PROSTATE BY,

SHARMEEN SHAKOOR

The prostate is a walnut-sized gland located between the bladder and the penis.

The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secretes fluid that nourishes

and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen

Anatomy

Lateral view

The prostate gland is divided into : Peripheral zone. Central zone. Transition zone

zones

Glandular cells Smooth muscle cells Stromal cells The prostate gland also contains an

enzyme5 alpha-reductase type-2 that convertstestosterone to Dihydrotestosterone (morepotent)

Normal physiology

Enlarged prostate i.e Benign prostatic hyperplasia

Prostate cancer Prostatitis

Conditions

Benign prostatic hyperplasia (BPH) is the enlargement of the gland .

As the prostate starts to enlarge it exerts pressure on the walls of the urethra.

Benign prostatic hyperplasia

The exact etiology of BPH is still poorly Understood.

In BPH there is decrease in testosterone level with advancing age but estrogen level does not decrease equally.

Inc in estrogen level causes hypertrophy of prostate.

DIHYDROTESTOSTRONE is main mediator of BPH.

Etiology

Symptoms related to urine storage in the bladder are the following:

Frequent micturition. Nocturia (nocturnal urination). Urinary urgency. Urge incontinence

Symptoms

Symptoms related to urine voiding from the bladder are the following:

Reduction in urine flow and force. Intermittent micturition. Leak of urine drops after the end of

micturition Feeling of incomplete bladder voiding. Urine retention. Dribbling.

history Physical examination :• digital rectum test• palpate PrUrinalysis Uroflowmetry Cystoscopy Ultrasound prostate Specific Antigen (PSA) Test

diagnosis

How often have you had a sensation of not emptying your bladder completely after you finished urinating?

How often have you had to urinate again less than two hours after you finished urinating?

How often have you stopped and started again several times when you urinated?

How often have you found it difficult to urinate? How often have you had a weak urinary stream? How often had you had to push or strain to begin urination? How many times did you most typically get up to urinate

from the time you went to bed at night until the time you got up in the morning?

BPH symptom score

International prostate symptom score

Prostatitis Bladder obstruction Bladder cancer Neurogenic bladder

Differential diagnosis

Watching waiting Home plan Medications : surgery

Treatment

Prostate cancer

the prostate cancer starts in the gland cells - this is called adenocarcinoma. 

prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells.

Prostatic intraepithelial neoplasia (PIN). Prostatic intraepithelial neoplasia means

"dysplastic changes involving glands and ducts of the prostate that may be a precursor of adenocarcinoma

Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers

If the tumor is within the gland, the cancer is said to be localized and curable

If the cancer escapes the gland it is considered incurable

Early detection before the cancer escapes the gland becomes very important

- Age- Genetics- Faulty BRCA2 gene linked to aggressive.- Diet- Medication- Obesity- STDs- Agent orange- Enzyme PRSS3 linked to aggressive

Etiology

Stage I Stage II Stage III Stage IV

STAGES

During the early stages: The patient urinates more often The patient gets up at night more often to urinate He may find it hard to start urinating He may find it hard to keep urinating once he has

started There may be blood in the urine Urination might be painful Ejaculation may be painful (less common) Achieving or maintaining an erection may be

difficult (less common)

Symptoms

Bone pain, often in the spine (vertebrae), pelvis, or ribs

The proximal part of the femur can be painful

Leg weakness (if cancer has spread to the spine and compressed the spinal cord)

Urinary incontinence (if cancer has spread to the spine and compressed the spinal cord)

Fecal incontinence (if cancer has spread to the spine and compressed the spinal cord)

Symptoms of Advanced cancer :

Metastasis Incontinence Erectile dysfunction Metabolic factors  

Complications

A 60-year-old black man presents to his general practitioner with complaints of difficulty with urination. He describes a weak stream and a sense of incomplete voiding. He describes nocturia (5 episodes per night) and has been taking an alpha-blocker for this with minimal improvement. He says he can last about 60 to 90 minutes without urinating. He denies any suprapubic tenderness, dysuria, or haematuria. He further denies any back pain or gastrointestinal complaints.

case

PSA test blood test Prostate biopsy Transrectal ultrasound Bone scan CT MRI ProstaScintTM scan

diagnosis

Gleason score

Prostatitis BPH

Differential diagnosis

Medication Watchful waiting Prostatectomy Radiation placed inside your body (brachytherapy) Radiation that comes from outside of your body

(external beam radiation) Hormonotherapy Chemotherapy Freezing prostate tissue Heating prostate tissue using Ultrasound cryotherapy

Treatment

Prostatitis

Prostatitis is inflammation caused by an infection of the prostate.

Treated with antibiotics