00:02
Our topic is prostate pathology.
00:05
I’ll walk you through
some infections
and I’ll walk you through BPH
and then finally get into what’s
known as your prostate cancer.
00:12
I’ll begin our discussion by looking
at acute bacterial prostatitis.
00:17
Think about the prostate and
now there might be infection.
00:22
So now with this infection, how
is the patient going to present?
Lower back pelvic pain.
00:27
Do not confuse this with
pyelonephritis or urinary
tract infection.
00:34
Keep it as a differential.
00:36
In a male, the prostate
should come to mind.
00:39
Dysuria, frequency, tender,
warm, enlarged prostate.
00:45
Dysuria, frequency,
what about that?
Be careful, do not confuse
this with BPH.
00:51
Okay.
00:51
So two differentials
with the first two
presentations.
00:55
Lower back pain,
maybe pyelonephritis
being a differential
or urinary tract infection
with suprapubic pain.
01:03
Or number two here, with frequency
as a differential, BPH.
01:08
How can you rule out
one from the other?
The next statement.
01:11
Upon digital rectal examination,
warm, enlarged prostate.
01:16
DRE.
01:17
Digital rectal.
01:19
Warm, enlarged, what
does it feel like?
See my big nose?
You press on big nose and
it’s kind of soft and boggy.
01:29
That’s protatitis.
01:31
If it feels like my ugly
chin and it’s gritty,
that’s not good.
01:35
That’s prostate cancer.
01:38
Next, etiology,
sexually transmitted
infections such as gonococcal,
Chlamydia, usual suspects.
01:43
And BPH with what’s known as coliform
or E. coli in elderly.
01:49
Understand the statements here.
01:50
Pathogenesis:
Young patient with sexually
transmitted infection.
01:54
Uh-oh.
01:55
Acute bacterial prostatitis.
01:57
If you have a male
who’s older, 67-72,
has frequency and you don’t
find an increase in PSA
and you can’t feel
any prostate issues
because this is BPH,
imagine now if there’s frequency
and unable to properly void
when he goes to the bathroom.
02:19
The perfect nidus or environment
for urinary tract infection,
E. coli, E. coli, E. coli.
02:24
Here comes the E.
coli, up the urethra,
climbing up the urethra,
causing prostatitis.
02:33
Antibiotics are used to treat this infection.
02:35
Chronic prostatitis:
What’s interesting when
you go into practice
and, you know, you’re going through
internal medicine, so on and so fourth.
02:44
And then you suspect
prostatitis,
oftentimes, you’ll find a chronic
prostatitis being an issue,
very common.
02:52
And what’s amazing,
is the fact abacterial chronic
prostatitis is the most common.
02:58
Even though we call
it abacterial,
we just don’t have
the proper tools
to maybe perhaps
diagnose the infection.
03:06
Important, chronic.
03:08
Our topic is BPH.
03:10
With benign prostatic
hyperplasia,
who’s your patient?
BPH is commonly seen in men over age 50,
but it can be asymptomatic and only requires treatment if it is bothersome to the patient.
03:21
The enlarged prostate is palpable on digital rectal exam; however,
the size of the prostate on exam does not correlate with symptom severity.
Clinical presentation may include urinary frequency,
inability to empty the bladder completely, urinary dribbling,
and an increase in nocturia with patients having to get up to urinate
several times during the night.
03:41
BPH can also increase the risk of urinary tract infection
of the bladder in older men.
Management can be with alpha-blockers, phosphodiesterase type 5 inhibitors,
5-alpha reductase inhibitors
or surgery. Some alpha-blockers such as terazosin and doxazosin are also used to treat high blood pressure
Prostate adenocarcinoma.
04:02
You may notice an asymmetric enlargement of the
prostate or nodule on digital rectal exam.
04:07
This is an adenocarcinoma.
04:08
What does that mean to you?
Glandular, glandular, glandular.
04:12
Isn’t that what the
prostate does?
It secretes fluid into
the seminal vesicle,
mixes it all up and then
when the time is right,
what have you?
Erection, ejaculation,
emission, so on and so forth.
04:24
But adenocarcinoma, it’s
glandular. Glandular.
04:27
As far as you’re concerned, you’ll
be paying attention to PSA.
04:31
What if you also find
increase in alk phos?
Uh-oh.
04:36
PSA and alkaline phosphatase, why
was I so dramatic about that?
Because now, the prostate
cancer has metastasized
from the prostate
to the vertebrae
through your Batson
paravertebral plexus.
04:50
And now, upon your x-ray, what
does this bone look like?
Hot.
04:54
What does hot mean?
Clinically hot then means
that it’s opaque and white.
04:59
It’s an osteoblastic
type of metastasis.
05:02
Prostate adenocarcninoma,
you can feel it,
increased PSA.
05:08
Always look to see as to whether
or not there is metastasis.