Pathology of BPH

“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 Pathology of Prostatic Enlargement Dr. Venkatesh M. Shashidhar Associate Professor of Pathology Fiji School of Medicine Introduction  Anatomy – 5 lobes. Median/Posterior – (BPH/Cancer) Function ? Hormone response – Estrogen like       Enlargement – Inflammation / growth Neoplastic / Non neoplastic growth. BPH / Cancer. Male Urogenital System Male Urogenital System Enlargement of Prostate: BPH – Benign Prostatic Hyperplasia  Inflammations – infections  Neoplasms – Carcinoma.  Introduction  Common non-neoplastic lesion. Involves peri urethral zone. BPH is common as men age. 75% among men aged 70-80years       Over 90% in people aged over 90y Rare before the age of 40y. ? Physiological … BPH-Pathophysiology: Excess hormones – estrogen like.  Nodular hyperplasia of glands & stroma.  From normal 20 to 30 50 to 100 gm.  Press upon the prostatic urethra.  Obstruction - difficulty on urination  Dysuria, retention, dribbling, nocturia  Infections, hydronephrosis, renal failure.  Not a premalignant condition*  BPH - Mechanism  Hormonal imbalance with ageing. Estrogen sensitive peri-urethral glands. Accumulation of dihydrotestosterone in the prostate and its growth-promoting androgenic effect Some Drugs (Finasteride) inhibit dihydrotestosterone and diminishes prostatic enlargement.    BPH-Morphology  Microscopically, nodular prostatic hyperplasia consists of nodules of glands and intervening stroma. (Mostly glands) The glands variably sized, with larger glands have more prominent papillary infoldings. Nodular hyperplasia is NOT a precursor to carcinoma.   BPH-mechanism of obstruction: Median lobe (3rd lobe) Ball valve mechanism BPH-Complications: 1. 2. 3. 4. 5. 6. 7. Urethral compression Ball valve mechanism Bladder hypertrophy Trabeculation Diverticula formation Hydroureter – bilateral Hydronephrosis BPH-Bladder Gross – Identify Cues?  Trabeculations  Hypertrophy of wall  Stone - urolithiasis  Inflammation  Median lobe- ball valve.  Enlarged prostate. BPH-Bladder morphology:    Hypertrophy Trabeculation Median lobe protrusion. Benign Prostatic Hyperplasia: Normal Prostate: Nodular BPH: BPH - Morphology Adenocarcinoma Prostate:  Adenocarcinoma of the prostate is common in elderly men.  It is rare before the age of 50, but seen in over half of men 80 years old.  Many of these carcinomas are small and clinically insignificant.  Is second only to lung carcinoma as a cause for tumor-related deaths among males. Cancer Statistics – 2002 USA Cancer Statistics – 2002 USA Adeno-Ca Prostate Adeno-Carcinoma + BPH BPH with Adenocarcinoma: Adenocarcinoma Prostate: (HP) Diagnosis:  Digital examination – hard, gritty, fixed. Ultrasonography (transrectal) Tumor Marker – PSA Biopsy - TURP      None of these methods can reliably detect small cancers. Occult cancer is more common than clinical ca. Prognosis of Adenocarcinoma:  Grade & Stage  Prognosis. Urinary obstruction, metastasize to lymph nodes and bones. Bladder, kidney damage. Hematuria.     Spread to Lungs or liver – rare. TURP-Bits (Diagnosis + Treat )