Benign Prostatic Hyperplasia

Dr. Venkatesh M. Shashidhar

Senior Lecturer in Pathology Fiji School of Medicine

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.

Male Urogenital System

Male Urogenital System

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*

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.

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

BPH with Adenocarcinoma:

Adeno-Ca Prostate

Adeno-Carcinoma + BPH

WD - Adenocarcinoma Prostate:

Adenocarcinoma Prostate: (HP)

Adenocarcinoma Infiltration:

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.

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.

TURP-Bits (Diagnosis + Treat )