This 68-year-old male carpenter presents with urinary symptoms including frequency, urgency, terminal dribbling, poor stream, and occasional incontinence. His differential diagnosis includes benign prostatic hyperplasia, prostatitis, prostate cancer, stones, and other causes. Further workup is needed to determine the underlying pathology and guide treatment.

4. Pathology Symptom Testicular tum Gynaecomastia Testicular tum teratoma. Raised α FP/HCG Prostate carcinoma Raised acid Phos. Prostate carcinoma Bone pain STI, syphilis Ulceration UTI, urethritis, gonorrhoea Discharge Prostate, stone, stricture, tumor Retention Prostate, UTI, Polyuria Frequency Bladder neck obstruction. Prostate BPH (rarely stricture/tumor) Poor stream / dribbling. Inflammation urethra, UTI Dysuria

6. When you lose, don’t lose the lesson. Lao Tzu Everyone makes Mistakes, only intelligent learn from it.

8. Pathology of Prostate Dr. Shashidhar Venkatesh Murthy Associate Professor & Head of Pathology

10. Male Urogenital System - anatomy

11. Male Urogenital System - anatomy Ca BPH

13. Normal Histology: Fibro-Musclular-Gland Two Layer Ep. Fibromuscular stroma Secretions

16. Prostatitis:

18. Patho-Physiology: Testosterone  DHT  GF Finasteride

20. Benign Prostatic Hyperplasia:

24. Mucosal trabeculation: Muscular hypertrophy

25. Mucosal trabeculation: Muscular hypertrophy Bulging BPH central Lobes

26. TURP-Bits (Diagnosis + Treat ) Transurethral resection of Prostate - TURP Partial removal by resectoscope. Complications: Hemorrhage, Infection, Granulomatous prostatitis Retrograde ejaculation.

27. BPH: Nodular, Gland+stromal hyperplasia Cystic Gl Nodule of BPH Secretions

28. BPH - Morphology Corpora Amylacea

30. Normal – Prostatitis - BPH

32. Cancer Statistics – 2002 USA

33. Cancer Statistics – 2002 USA

36. BPH with Adenocarcinoma:

37. BPH with Adenocarcinoma: Ca Ca BPH BPH

38. “ The only gracious way to accept an insult is to ignore it. If you can’t ignore it, top it. If you can’t top it, laugh at it. If you can’t laugh at it, it’s probably deserved ...! ” –Joseph Russell Lynes

40. Adeno-Ca Prostate

41. Adeno-Carcinoma + BPH

42. Adeno Carcinoma + BPH Stone Solid-Ca Cystic, soft BPH

43. PIN: Crowding, stratification Pleomorphism Nuclear enlargement. Low grade PIN  High grade PIN  Grade II - III 

44. Prostatic Carcinoma: grade 4

45. Adenocarcinoma Prostate: (High grade)

46. Gleason Grading & Scoring of Prostatic Ca.

48. Gleason score – 1+1=2

49. Gleason score – 2+2=4

50. Prostate Cancer – Gleason grade 3 Gleason grade 3: Pleomorphic glands. There is considerable variation in size, shape, and spacing of the glands. The glands are haphazardly infiltrating the stroma; however, they are still discrete (i.e. there is no fusion of glands - a hallmark of Gleason grade 4). Some of the glands have occluded or abortive lumens.

51. ? Gleason Grade 4 – Gland Fusion, no stroma

52. Small irregular nests & ribbons - Gleason grade 4+4. Prostate Cancer

53. Prostate Cancer-High grade. Grade 5 – sheets, no attempts at gland or clustering.

54. Most prostatic tumours include components of two or more patterns and therefore current practice gives the grade of the two most common components and their sum. This is known as the combined Gleason grade or score. For example, in this image many glands in this example are fused (Gleason grade 4); others maintain individual outlines but are closely packed with their neighbours (Gleason grade 3). Therefore, the score is 7 (4+3). Prostate Cancer High grade

56. Prostate Cancer Poorly differentiated: Normal Gl. Malignant cells

57. Adenocarcinoma – PSA IPx +ve :

59. Ca Prostate – Stage & Prognosis: <10% Evident distant metastases D2 17-20% Metastases to regional lymph nodes, or extensive regional spread D1 33-39% Invades seminal vesicle C2 40-50% Invades capsule of prostate C1 62% Larger palpable nodule B2 70-75% Palpable nodule in one lobe but <1.5 cm in diameter B1 50% Incidental, >5% of volume, or high grade A2 93-98% Incidental, <5% of volume A1 10y Survival Definition Stage

61. “ The weak can never forgive. Forgiveness is the attribute of the strong.” –Mohandas Gandhi

62. Urinary Calculi: Dr. Shashidhar Venkatesh Murthy Associate Professor & Head of Pathology

66. Small renal calculus that would likely respond to extracorporeal shock-wave lithotripsy

69. Staghorn Calculus:

70. Staghorn Calculus

72. Hydronephrosis:

89. Today is the First Day, of Rest of Your Life...!

91. Referral - if >5 mm or has not passed after two weeks. US X-Ray no contrast Helical CT Management

94. Prostatic neoplasms: Overview Rare Normal Microscopic focus of adenocarcinoma Any site Commoner than clinical carcinoma; 80% of glands over 75 years Latent (incidental) carcinoma Bone Lymph node Lung Liver Raised in approximately 60% of cases Infiltrating adenocarcinoma Posterior subcapsular zone Common tumour; peak 60-85 years Clinical (symptomatic) carcinoma None Normal Nodular hyperplasia of glands and stroma Peri-urethral zone 75% of men >70 years Benign nodular hyperplasia Metastases Serum acid phosphatase Morphology Location in gland Incidence Condition