiological …

BPH-Pathophysiology:BPH-Pathophysiology:

Excess hormones – estrogen like. Nodular hyperplasia of glands & stroma.From normal 20 to 30 50 to 100 gm.Press upon the prostatic urethra.Obstruction - difficulty on urination Dysuria, retention, dribbling, nocturiaInfections, hydronephrosis, renal failure. Not a premalignant condition*

BPH - MechanismBPH - Mechanism

Hormonal imbalance with ageing.Estrogen sensitive peri-urethral glands.Accumulation of dihydrotestosterone in

the prostate and its growth-promoting androgenic effect

Some Drugs (Finasteride) inhibit dihydrotestosterone and diminishes prostatic enlargement.

BPH-MorphologyBPH-Morphology

Microscopically, nodular prostatic hyperplasia consists of nodules of glands and intervening stroma. (Mostly glands)

The glands variably sized, with larger glands have more prominent papillary infoldings.

Nodular hyperplasia is NOT a precursor to carcinoma.

BPH-mechanism of obstruction:BPH-mechanism of obstruction:Median lobe (3rd lobe) Ball valve mechanism

BPH-Complications:BPH-Complications:

1. Urethral compression2. Ball valve mechanism3. Bladder hypertrophy4. Trabeculation5. Diverticula formation6. Hydroureter – bilateral7. Hydronephrosis

BPH-Bladder Gross – Identify Cues?BPH-Bladder Gross – Identify Cues?

Trabeculations Hypertrophy of wall Stone - urolithiasis Inflammation Median lobe- ball valve. Enlarged prostate.

BPH-Bladder morphology:BPH-Bladder morphology:

Hypertrophy Trabeculation Median lobe

protrusion.

Benign Prostatic Hyperplasia:Benign Prostatic Hyperplasia:

Normal Prostate:Normal Prostate:

Nodular BPH:Nodular BPH:

BPH - MorphologyBPH - Morphology

Adenocarcinoma Prostate:Adenocarcinoma Prostate:

Adenocarcinoma of the prostate is common in elderly men.

It is rare before the age of 50, but seen in over half of men 80 years old.

Many of these carcinomas are small and clinically insignificant.

Is second only to lung carcinoma as a cause for tumor-related deaths among males.

Cancer Statistics – 2002 USACancer Statistics – 2002 USA

Cancer Statistics – 2002 USACancer Statistics – 2002 USA

Adeno-Ca ProstateAdeno-Ca Prostate

Adeno-Carcinoma + BPHAdeno-Carcinoma + BPH

BPH with Adenocarcinoma:BPH with Adenocarcinoma:

Adenocarcinoma Prostate: (HP)Adenocarcinoma Prostate: (HP)

Diagnosis:Diagnosis:

Digital examination – hard, gritty, fixed.Ultrasonography (transrectal) - Tumor Marker – PSA Biopsy - TURPNone of these methods can reliably detect

small cancers.Occult cancer is more common than

clinical ca.

Prognosis of Adenocarcinoma:Prognosis of Adenocarcinoma:

Grade & Stage Prognosis. Urinary obstruction, metastasize to

lymph nodes and bones.Bladder, kidney damage.Hematuria.Spread to Lungs or liver – rare.

TURP-Bits (Diagnosis + Treat )TURP-Bits (Diagnosis + Treat )