PROSTATE

PROSTATE
The most important categories :
1. Infl. Lesions ( prostatitis )
2. Nodular hyperplasia (BPH)
3. Carcinoma

Prostatitis clin. manifestations :

Acute
Chronic

Clinical features
localized
Microscopic exam
Cultur : urine : before -

dysuria
urinary freq.
LBP
poorly

pelvic pain
after

PROSTATE
INFLAMMATIONS
1. Acute and chronic bacterial
2. Chronic abacterial and granulomatous
prostatitis

Prostatitis clin. manifestations :

dysuria
urinary freq.
LBP
poorly localized
pelvic pain

PROSTATE
Acute Prostatitis : bacterial
caused by some organism
E. coli
Other gram - negative
Associated with acute urinary tract
inf. (UTI)
- direct ext. ( urethra bladder )
- vascular channels

PROSTATE
Chronic Prostatitis :
Follow of acute prostatitis
Develop insidiously
Chr.

bacterial prost.
Chr. a bacterial prost.
= prostatodymia : most cases
( = non gonococcal urethritis )
Causa : - chlamidya tr.
- ureaplasma urealyticum

PROSTATE
morphology :
Acute prostatitis

neutrophilic inflam., congestion,

stromal edema, microabcesses
Chronic prostatitis
lymphoid infiltrate
tissue destruction, prolif. fibrobl.
Granulomatous infl.
systemic inflam. (granulomatous)
TBC, sarcoidosis, fungal inf.

Nodular hyperplasia
Normal prostate
Glandular
Stromal surround the urethra
Prostatic parenchyma
(anatomically, biologically)
Peripheral
Central
Transitional
Periurethral zones

Nodular hyperplasia
Important ! :
Most hyperplastic
Transitional
Periurethral zones

Most carcinomas
Peripheral zones

Nodular hyperplasia
= Gland and stro. hyperplasia :
= Extremely common abn. of the prostate
20 % of males by 40 years
Rise progressively with the age
90 % by the eighth decade
prolif : epithel
stromal

Enlargement
(urinary obs.)

BPH : Benign Prostatic Hypertrophy

Nodular hyperplasia
Causa : androgens
estrogens
Before puberty : castrate = BPH (-)
= dihydroxytestosteron ( DHT )
androgen derived : testosteron
Tx = 5 - reductase inhibitors

Morphology :
Most common : periurethral gland
Severe cases : 200 gr
Surface
: multiple, nodul
well circumscribed

Morphology :
Microscopically :
varying proportions of proliferating
Glandular elem
Fibromuscular str.
Stroma is always between
Hiperplastic glands; lined by :
tall, columnar epithelial cells
( crowding, papillary : in some gland )
Often : corpora amylacea

Figure 21-33 Nodular prostatic hyperplasia. A, Well-defined nodules of BPH compress the urethra into a slitlike lumen. B, A microscopic view of a whole mount of the
prostate shows nodules of hyperplastic glands on both sides of the urethra.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM)
2005 Elsevier

Figure 21-31 Benign prostate gland with basal cell and secretory cell layer.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM)
2005 Elsevier

Figure 21-32 Simplified scheme of the pathogenesis of prostatic hyperplasia. The central role of the stromal cells in generating dihydrotestosterone should be noted.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM)

Clinical features :
Manifest only about 10 %
Lower urinary tract obstruction.
Hesitancy : diff. in start
the stream of uria
Intermitten
Complete urinary obstruction
Painful distention of the bladder
hydronephrosis

CARCINOMA OF THE PROSTATE

Most common :
Visceral cancer in male
Ranking as the second : death
male older than 50 years ( = ca of the
lung)
Peak incidence : 65 75 years
Latent cancers : 50 % in men older : 80
Causa : unknown
Exp. Obs :
1. Hormonal
2. Genetic ( familial )
3. Environmental factors

Figure 21-30 Adult prostate. The normal prostate contains several distinct regions, including a central zone (CZ), a peripheral zone (PZ), a transitional zone (TZ), and a
periurethral zone. Most carcinomas arise from the peripheral glands of the organ and may be palpable during digital examination of the rectum. Nodular hyperplasia, in
contrast, arises from more centrally situated glands and is more likely to produce urinary obstruction early on than is carcinoma.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:11 AM)
2005 Elsevier

Ad. 1. Male castrated = (-) : < puberty

Androgen !!
Tx : estrogen
diethyl stilbestrol
Ad. 2. Genetic factors
American blacks > white
Asian, Hispanics
Ad. 3. Environmental factors
industrial
significant geographic diff. :
Scandinavian countries : >>
Japan Asian : <<

Morphology :
70 % : peripheral : rectal digital exam : (+)
Initial stages : urethral obstr. : (-)

Grossly :
cut surface : firm,gray-white to yellow
ill defined margins
metastases : pelvic lymph nodes early

Figure 21-34 Adenocarcinoma of the prostate. Carcinomatous tissue is seen on the posterior aspect (lower left). Note the solid whiter tissue of cancer in contrast to the
spongy appearance of the benign peripheral zone on the contralateral side.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM)
2005 Elsevier

Microscopically :
Most prostatic Ca adeno ca
Glands : infiltrate the adjacent stroma
in irregular, back to back, irregular, ragged,
papillary, cribiform
sheets : in extreme cases.
Cells : cuboidal, nucleoli

Figure 21-36 A, Photomicrograph of a small focus of adenocarcinoma of the prostate demonstrating small glands crowded in between larger benign glands. B, Higher
magnification shows several small malignant glands with enlarged nuclei, prominent nucleoli, and dark cytoplasm, compared to the larger benign gland (top).

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM)
2005 Elsevier

Figure 21-37 Carcinoma of the prostate showing perineural invasion by malignant glands. Compare to a benign gland (left).

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM)
2005 Elsevier

Figure 21-38 A, Low-grade (Gleason score 1 + 1 = 2) prostate cancer consisting of back to back, uniformly sized malignant glands. Glands contain eosinophilic intraluminal
prostatic crystalloids, a feature that is more commonly seen in cancer than in benign glands and more frequently seen in lower grade than in higher grade prostate cancer.
B, Needle biopsy of the prostate with variably sized, more widely dispersed glands of moderately differentiated (Gleason score 3 + 3 = 6) adenocarcinoma. C, Poorly
differentiated Gleason score (5 + 5 =10) adenocarcinoma composed of sheets of malignant cells.
Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM)
2005 Elsevier

Figure 21-38 A, Low-grade (Gleason score 1 + 1 = 2) prostate cancer consisting of back to back, uniformly sized malignant glands. Glands contain eosinophilic
intraluminal prostatic crystalloids, a feature that is more commonly seen in cancer than in benign glands and more frequently seen in lower grade than in higher grade
prostate cancer. B, Needle biopsy of the prostate with variably sized, more widely dispersed glands of moderately differentiated (Gleason score 3 + 3 = 6)
adenocarcinoma. C, Poorly differentiated Gleason score (5 + 5 =10) adenocarcinoma composed of sheets of malignant cells.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM)
2005 Elsevier

Figure 21-35 Metastatic osteoblastic prostatic carcinoma within vertebral bodies.

Downloaded from: Robbins & Cotran Pathologic Basis of Disease (on 27 April 2006 11:19 AM)
2005 Elsevier

Morphology :
Histologic grading :
Gland diff.
Architecture of the neopl. gland
Nuclear anaplasia
Mitotic activity - stage
- prognosis

Clinical features :
Early stages : silent
60 % : > 80 years : autopsy studies
More extensive prostatism ~ BPH

 Metastases : bone :
- osteolytic (bone destruction)
- osteoblastic (bone-producing)
virtually dx.
Screening test :
PSA : Prostate Specific Antigen : > 4mg/ml

(+) - digital rectal exam

- transrectal sonography
- needle biopsy
Staging : clin.,surg.,radiograph.,tu. marker
Therapy : surgery, radiation therapy, hormonal
~staging, grading

Staging ( tnm )
T ( Tumor primer )
T1 : Lesi tidak teraba
T2 : Ca teraba, terbatas pd prostat
T3 : Perluasan keluar prostat, lokal
T4 : Invasi ke organ lain

 N ( KGB )
N0 : Metastase KGB regional
N1 : Metastase 1 KGB diameter < 2 cm
N2 :
> 2-5 cm
atau banyak KGB diameter < 5 cm
N3 : KGB diameter > 5 cm

 M ( metastase jauh )
M0 : Metastase
M1 : Metastase +