Benign prostatic hyperplasia

Anatomy of prostate
Histology of prostate
Development of prostate
1. prostate arises from a budding collection of tissue in the urogenital sinus.
2. The prostate develops from epithelial outgrowths form the prostatic segment of the urethra that grows into the surrounding mesenchyme.
  1. This outgrowth and branching start at week 10 during embryo growth; by week 12, there are 5 groups of tubules that form the lobes of the prostate.
Funtion of prostate
1. Production of seminal fluid
Risk factors of BPH
1. Age
  1. Occurs in 20% of men over 40
  2. Occurs in 90% of men over 70
2. Lifestyle
3. Family History
4. Race
5. Diabetes and heart disease
6. others
Signs and symptoms of BPH
1. Hesitancy
2. Frequency
3. Dribbling
4. bladder hypertrophy
5. my cause obstruction
6. Frequent UTI
Investigations of BPH
1. PSA
  1. produced by the prostate gland.
  2. is a 33-kd protein consisting of a single-chain glycoprotein of 237 amino acid residues, 4 carbohydrate side chains, and multiple disulfide bonds.
2. DRE
3. CBC
4. Urinary flow test
5. Postvoid Residual volume test
6. 24 hour voiding diary
7. Transrectal Ultrasound
8. Prostate Biopsy
9. Urodynamic and pressure flow studies
10. Cystoscopy
BPH histology
1. Nodular hyperplasia
2. Transitional zone
3. Urethra compressed into slit
BPH Pathophysiology
1. Proliferation of both epithelial and stromal elements
2. Both androgens and estrogens may play a role
3. Relative increase in estrogens in older men may increase DHT receptors in prostate
BPH Treatment
1. Pharmacology
2. Surgical management
  1. Transurethral resection of the prostate
  2. Open prostatectomy
prostate cancer
1. Malignant prolifration of prostatic glands
  1. Spread to lumbar spine or pelvis is common
2. most common cancer in men
  1. second most common cause of cancer death
3. Risk factors
  1. Age
  2. race
    1. African american
  3. diet high in saturated fat
4. arise in the posterior peripheral region
  1. doesnt produce urinary symptoms early
5. screening beins at the agae of 50 with DRE and PSA
  1. Decreased % free PSA suggest cancer
    1. Biopsy is required to confirm
      1. Shows small invasive glands with prominent nucleoli
6. Gleason grading system
7. Treatment
  1. Prostatectomy
  2. GnHR analogs
    1. leuprolide
  3. Flutamide

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Benign prostatic hyperplasia

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