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Benign Prostate Hyperplasia & Prostate Cancer

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Property of Prof Dr. Ahmed Sakr, Department of Urology, Faculty of Medicine, University of Zagazig, Egypt

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Benign Prostate Hyperplasia & Prostate Cancer

  1. 1. Prostate gland Ahmed Sakr, Urology MD By Zagazig Urology Department
  2. 2. Anatomy of the prostate • The prostate surrounds the bladder outlet & the beginning of male urethra. • Its shape is like a chestnut or inverted cone. • It measures 3 × 4 × 2 cm & weighs about 18 gm. • Relations:
  3. 3. Zonal anatomy: • TZ (the commonest site for BPH) • CZ • PZ (the commonest site for prostatic carcinoma) • Anterior fibro-muscular stroma Clinically : The prostate has 2 lat. Lobes separated by a central sulcus and a median lobe which may project into the cavity of the U.B.
  4. 4. Benign prostatic hyperplasia “Senile enlargement of the prostate” • The commonest tumor of the prostate • Affects about ⅔ of men over 50 y. Etiology: 1- Unknown 2- Aging 3- Normal testosterone Pathology: • From TZ or peri-urethral region • As adenoma enlarges, it compresses the normal prostatic tissue forming a false capsule with a line of cleavage.
  5. 5. Histology: • Hyperplasic acini • Variable in size • Lined with one or more layers of cells • some acini contain corpora amylacea • The fibro-muscular stroma shows hypertrophy BPH Normal prostate
  6. 6. Pathologic effect: • Urethra: compressed, stretched, elongated & may be tortuous
  7. 7. • Bladder: - Bladder → Hypertrophied wall with ↑ pressure inside → cellule & diverticula - Bladder decompensation → urine retention (acute or chronic)
  8. 8. • Upper tract: Hydroureter & hydronephrosis & may lead to renal insufficiency
  9. 9. Clinical picture: (LUTS obstructive or irritative) • Obstructive : hesitancy, weak stream, interrupted stream & urine retention • Irritative : ↑ frequency, urgency & urge incontinence - Obstructive symptoms occur first but with infection & stone formation irritative symptoms become manifest
  10. 10. Physical examination: • Abdominal mass (hydronephrosis) • Pelvic mass (retained bladder) • DRE: 1. Symmetrical or asymmetrical enlargement 2. Preserved sulcus 3. Smooth surface 4. Sliding rectal mucosa over the gland 5. Consistency like that of contracted thenar eminence
  11. 11. Investigations: A. Basic investigations: 1. Urinalysis 2. Serum creatinine 3. PSA: • Normal level → 0-4 ngml • BPH → 4-10 ngml • > 10 ngml may indicate cancer 4. U/S: • Abdominal • TRUS
  12. 12. B. Additional investigations: • IVP • Uroflowmetry • Estimation of post-voiding residual urine • Cystoscopy
  13. 13. Complications: 1. Hematuria 2. Urine retention (acute or chronic) 3. Infection 4. Stone formation 5. uremia
  14. 14. Treatment: 1. Watchful waiting: ( in mild symptoms) • ↓ fluid intake • Timed voiding • Avoidance of constipation • Avoid exposure to cold • Avoid diuretics & anti-cholinergic • Avoid sexual excitement
  15. 15. 2. Medical treatment: - Indications: Bothersome symptoms with no complications - Drugs: • α – adrenergic blockers (Doxazocin – Terazocin) They act by ↓ the tension of the smooth muscle of prostatic capsule • 5 – α reductase inhibitors (Finasteride): It inhibits the 5 – α reductase enzyme responsible for conversion of testosterone to DHT
  16. 16. 3. Surgical treatment: • Indications: 1. Recurrent attacks of acute retention 2. Hematuria 3. Recurrent urinary tract infection 4. Bladder stone or diverticula 5. Renal insufficiency • Routes of intervention: - Open surgery: Transvesical or retropubic - TUR-P 4. Minimally invasive techniques: • LASER prostatectomy • Prostatic balloon ablation • Prostatic stents • Thermotherapy
  17. 17. Prostate cancer Etiology: Unknown Risk factors: Family history, high fat diet & racial factors Pathology: - Gross: Hard nodular prostate, may invade the capsule or adjacent structures - Microscopic: Adenocarcinoma of varying degrees Spread: 1. Direct spread 2. Lymphatic spread 3. Blood spread
  18. 18. Clinical picture: • Asymptomatic & discovered accidentally • Symptoms of metastasis without urinary symptoms (occult carcinoma) • LUTS (shorter duration & progressive course)
  19. 19. Diagnosis: 1. DRE 2. Elevated PSA 3. Prostatic biopsy 4. Other markers as serum acid phosphatase & serum alkaline phosphatase 5. Plain X-ray spine for metastasis 6. Isotopic bone scan 7. CT scan 8. Cystoscopy
  20. 20. Treatment: 1. Watchful waiting. 2. Radical surgery. 3. Radiotherapy: External or brachytherapy 4. Hormonal therapy: in advanced cases Depends on androgen ablation by: • Bilateral orchiectomy • Oral estrogen • Antiandrogens

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