Benign Prostatic Hyperplasia

1
Benign Prostatic Hyperplasia

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

2
Introduction

• Common non-neoplastic lesion.
• Involves peri urethral zone.
• BPH is common as men age.
• 25 by 50y, but 90 By 80y..!
• About 10 are symptomatic.

3
Male Urogenital System
4
Male Urogenital System
5
BPH-Pathophysiology

• Nodular hyperplasia of glands and 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

6
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.

7
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.

8
Benign Prostatic Hyperplasia
9
Normal Prostate
10
Nodular BPH
11
BPH - Morphology
12
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.

13
Cancer Statistics 2002 USA
14
Cancer Statistics 2002 USA
15
BPH with Adenocarcinoma
16
Adeno-Ca Prostate
17
Adeno-Carcinoma BPH
18
WD - Adenocarcinoma Prostate
19
Adenocarcinoma Prostate (HP)
20
Adenocarcinoma Infiltration
21
Laboratory Diagnosis

• Prostate cancers may be detected by digital
  examination.
• Ultrasonography (transrectal ultrasound),
• Screening with a blood test for prostate specific
  antigen (PSA).
• Biopsy study. (TURP)
• None of these methods can reliably detect small
  cancers.

22
Prognosis of Adenocarcinoma

• The grade and the stage of tumour correlate with
  the prognosis.
• Advanced prostatic adenocarcinomas typically
  cause urinary obstruction, metastasize to
  regional (pelvic) lymph nodes and to the bones.
• Metastases to the lungs and liver are seen in a
  minority of cases.

23
TURP-Bits (Diagnosis Treat )