Prostate Pathology Study Guide

Prostate

The prostate is a small, round gland in men that helps in the production of ejaculate.

The prostate is located at the base of the bladder and surrounds the urethra.

Since the prostate is anterior to the rectum, the posterior aspect of the prostate can be palpated using a digital rectal exam (DRE).

The prostate consists of glands and stroma.

An inner layer of luminal cells and an outer layer of basal cells make up a prostate gland.

The prostate secretes an alkaline, milky fluid that combines with sperm and seminal vesicle fluid.

Prostate pathology includes:

Acute prostatitis
Chronic prostatitis
Benign prostatic hyperplasia (BPH)
Prostate adenocarcinoma

Prostate. Zones of prostate Mikael Häggström, M.D. Not altered. CC0
Prostate. A digital rectal examination may be performed to investigate how large a prostate is Unknown author - This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 7136 (image) (next).. Not altered. Public Domain
Prostate. Micrograph showing normal prostate cancer in the right upper aspect of image. HPS stain. Prostate biopsy. Nephron - Not altered. CC BY-SA 3.0
Prostate. Microscopic glands of the prostate Original: NIH, Explanation: en:User:InvictaHOG - Not altered. Public Domain
Prostate. Micrograph showing an inflamed prostate gland, found in prostatitis. A large amount of darker cells, representing leukocytes, can be seen. An area without inflammation is seen on the left of the image. H&E stain. Nephron - Not altered. CC BY-SA 3.0

Acute Prostatitis

Acute prostatitis is a sudden prostate gland inflammation that is typically brought on by bacteria.

Common causes of acute prostatitis include:

Neisseria gonorrhoeae
Chlamydia trachomatis
Pseudomonas
Escherichia coli

Symptoms of acute prostatitis include:

Dysuria
Chills
Fever

On the digital rectal examination (DRE), the prostate is soft and squishy.

White blood cells (WBCs) are seen in the prostate secretions, and the causing bacteria can be identified through culture.

Acute Prostatitis. Abscess of the prostate (red arrow) resulting in urinary retention (blue arrow) James Heilman, MD - Own work Not altered. CC BY-SA 4.0
Acute Prostatitis. Abscess of the prostate (red arrow) resulting in urinary retention (blue arrow) James Heilman, MD - Not altered. CC BY-SA 4.0
Acute Prostatitis. Micrograph showing a neutrophilic infiltration of prostatic glands - the histologic correlate of acute prostatitis. H&E stain. Nephron. Not altered. CC BY-SA 3.0
Abscess drainage with transurethral resection of the prostate. Acute bacterial prostatitis and abscess formation. Lee DS, Choe HS, Kim HY, Kim SW, Bae SR, Yoon BI, Lee SJ - BMC urology (2016). Not Altered. CC.

Chronic Prostatitis

Chronic prostatitis is inflammation of the prostate that lasts for three months or more.

Symptoms of chronic prostatitis include:

Dysuria
Pelvic pain
Low back pain

White blood cells are seen in the prostatic secretions, but cultures are usually negative.

Low power view of IgG4-related prostatitis. The prostatic stroma shows a dense inflammatory infiltrate and fibrosis (H&E, 100x). IgG4-Related Autoimmune Prostatitis: Is It an Unusual or Underdiagnosed Manifestation of IgG4-Related Disease? Bourlon MT, Sánchez-Ávila M, Chablé-Montero F, Arceo-Olaiz R - Case reports in urology (2013). Not Altered. CC.
Evidence of chronic bacterial prostatitis in general hospital (n=12). The microbial pathogen distributions in a general hospital in Korea. The most common pathogen was Escherichia coli (41%), followed by Enterococcus faecalis (20%), Stwaphylococcus epidermidis (13%), and Staphylococcus hemolyticus (13%).Microbiological etiology of bacterial prostatitis in general hospital and primary care clinic in Korea. Choi YS, Kim KS, Choi SW, Kim S, Bae WJ, Cho HJ, Hong SH, Kim SW, Hwang TK, Lee JY - Prostate international (2013). Not Altered. CC.

Benign Prostatic Hyperplasia (BPH)

As men age, a condition known as benign prostatic hyperplasia, or enlargement of the prostate gland, becomes more prevalent.

Symptoms of benign prostatic hyperplasia (BPH) include:

Hydronephrosis
Poor bladder emptying
Increased bladder infections
Problems initiating urination
Problems stopping urination

Dihydrotestosterone (DHT), a hormone that promotes the development of masculine traits (an androgen), is associated with benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) may be treated with a 5-alpha-reductase inhibitor.

5-alpha-reductase inhibitors stop the conversion of testosterone into dihydrotestosterone (DHT).

Dihydrotestosterone (DHT) causes hyperplastic nodules to form in the prostate by interacting with the androgen receptor on stromal and epithelial cells.

Benign prostatic hyperplasia (BPH) may result in smooth muscle hypertrophy of the bladder wall that increases the risk of bladder diverticula.

Due to the increased number of glands, prostate specific antigen (PSA) is frequently only slightly elevated, typically less than 10 ng/mL.

The use of alpha-1-antagonists, such as terazosin, in the treatment lowers blood pressure by relaxing vascular smooth muscle in addition to smooth muscle in the body.

5-alpha-reductase inhibitor blocks conversion of testosterone to dihydrotestosterone (DHT) and takes months to produce results.

Side effects of medical treatment of benign prostatic hyperplasia (BPH) include:

Gynecomastia
Sexual dysfunction

Benign Prostatic Hyperplasia. Benign Prostatic Hyperplasia (BPH). See a full animation of this medical topic. BruceBlaus - Not altered. CC BY-SA 4.0
Benign Prostatic Hyperplasia. Two-panel drawing shows normal male reproductive and urinary anatomy and benign prostatic hyperplasia (BPH). Panel on the left shows the normal prostate and flow of urine from the bladder through the urethra. Panel on the right shows an enlarged prostate pressing on the bladder and urethra, blocking the flow of urine. Unknown author - National Cancer Institute, AV Number: CDR462221. Not altered. Public Domain
Benign Prostatic Hyperplasia. Benign Prostatic Hyperplasia. Microscopic examination of different types of prostate tissues (stained with immunohistochemical techniques): A. Normal (non-neoplastic) prostatic tissue (NNT). B. Benign prostatic hyperplasia. C. High-grade prostatic intraepithelial neoplasia. D. Prostatic adenocarcinoma (PCA). Ming Yin, Rajiv Dhir and Anil V Parwani - Not altered. CC BY 2.0
Benign Prostatic Hyperplasia. Micrograph showing nodular hyperplasia (left off center) of the prostate from a transurethral resection of the prostate (TURP). H&E stain. Nephron -Not altered CC BY-SA 3.0
Benign Prostatic Hyperplasia (BPH). Benign prostate hyperplasia Benign prostate hyperplasia H&E stained microscopy at low power. S.M. Samee. Not altered. CC BY-SA 4.0
Pathological findings of the specimen obtained from radical prostatectomy ((a) ×4, (b) ×40, and (c) ×400). The pathological finding was that epithelial cell proliferations without nuclear enlargement were frequently seen in the tumor of the prostate. It was just like benign epithelial hyperplasia and there was no evidence suggesting malignant tumor. Immunohistochemical pathology revealed that basal membranes were preserved by p63 staining and few cells were stained by p504S (d), suggesting that the tumor was not malignant.Prostatic Stromal Tumor of Uncertain Malignant Potential Which Was Difficult to Diagnose. Matsuyama S, Nohara T, Kawaguchi S, Seto C, Nakanishi Y, Uchiyama A, Ishizawa S - Case reports in urology (2015). Not Altered. CC.
photomicrograph of benign prostatic hyperplasia specimen (H&E, ×200). Inset shows negative cyclin D1 expression and 4 to 5 AgNOR dots per nucleus.Role of cyclin D1 immunoreactivity and AgNOR staining in the evaluation of benign and malignant lesions of the prostate. Gupta V, Garg M, Chaudhry M, Singh S, Sen R, Gill M, Sangwaiya A - Prostate international (2014). Not Altered. CC.

Prostate Adenocarcinoma

Prostate adenocarcinoma is a type of cancer that starts in the gland cells of the prostate and affects only men.

Prostatic adenocarcinoma is the most common type of cancer in men and the second leading cause of cancer death.

Prostatic adenocarcinoma is typically asymptomatic.

Prostate specific antigen (PSA) and a digital rectal exam (DRE) are the first screening tools used when someone turns 50.

When normal serum prostate specific antigen (PSA) is 5.0 ng/mL for people aged 40 to 49, it is related to benign prostatic hyperplasia (BPH), whereas it is 5 ng/mL for people aged 70 to 79.

At any age, patients with prostate specific antigen (PSA) levels greater than 10 ng/dL are quite concerning.

Reduced free prostate specific antigen (PSA), which results in bound PSA, is symptomatic of malignancy.

A prostate biopsy is necessary to confirm the existence of prostatic adenocarcinoma.

Histology of prostatic adenocarcinoma shows the appearance of tiny, invasive glands with noticeable nucleoli.

The Gleason grading method is used to describe prostatic adenocarcinoma.

Because tumor architecture differs from area to area, it is necessary to evaluate several tumor regions.

Two distinct regions each receive a score between 1 and 5, which are added together to yield an overall score between 2 and 10.

The higher the score, the worse the prognosis is.

Prostatic adenocarcinoma may metastasize.

It frequently spreads to the pelvis bones or lumbar spine.

Low back discomfort and elevated levels of serum alkaline phosphatase, prostate specific antigen (PSA), and prostatic acid phosphatase (PAP) are the symptoms of osteoblastic metastases.

Localized disease is treated by prostate resection.

Hormone suppression is used to treat advanced disease and lower dihydrotestosterone (DHT) and testosterone levels.

Leuprolide, a continuous gonadotropin releasing hormone (GnRH) analog, causes the hypothalamus to shut down as luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels fall.

The androgen receptor is competitively inhibited by flutamide.

Prostate Adenocarcinoma. If already having grown large, a prostate cancer may first be detected on CT scan. Mads Ryø Jochumsen, Bjørn Agerbo Sahlholdt and Jørgen Bjerggaard Jensen. Not altered. CC BY 4.0
Prostate Adenocarcinoma. Sclerosis of the bones of the pelvis due to prostate cancer metastases James Heilman, MD - Not altered. CC BY-SA 4.0
Prostate Adenocarcinoma. A diagram of prostate cancer pressing on the urethra, which can cause symptoms Cancer Research UK - Not altered. CC BY-SA 4.0
Prostate Adenocarcinoma. Prostate cancer Bruce Blaus. Not altered. CC BY-SA 4.0
Prostate Adenocarcinoma. Micrograph of prostate adenocarcinoma, acinar type, the most common type of prostate cancer. Needle biopsy, H&E stain Nephron - Not altered. CC BY-SA 3.0
a Photomicrographs from tissue histopathological examination reveals prostate adenocarcinoma, Gleason 4 pattern (left of image), characterized by collections of neoplastic cells with minimal gland formation, with benign prostatic glandular elements and seminal vesicular tissue (right of image), H&E stain image, 10× magnification. b Prostate adenocarcinoma, predominant Gleason 4 pattern and secondary Gleason 3 pattern, H&E stain image, 10× magnification. The carcinoma involves approximately 60 % of the submitted core biopsy fragmentsProstate cancer arising in ectopic prostatic tissue within the left seminal vesicle: a rare case diagnosed with multi-parametric magnetic resonance imaging and magnetic resonance imaging-transrectal ultrasound fusion biopsy. Somwaru AS, Alex D, Zaheer AK - BMC medical imaging (2016). Not Altered. CC.
Prostate Adenocarcinoma. Diagram showing the position of the prostate and rectum. Cancer Research UK - Not altered. CC BY-SA 4.0
Prostate Adenocarcinoma. Micrograph showing a prostate cancer (conventional adenocarcinoma) with perineural invasion. H&E stain. Nephron - Not altered. CC BY-SA 3.0
Prostate Adenocarcinoma. Sclerosis of the bones of the thoracic spine due to prostate cancer metastases (CT image) James Heilman, MD - Not altered . CC BY-SA 4.0