Diseases of the prostate

1
Diseases of the prostate
Prostatitis Hyperplasia Tumors
2
Infalammmations of the prostate

• Ascending or lymphohaematogeneous infection
• Acute bacterial
• E. Coli
• Gr. rods
• Enterococcus
• Staphylococcus
• Chronic bacterial
• agents same as above.
• Associated with recurrent urinary tract
  infections
• Chronic abacterial
• cultures are negative (Chlamydia?)
• Chronic granulomatous
• After BCG therapy
• In case of real TBC infection
• Immundeficiency fungal infection
• Post-inflammatory cases, jatrogenous prostatic
  secretory products in EC space

3
Prostatic hyperplasia

• Symptoms
• Nycturia
• Frequency
• Difficulties in starting and stopping the stream
• overflow dribbling
• Dysuria
• Sequales
• Infections
• Thickening of the wall
• Diverticulum formation
• Th. a reductase blockers
• TUR
• HIFU
• Laser
• Hyperthermia
• Radiofrequency ablation

4
Prostatic carcinoma

• Incidency
• 3-4 /100000 Japan
• 1 /100000 Hong Kong
• 50-60/100000 USA Blacks!
• Environmental factors?
• Genetic state ? AR length(short CAG, higher
  incidence)
• Sussectibility gene 1q24-25
• 8p, 10q, 13q,16q
• p53 mutation only in metastatic disease
• E-cadherin, CD44 loss
• her2 neu plays no role in prostatic cc.
• alfamethyl-acylCOA racemase î, EZH2
  transcription factor î
• gluthatione S-transferase (GSTP1)
  hypermetilatio, - loss of function (11q13)
• Family
• Preventive agents
• Lycopenes (tomato)
• A vitamine
• E vitamine
• Soy products

5
Prostatic carcinoma

• Diagnostics
• PSA ( 4 ng/ml)
• Free/ total norm gt 0.15
• Density PSA / Prostatic volume
• 2.5 ng/ml 40-49 y
• 3.5 ng/ml 50-59 y
• 4.5 ng/ml 60-69 y
• 6.5 ng/ml 70-79 y
• Velocity rise/ y 0.75 ng /ml / y

6
Prostatic carcinoma

• Thick needle biopsy
• US
• TUR
• Staging CT, MR

7
PIN

• Cytologically identical to
• carcinoma,
• BUT
• BM preserved
• Frequently CC in the neighbourhood

8
Prostatic carcinoma

• Latent(autopsy), Occult, (met) Incidental ( by
  hpl)

9
Prostata cc - spread

• Local vesicula seminalis, rectum, bladder
• Haematogenous bones (Batson veins) lumbal
  vertebra, femur, pelvis, thoracal vertebra, ribs,
  calvarium, lung, brain
• Lymphogenous obturator, perivesical,
  hypogastric, iliacal, presacral, paraaortic lymph
  nodes

10
Therapeutic possibilities

• Surgical
• Hormonal
• Radioth