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NORMAL STRUCTURE
20g in normal adult.
It surrounds the commencement of the male urethra.
Composed of 5 lobes during embryonic development: Anterior, middle, posterior and two lateral
lobes.
At birth, the five lobes fuse to form 3 distinct lobes: Two major lateral lobes and a small median
lobe
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HISTOLOGY
Composed of tubular alveoli (acini) embedded in fibromuscular tissue mass.
The glandular epithelium forms infoldings and consists of 2 layers—a basal layer of low cuboidal cells and
an inner layer of mucus secreting tall columnar cells.
The alveoli are separated by thick fibromuscular septa containing abundant smooth muscle fibres.
The prostate has numerous blood vessels and nerves.
In addition to nervous control, the prostate is an endocrine dependent organ.
Based on hormonal responsiveness, the prostate is divided into 2 separate parts:
Inner periurethral female part which is sensitive to estrogen and androgen.
Outer subcapsular true male part which is sensitive to androgen.
Prostate is involved in 3 important pathologic processes:
1. Prostatitis
2. Nodular hyperplasia
3. Carcinoma.
While benign nodular hyperplasia occurs in the periurethral part distorting and compressing the centrally
located urethral lumen, the prostatic carcinoma usually arises from the outer
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PROSTATITIS
• Is the inflammation of the prostate.
• May be of acute, chronic and granulomatous
types.
• Acute or chronic prostatitis may superimpose
on nodular hyperplasia.
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Acute prostatitis
• Acute focal or diffuse suppurative inflammation of the prostate is not uncommon.
• It occurs most commonly due to ascent of bacteria from the urethra, less often by descent from the upper urinary
tract or bladder, and occasionally by lymphogenous or hematogenous spread from a distant focus of infection.
• The infection may occur spontaneously or may be a complication of urethral manipulation such as by
catheterisation, cystoscopy, urethral dilatation and surgical procedures on the prostate.
• The common pathogens are those which cause UTI, most frequently E. coli, and others such as Klebsiella, Proteus,
Pseudomonas, Enterobacter, gonococci, staphylococci and streptococci.
• The diagnosis is made by culture of urine specimen.
MORPHOLOGIC FEATURES
Grossly,
Prostate is enlarged, swollen and tense.
Cut section shows multiple abscesses and foci of necrosis.
Histologically,
Prostatic acini are dilated and filled with neutrophilic exudate.
There may be diffuse acute inflammatory infiltrate.
Edema, hyperemia and foci of necrosis frequently accompany acute inflammatory involvement.
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Chronic prostatitis
More common
Foci of chronic inflammation are frequently present in the prostate of men above 40 years of age.
Usually asymptomatic but may cause allergic reactions, iritis, neuritis or arthritis.
Is of 2 types; bacterial and abacterial.
Chronic bacterial prostatitis
Caused in much the same way and by the same organisms as the acute prostatitis.
Generally a consequence of recurrent UTI.
Diagnosis is made by detection of more than 10-12 leucocytes per high power field in expressed prostatic
secretions, and by positive culture of urine specimen and prostatic secretions
More difficult to treat since antibiotics penetrate the prostate poorly.
Chronic abacterial prostatitis
More common.
No hx of recurrent UTI and culture of urine and prostatic secretions is always negative, though leucocytosis is
demonstrable in prostatic secretions.
The pathogens implicated are Chlamydia trachomatis and Ureaplasma urealyticum.
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CONT…
MORPHOLOGIC FEATURES
Pathologic changes in both bacterial and
abacterial prostatitis are similar.
Grossly,
Prostate may be enlarged, fibrosed and
shrunken.
Histologically,
Dx of chronic prostatitis is made by foci of
lymphocytes, plasma cells, macrophages and
neutrophils within the prostatic substance.
Corpora amylacea, prostatic calculi and foci of
squamous metaplasia in the prostatic acini may
accompany inflammatory changes.
Seminal vesicles are invariably involved.
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Granulomatous prostatitis
Is a variety of chronic prostatitis
Caused probably by leakage of prostatic secretions
into the tissue, or could be of autoimmune origin.
MORPHOLOGIC FEATURES
Grossly,
The gland is firm to hard, giving the clinical
impression of prostatic carcinoma on rectal
examination.
Histologically,
The inflammatory reaction consists of
macrophages, lymphocytes, plasma cells and some
multinucleate giant cells.
The condition may be confused with tuberculous
prostatitis.
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NODULAR
HYPERPLASIA
Non-neoplastic tumor-like enlargement of the
prostate
Commonly termed benign nodular hyperplasia
(BNH) or benign enlargement of prostate
(BEP)
Very common condition in men and
considered by some as normal ageing process.
It becomes increasingly more frequent above
the age of 50 years and its incidence
approaches 75-80% in men above 80 years.
However, symptomatic BEP producing
urinary tract obstruction and requiring surgical
treatment occurs in 5-10% of cases only.
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Etiology
• The cause of BEP has not been fully established.
• However, a few etiologic factors such as endocrinologic, racial, inflammation and arteriosclerosis
have been implicated but endocrine basis for hyperplasia has been more fully investigated and
considered a strong possibility in its genesis.
• It has been found that both sexes elaborate androgen and estrogen, though the level of androgen is
high in males and that of estrogen is high in females.
• With advancing age, there is decline in the level of androgen and a corresponding rise of estrogen
in the males.
• The periurethral inner prostate which is primarily involved in BEP is responsive to the rising level
of estrogen, whereas the outer prostate which is mainly involved in the carcinoma is responsive to
androgen.
• A plausible hypothesis suggested is that there is synergistic stimulation of the prostate by both
hormones—the estrogen acting to sensitise the prostatic tissue to the growth promoting effect of
dihydroxy-testosterone derived from plasma testosterone.
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Morphologic features
Grossly,
Enlarged prostate is nodular, smooth and firm and
weighs 2-4 times its normal weight i.e. may weigh
up to 40-80 gm.
The appearance on cut section varies depending
upon whether the hyperplasia is predominantly of
the glandular or fibromuscular tissue
In primarily glandular BEP the tissue is yellow-
pink, soft, honey-combed, and milky fluid exudes
In mainly fibromuscular BEP the cut surface is firm,
homogeneous and does not exude milky fluid.
The hyperplastic nodule forms a mass mainly in the
inner periurethral prostatic gland so that the
surrounding prostatic tissue forms a false capsule
which enables the surgeon to enucleate the nodular
masses.
The left-over peripheral prostatic tissue may
sometimes undergo recurrent nodular enlargement
or may develop carcinoma later.
Histologically,
In every case, there is hyperplasia of all three tissue
elements in varying proportions—glandular, fibrous and
muscular:
Glandular hyperplasia
Predominates in most cases
Identified by exaggerated intra-acinar papillary
infoldings with delicate fibrovascular cores.
The lining epithelium is two-layered: the inner tall
columnar mucus-secreting with poorly-defined borders,
and the outer cuboidal to flattened epithelium with
basal nuclei.
Fibromuscular hyperplasia
When present as dominant component appears as
aggregates of spindle cells forming an appearance akin
to fibromyoma of the uterus.
In addition to glandular and/or fibromuscular
hyperplasia, other histologic features frequently found
include foci of lymphocytic aggregates, small areas of
infarction, corpora amylacea and foci of squamous
metaplasia.
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Clinical features
Clinically, the symptomatic cases develop
symptoms due to complications such as urethral
obstruction and secondary effects on the bladder
(e.g. hypertrophy, cystitis), ureter (e.g.
hydroureter) and kidneys (e.g. hydronephrosis).
The presenting features include:
1. Frequency
2. Nocturia
3. Difficulty in micturition
4. Pain
5. Hematuria
6. Acute retention of urine requiring immediate
catheterisation.
