Benign Prostatic Hyperplasia

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The only gracious way to accept an insult is to
ignore it. If you cant ignore it, top it. If
you cant top it, laugh at it. If you cant laugh
at it, its probably deserved...! Joseph
Russell Lynes
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Pathology of Prostatic Enlargement

• Dr. Venkatesh M. Shashidhar
• Associate Professor of Pathology
• Fiji School of Medicine

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Introduction

• Anatomy 5 lobes.
• Median/Posterior (BPH/Cancer)
• Function ?
• Hormone response Estrogen like
• Enlargement Inflammation / growth
• Neoplastic / Non neoplastic growth.
• BPH / Cancer.

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Male Urogenital System
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Male Urogenital System
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Enlargement of Prostate

• BPH Benign Prostatic Hyperplasia
• Inflammations infections
• Neoplasms Carcinoma.

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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 ?

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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

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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.

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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.

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BPH-mechanism of obstruction
Median lobe (3rd lobe) Ball valve mechanism
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BPH-Complications

• Urethral compression
• Ball valve mechanism
• Bladder hypertrophy
• Trabeculation
• Diverticula formation
• Hydroureter bilateral
• Hydronephrosis

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BPH-Bladder Gross Identify Cues?

• Trabeculations
• Hypertrophy of wall
• Stone - urolithiasis
• Inflammation
• Median lobe- ball valve.
• Enlarged prostate.

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BPH-Bladder morphology

• Hypertrophy
• Trabeculation
• Median lobe protrusion.

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Benign Prostatic Hyperplasia
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Normal Prostate
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Nodular BPH
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BPH - Morphology
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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.

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Cancer Statistics 2002 USA
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Cancer Statistics 2002 USA
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Adeno-Ca Prostate
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Adeno-Carcinoma BPH
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BPH with Adenocarcinoma
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Adenocarcinoma Prostate (HP)
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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.

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Prognosis of Adenocarcinoma

• Grade Stage ? Prognosis.
• Urinary obstruction, metastasize to lymph nodes
  and bones.
• Bladder, kidney damage.
• Hematuria.
• Spread to Lungs or liver rare.

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TURP-Bits (Diagnosis Treat )