2. Anatomy
The prostate is a walnut-sized gland located between the bladder and the penis.
The prostate is just in front of the rectum.
The urethra runs through the center of the prostate, from the bladder to the penis, letting
urine flow out of the body.
The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the
prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen
5. Normal Physiology:
Glandular cells
Smooth muscle cells
Stromal cells
The prostate gland also contains an enzyme5 alpha-reductase type-2 that converts
testosterone to Dihydrotestosterone (morepotent)
7. Benign Prostate Hyperplasia:
Benign prostatic hyperplasia (BPH) is the enlargement of the gland .
As the prostate starts to enlarge it exerts pressure on the walls of the urethra.
8. Symptoms
Difficult for you to start urination
• Weaken the flow of urine
• Strain to pass urine
• Frequently need to urinate
• Wake up frequently during the night to urinate
• Sudden urge to urinate
• Blood in the urine (haematuria)
9.
10. Cont.…
Symptoms related to urine voiding from then bladder are the following:
Reduction in urine flow and force.
Intermittent micturition.
Leak of urine drops after the end of micturition
Feeling of incomplete bladder voiding.
Urine retention.
Dribbling
11. Etiology
The exact etiology of BPH is still poorly Understood.
In BPH there is decrease in testosterone level with advancing age but estrogen level does
not decrease equally.
Inc in estrogen level causes hypertrophy of prostate.
DIHYDROTESTOSTRONE is main mediator of BPH.
12. Diagnosis:
history
Physical examination :
• digital rectum test
• palpate
PR Urinalysis
Uroflowmetry
Cystoscopy
Ultrasound
prostate Specific Antigen (PSA) Test
14. BPH symptoms score:
How often have you had a sensation of not emptying your bladder completely after you
finished urinating?
How often have you had to urinate again less than two hours after you finished urinating?
How often have you stopped and started again several times when you urinated?
How often have you found it difficult to urinate?
How often have you had a weak urinary stream?
How often had you had to push or strain to begin urination?
How many times did you most typically get up to urinate from the time you went to bed at
night until the time you got up in the morning?
15. Differential Diagnosis:
Prostatitis
Bladder obstruction
Bladder cancer
Neurogenic bladder
DRE
Elevated PSA
Prostatic biopsy
Other markers as serum acid phosphatase & serum alkaline phosphatase
Plain X-ray spine for metastasis
Isotopic bone scan
CT scan
Cystoscopy
16. Treatment
Watching waiting
Home plan
Medications :
surgery
Radical surgery.
Radiotherapy: External or brachytherapy
Hormonal therapy: in advanced cases Depends on androgen ablation by:
• Bilateral orchiectomy
• Oral estrogen
• Antiandrogens
19. Prostate Cancer:
the prostate cancer starts in the gland cells - this is called adenocarcinoma.
prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells.
Prostatic intraepithelial neoplasia (PIN).
Prostatic intraepithelial neoplasia means "dysplastic changes involving glands and ducts of
the prostate that may be a precursor of adenocarcinoma.
20. Cont…
Most prostate cancers are slow growing; however, there are cases of aggressive prostate
cancers
If the tumor is within the gland, the cancer is said to be localized and curable
If the cancer escapes the gland it is considered incurable
Early detection before the cancer escapes the gland becomes very important
21. Etiology:
Age
Genetics
Faulty BRCA2 gene linked to aggressive.
Diet
Medication
Obesity
STDs
Agent orange
Enzyme PRSS3 linked to aggressive
23. Symptoms:
During the early stages:
The patient urinates more often
The patient gets up at night more often to urinate
He may find it hard to start urinating
He may find it hard to keep urinating once he has started
There may be blood in the urine
Urination might be painful
Ejaculation may be painful (less common)
Achieving or maintaining an erection may be difficult (less common)
24. Symptoms of advanced cancer:
Bone pain, often in the spine (vertebrae), pelvis, or ribs
The proximal part of the femur can be painful
Leg weakness (if cancer has spread to the spine and compressed the spinal cord)
Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)
Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord)
26. Diagnosis:
PSA test blood test
Prostate biopsy
Trans rectal ultrasound
Bone scan
CT
MRI
ProstaScint scan
27. Medications:
Medication
Watchful waiting
Prostatectomy
Radiation placed inside your body (brachytherapy)
Radiation that comes from outside of your body (external beam radiation)
Hormonotherapy
Chemotherapy
Freezing prostate tissue
Heating prostate tissue using Ultrasound
cryotherapy
28. Cont…
First line of defense against bothersome urinary symptoms
Two major types:
α blockers - relax the smooth muscle of prostate and provide a larger urethral
opening (Hytrin,Doxaben,Harnalidge)
5 α reductase inhibitor – Shrink the prostate gland (Proscar,Avodart)
29. Medication
Benefits
Convenient
No loss of work
time
Minimal risk
Disadvantages
Drug Interactions
Must be taken every day
Manages the problem
instead of fixing it
32. Etiology
A bacterial infection is only sometimes responsible.
• In many cases of chronic (long-term) prostatitis, doctors can't find any infection in the
prostate gland, In these cases, the cause is poorly understood.
• Chronic prostatitis is thought to be caused by a number of suggested factors, including
partial blockage of the flow of urine and underlying problems with the immune system,
pelvic floor or nervous system.
33. Symptoms:
Pain in the pelvis, genitals, lower back and buttocks
• Pain when urinating
• Frequent need to urinate
• Difficulty urinating, such as problems starting or 'stopstart‘ urination
• Pain when ejaculating, which may contribute to erectile dysfunction
• Discomfort in the perineal area (the area between the scrotum and the anus)
36. Etiology
Age
• Ethnic group
• Family history
• Obesity
• Exercise
• Diet
37. Symptoms
Urinate more frequently, often during the night
• Needing to rush to the toilet
• Difficulty in starting to urinate
• Straining long time while urinating
• Feeling that your bladder has not emptied fully
38. Diagnosis
Ask for a urine sample to check for infection
• Take a blood sample to test your level of prostate-specific antigen (PSA)
• Examine your prostate (digital rectal examination)
• Gleason score
• Biopsy