Obstructive Uropathy 2

Prostate
Dr. Fouzia Zeeshan Khan
 Learning Objectives
• At the end of lecture, student can understand:

• Causes of Prostitis
• Pathogenesis of Prostitis
• Management of Prostitis
• Clinical course of Prostitis
 Pathology
• Inflammation

• Tumors

• Hyperplasia
• Acute Bacterial Prostitis
• Chronic Bacterial Prostitis
• Abacterial Prostitis
• Granulomatous Prostitis
 Nodular Hyperplasia
• Nodules appear in periurethral gland
• Age 50 plus
• Hyperplasia of stromal and epithelial cells
 Clinical Presentations
• Storage symptoms:
urgency, frequency, nocturia and urge urinary
incontinence

• Voiding Symptoms
reduced flow and feeling of incomplete
emptying
• Post-void dribbling
 Management
• Lifesytle change: Increase fluid intake
• Alpha blockers
• 5 alpha reductase inhibitors
• Surgery
Prostatic Carcinoma
• Etiolgy
• Family history
• Hereditary Association
• Racial Factors
• Environmental Factors
• Diet

No association with cigeratte smoking, alcohol, height

an weight, blood grps
No viral origin
No evidence of vasectomy
• Mutations with BRCA 2 and HOXB13
• The most common acquired genetic lesion
TPRSS2-ETS fusion gene and mutation in
PI3K/AKT signaling pahway.
Normal Histology
Prostatic Carcinoma(Morphology)
Grading of Ca.
Staging of Prostatic Ca Using TNM System
 Serum PSA
• Prostate-specific antigen, or PSA, is a protein
produced by normal, as well as malignant,
cells of the prostate gland.
• It is androgen related serine protease
• PSA Density
• PSA Velocity
• Ratio of free and bound PSA levels in the
serum.
Genes serve as Biomarker in Prostate Cancer

• Urinary PCA3

• Combination of Urinary PCA3 and

TMPRSS2-ERG fusion DNA
 Treatment
1. Anti-androgens + Chemotherapy
2. Surgery (Radical prostatectomy and pelvic
lymphadenectomy).
3. External-beam radiotherapy (EBRT), and
brachytherapy
4. Cryosurgery 
 References
• Huang SW et al. Comparative efficacy and safety of new surgical
treatments for benign prostatic hyperplasia: Systematic review and network
meta-analysis. BMJ 2019 Nov 14; 367:l5919
• Zhang L, Wang Y, Qin Z, et al. Correlation between Prostatitis, Benign
Prostatic Hyperplasia and Prostate Cancer: A systematic review and Meta-
analysis. J Cancer. 2020;11(1):177-189. Published 2020 Jan 1.
doi:10.7150/jca.37235
• Fenton JJ, Weyrich MS, Durbin S, Liu Y, Bang H, Melnikow J. Prostate-
specific antigen-based screening for prostate cancer: Evidence report and
systematic review for the US preventive services task force. JAMA
2018;319(18):1914–31.
• Turkbey B, Rosenkrantz AB, Haider MA. Prostate imaging reporting and
data system version 2.1: 2019 update of prostate imaging reporting and
data system version 2. Eur Urol 2019;76(3):340–51. doi:
10.1016/j.eururo.2019.02.033