Good morning, have a nice time

What’s new about lesions of prostatic gland?

By Taghreed Abd El_Sameea

Ass. Prof. of pathologyFaculty of Medicine

Benha University

Anatomy of prostatic gland

Site of the gland

Relation to adjacent organsurinary bladder, prostate and different duct sagittal section

Prostatic carcinoma

• Causes:• Genetic:

- Dietary: Trans fats

- Medication exposure: conversion of testosterone to dihydrotestosterone

- Viral elements: HPV

- -precancerous lesions( LGPIN, HGPIN and ASAP)

Precancerous lesions in the prostate

• carcinoma in situ or prostatic intraepithelial neoplasia (PIN) that includes LGPIN, HGPIN and ASAP

LGPIN, note the irregular spacing of the lining epithelium with nuclear hyperchromasia and more frequent

inconspicuous nucleoli

Tufting, papillary formations and signet ring patterns (intraluminal signet ring neoplastic cells) confined to a pre-

existing gland, as demonstratedby positive basal cell staining in HGPIN

HGPIN/ micropapillary and cribriform patterns, note more benign appearing cytology towards center of gland .

HGPIN, papillary pattern and mucinous type with flat pattern of growth, note filling the gland by blue mucin

Diagnosis of PIN

• 1- Needle biopsy

• 2- TURP

• 3- TRUS

Gross pattern of normal prostate versus prostatic carcinoma

Ductal adenocarcinoma of the prostate. Papillary type of growth, Cribriform pattern.

invasive prostatic adenocarcinoma. • The neoplastic cells are arranged in glands around central lumens.

• Delicate fibrovascular stroma separates the malignant glands. • The neoplastic cells have prominent nucleoli and little cytoplasm.

Early diagnosis of prostatic carcinoma

• Engrailed-2 (EN2) in the urine is highly senstive

• Digital rectal examination

• Ultrasound (US) and Magnetic Resonance Imaging (MRI)

Role of tumor markers in diagnosis and follow up in patients with prostatic carcinoma

• PSA and PAP

• BCL-2

• Ki-67 ERK5

Prevention of prostatic caner

• Medications• Two medications which block the conversion of

testosterone to dihydrotestosterone, finasteride and dutasteride,.

• Vaccine, under trial

• Ejaculation frequency may decrease a man's risk of prostate cancer. Diet: fish , Omega-3 fatty acids • Trans fats may be associated with an increased risk

of cancer

recommendations

• Starting at age 50 years, (45 years if your brother or father suffered from prostatic lesion before age 65)

• Engrailed-2 (EN2) in the urine

• Digital rectal examination may allow a doctor to detect perepheral zone prostate abnormalities.

• Biopsy.

Thanks to all, good bye