Disorders of the Prostate

Dr.M.Galuh Richata, SpU

Prostate Gland
A fibromuscular (30-50%) and glandular (50-70%) organ Weighs about 20 g; 2,5 cm in length Prostatic secretions: 1/3 of semen, discharged at ejaculation

Prostate Gland

BPH
Prostate Lobes (Lowsley): Anterior, Posterior, Median, Right Lateral, Left Lateral. Zonal Anatomy (3 Zones; McNeal, 1968) - Peripheral zone (70% of the volume) - Central zone (25%) - Transition zone (5%) McNeal, 1972 5 zones: - Anterior segment (fibromuscular area) - Preprostatic sphincteric zone

Prostate Gland

Prostate Gland

Disorders of the Prostate

Prostatitis most found in peripheral zone Benign Prostate Hyperplasia (BPH) develop in transition zone

Prostate Cancer mostly originates in peripheral zone (70%), 10-20% from transition zone, 5-10% central zone.

Prostatitis
Most common urologic diagnosis in men under 50 years of age. Probably results from ascending urethral infection intraprostatic reflux of urine? prostate anatomy? Microorganism: Aerobic Gram-negative (80% E coli, 10-15% Pseudomonas, Serratia, Klebsiella, Proteus)

Prostatitis
Signs & Symptoms - Rectal, low back, perineal pain - Fever and chills - Urinary urgency, frequency, dysuria - Acute urinary retention prostatic sweeling - Malaise, arthralgia, myalgia - Sometimes hematuria, cloudy urine

Prostatitis
Physical Exams DRE: prostate is tender, could be enlarged (irregularly firm & warm) Lab Blood: Leucocytosis Urine: pyuria, microscopic hematuria , bacteria Urine culture identify the organism

Prostatitis
DRE:

Prostatitis
Management - Antibiotics (guided by resistance test) - Antipyretics - Analgesics - Stool softeners - Hydration - Bed rest

Benign Prostate Hyperplasia (BPH)

Most common benign tumor in men Incidence is age-related Risk factor & Etiology: ??? (multi factorial, endocrine controlled) Its main concern is Bladder Outlet Obstruction (BOO)

BPH

BPH

BPH
BPH BOO complications: - Urinary retention - Urinary tract infection - Bladder stone - Hematuria - Bladder diverticulae - Renal impairment

BPH
Sign & Symptoms BOO LUTS (Lower Urinary Tract Symptoms) Obstructive Symptoms: Weak Stream, Straining, Hesitancy, Intermittency, Incomplete Emptying, Terminal Dribbling Irritative Symptoms: Frequency, Nocturia, Dysuria, Urgency IPSS International Prostate Symptoms Score

BPH
General condition: state of pain, body temperature, signs of renal impairment Suprapubic region: bladder: palpable? tenderness? DRE: Prostate: - Size: 20-40-60 g? - Consistency: Firm/Hard? - Symmetric/Asymmetric? - Surface: Smooth/Nodules? - Tender/nontender?

BPH
DRE:

BPH
Lab - General : blood, urine - PSA (Prostate Specific Antigen) Imaging - Ultrasound (transabdominal, transrectal) - IVU

BPH
Management For General Practitioners: - No complication oral therapy LUTS : Alpha Blockers, 5-Alpha Reductase Inhibitors. - Complications refer to Urologist Urinary Retention catheterization then refer to urologist

BPH
Catheterization

Cystostomy/ Bladder Puncture

BPH
Management Operative/Surgery - Open Prostatectomy - Cystoscopy & Trans Urethral Resection of Prostate (TURP)

BPH
Trans Urethral Resection of Prostate (TURP)

BPH
TURP

Prostate Cancer
Carcinoma of the Prostate (CaP) Most common cancer diagnosed 2nd leading cause of cancer death in American men Prevalence increase rapidly with age Risk Factor: still debatable 70% from the peripheral zone

Prostate Cancer

Prostate Cancer
Pattern of Progression - Local Extension - Metastases (lymphogenous or haematogenous) :
- Lymph Node (obturator, common illiac) - Bone - Visceral (lung, liver, adrenal)

Prostate Cancer

Prostate Cancer
General Practitioners Screening! Signs & Symptoms - asymptomatic - similar to BPH (LUTS, urinary retention, hematuria, etc) - hematospermia (local extension) - bone pain (metastases)

Prostate Cancer
DRE : - Volume : can be small/large - Consistency: hard, stony (induration) - Surface: uneven, nodule - Asymmetric

Lab: PSA : > 4 ng/mL

Prostate Cancer
Any male with LUTS screening with DRE found anything suspicious refer to urologist