Prostate Pathophysiolgy

• In the peripheral zone. 
• then the central and finally the transitional has the least 5%.

The transitional zone

Its function is to produce and expel secretions and because of this they have glands and fibromuscular tissue.

Peripheral zone of the prostate

• Dectection is only for about 1.5-7%
• detects at the most advanced stages
• there is a lot of inter examiner variability (what may seem normal for one may not be normal for another person)
• leads to increased biopsies and risk of infection and bleeding
• can't distinguish between a clinically indolent and aggressive carcinoma

Well we can use a transrecal US and biopsy. The device is placed against the anterior wall of the rectum which allows for assessment of the peripheral zone of the prostate and we can do a core biopsy at the same time

• 90%
• It can extend the life of the patient if the cancer is found when he is asymptomatic vs symptomatic.
• and there has been a decrease in the mortality.

• PSA is a serine protease that is normally produced by the prostatic glandular epithelium and functions in th liquefaction of the seminal cogulum.
• PSA from 4-10 does not distinguish between benign land non-neoplastic but it does tell us that there is an increased risk of cancer 20-25%..
• If the PSA value is greater than 10 then there is a greater than 50% chance that there is prostate cancer and this value increases as the PSA value rises

So because the PSA is from 4-10 then we know that there is an increased risk for cancer but its not above 10 which means that the risk for cancer is about 20-25% vs 50%. So differential is: prostate cancer, glandular hyperplasia, prostatitis, trauma and DRE (digital rectal exam).

transition zone around the urethra

To dx BPH it is not great for cancer dx because only 2.5% of cancers arise in the transition zone

Not really... It is a pretty bad exam that is why we also need PSA.

BAD! You need to inform the patient.. This is one of those exams that you need to have patients consent

You can't with only a PSA. You should probably get a Rectal US and biopsy.

• At the beginning it is almost the same: freq, urgency, hesitancy, incomplete emptying, straining, decease force, dribbling, nocturia..
• The only main difference at the beginning is that there shouldn't be hematuria with BPH but there can be with prostate cancer.
• later in the progression of the disease it is easier to tell
• Late onset BPH: bladder diverticula, hydronephrosis, peylonephritis
• Late onset prostatic cancer: metazoic disease, bone pain- low back, weight loss

2 cell layers

fibromuscular stroma of the prostate

• So we have the basement membrane
• basal cells: reserve cells
• columnar secretory epithelial cells and neurorendocrine are like around there also

• If we can see 2 cell layers then it is BPH if it only has 1 layer then it is prostate cancer.
• Cancer will also have a prominent nucleolus in the nuclei

No in BPH the prostate is not enlarged but it does weigh more that a normal prostate and therefore the urethra is almost closed off. It can weigh as much as double that of the normal

• Glandular Hyperplasia and fibromuscualr hyperplasia
• Glandular hyperplasia: cystic dilatations separated by fibrous aroma and lines by epithelium and basal cells
• Fibromuscualr: increased muscle tone and compression of the urethra due to compression of the s.m. around it.

Stromal and glandualr hyperplasia but his has 2 cell layers

Testosterone.. Yup.. So Androgens have the biggest effect on prostate growth. Stromal cells convert testosterone into DHT which binds to nuclear testosterone receptors and has autocrine and paracrine action that leads to cell proliferation. So we need this in the puberty years to make the prostate bigger but it does become more problematic when men get older.

BPH is not a premalignant lesion so the same as the rest of the population

because it is a progressive disease that can lead to UTI, bladder damage and kidney damage we need to keep an eye on it to see when we need to start with an actual treatment.

• alpha-adrenergic blockers such as: 5alpha reducatase, finasteride, and dutasteride block the conversion of testosterone to DHT.
• laser PVP and turp where there is a reduction of the prostate tissue

• way to see the grade of the prostate cancer..
• Grade 1: well diff- 2-6 gleason score
• Grade 2: mod diff - 7
• Grade 3: poorly diff- 8-10
• we do average scores to get the grade

• watchful- only TNM 1
• surgery
• radiation
• hormonal meds
• chemo
• immunotherapy

• orchiectormy: bye bye testicles
• estrogen: yup estrogen
• GnRH analogs (leuprolide): supresses LH-RH synthesis
• Antiandrogens (flutamide): inhibits androgen uptake and nuclear binding
• adrenal androgen sythesis blockade: ketoconazole

There could be a hereditary form of cancer

• age
• being AA
• living is the US

HPC1 gene linked to the RNASEL gene

• Early: asymptomatic or associated with hematuria or dysuria
• Late: bone pain

relax the fibromuscular tissue to decrease tone of the stromal smooth muscle.

• importence
• shortening of penis
• inconticence (urine or stool)
• hernia (ingunal)

• impotence
• incontincene, 
• increased risk for bladder and rectal cancers

• hot flashes
• impaired sexual fxn
• osteoporosis
• diahrea
• prirutus (itching)
•