Completed the unit in 2020 Sem 2.
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Renal Pathology
Prostate: multi-lobed male organ, found below
the bladder and in front of the bowel. The organ
depends on the influence of androgens, and
androgen ablation therapy (castration) can lead
to lobal atrophy.
• Produces fluid that nourishes and
protects sperm
• 4 areas: posterior (peripheral), lateral
and midzone (transitional zone) and
anterior. Posterior and transitional zones
are associated with most pathologies.
• Contains tubular glands – formed by
epithelial cells
• Surrounded by muscular stroma
• Wraps itself around the urethra – prostatic urethra. This means that the flow rate is
affected in male prostatic disorders
• Surrounded by nerves that control penile erection– erectile dysfunction can occur in
prostate pathologies
• Changes to the size of prostate occur as men age – inevitably develops disease
Primary prostate disorders
Prostatitis (benign)
• Inflammation and swelling of the prostate – can be caused by bacterial infections,
which are common in older men
• Acute urinary obstruction can occur due to prostatic
enlargement
• Can resolve itself or can be difficult to treat
• Personal hygiene is the key issue – enlarged prostate can
cause autoinfection
• Uncontrolled prostatitis can contribute to BPH
• High PSA levels but these lower once it has resolved
(BPH) (benign)
• Mainly affects the transitional zones – changes the lumen size of the prostatic
urethra (similar to prostatitis)
• Very common in older men and can have a genetic component
• Enlargement of the prostate is usual in most men > 50 years
• Treatment: antibiotics, muscle relaxants (flowmaxtra – increases urine flow by
relaxing muscle around the urethra) or alpha inhibitors
• Antibiotics treat the underlying cause of the infection
,CPAT3202
HD Level Notes
• Muscle relaxants release pressure around the prostatic urethra and release pressure
,CPAT3202
HD Level Notes
• Alpha inhibitors are associated with reducing testosterone – testosterone drives
enlargement and inhibiting this can cause shrinkage of the prostate
• More developed cases may require surgery to enlarge the urethral passage – trans
urethral resection of the prostate (TURP)
Prostatodynia
• Chronic prostatic disease – chronic pain
• Could be a manifestation of BPH because the prostate is enlarged
• No clear signs of infection or inflammation usually
• Pain + discomfort in the pelvic region
• Treatments: antibiotics, NSAIDs, muscle relaxants and pain management for chronic
pain
Prostate cancer (malignant)
• Since it develops in rear lobe, it needs to enlarge and protrude into the transitional
zone to cause symptoms
• Correlations with increasing plasma prostate specific antigen (PSA) may be useful in
diagnosis
• PSA is not specific to prostate cancer - better to monitor PSA levels over a few
months and obtain a trend
• Digital rectal examination indicates changes in shape and structure
Symptoms: (can be similar across the 4 disorders)
• Nocturia (urinating at night) • Discomfort when urinating +
• Sudden urgent need to urinate blockage of flow
• Difficulty in starting to urinate • Blood in the urine (haematuria) or
• Painful ejaculation blood in the semen
• Decrease in libido • Reduced ability to get an erection
• Slow flow of urine and difficulty in • Staccato flow – disjointed flow can
stopping cause hygiene issues
Normal prostate
, CPAT3202
HD Level Notes
1. Glandular epithelial cells distributed in a columnar manner:
- Line the glands
- Mature up a column – bottom (myoepithelial, cuboidal) = non-secretory and top =
secretory (epithelial cells)
- Secretion requires a lot of energy, so cell turnover is necessary. Finite lifetime
2. Surrounding muscular stroma – contractile
- Arranged in a striated manner and muscle runs in parallel fibres for maximum force
3. Glandular secretions that supplement seminal fluid and sperm viability
- Proteinaceous material
Benign prostatic hyperplasia (BPH)
• Nodular hyperplasia – proliferative
• Large nodules made of proliferative stromal cells or hyperplastic glands grow toward
the urethra and compress the lumen
• Stromal proliferation enlarges the prostate, and this can result in a thickening of the
muscular wall of the bladder as the bladder needs to contract more to expel urine
because the urethra is blocked by the prostate
• Ruggae become enlarged and become trabeculated
• Fibrous tissue produced
• Bacteria can become colonised in the valleys and folds – purulent bladder can infect
the kidneys
• Variable histopathological patterns – gland vs fibromuscular proliferation
• Most of the changes occur in the transitional zones
• Occult = stage development
•
• Classic features
- Proliferation of the epithelium
- Cysts occur because the epithelium becomes activated towards the lumen – fusion of
the papillae cause cysts to form due to oedema
- Increases in wet weight
- Proliferation of muscle – disorganised muscle rather than normal striated muscle
Prostate cancer
• Second most common cancer in men – lung cancer is the highest
• Well-differentiated adenocarcinoma – cancers that originate from glandular cells and
are highly treatable in the early stages
• Commonly arises in the posterior lobe – importance of digital rectal exams
• If cancer is present, the prostate is usually rock-hard, but it can be soft if there is
considerable inflammation
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