TAILIEUCHUNG - Chapter 091. Benign and Malignant Diseases of the Prostate

Benign and malignant changes in the prostate increase with age. Autopsies of men in the eighth decade of life show hyperplastic changes in 90% and malignant changes in 70% of individuals. The high prevalence of these diseases among the elderly, who often have competing causes of morbidity and mortality, mandates a risk-adapted approach to diagnosis and treatment. This can be achieved by considering these diseases as a series of states. Each state represents a distinct clinical milestone for which intervention(s) may be recommended based on current symptoms or the risk of developing symptoms or death from disease within a given. | Chapter 091. Benign and Malignant Diseases of the Prostate Benign and malignant changes in the prostate increase with age. Autopsies of men in the eighth decade of life show hyperplastic changes in 90 and malignant changes in 70 of individuals. The high prevalence of these diseases among the elderly who often have competing causes of morbidity and mortality mandates a risk-adapted approach to diagnosis and treatment. This can be achieved by considering these diseases as a series of states. Each state represents a distinct clinical milestone for which intervention s may be recommended based on current symptoms or the risk of developing symptoms or death from disease within a given time frame Fig. 91-1 . For benign proliferative disorders symptoms of urinary frequency infection and potential for obstruction are weighed against the side effects and complications of medical or surgical therapy. For prostate malignancies the risks of developing the disease symptoms or death from cancer are balanced against the morbidities of the interventions recommended and preexisting comorbid conditions. Figure 91-1 Clinical states of prostate cancer. PSA prostate-specific antigen. Anatomy and Pathology The prostate is located in the pelvis and is surrounded by the rectum the bladder the periprostatic and dorsal vein complexes that are responsible for erectile function and the urinary sphincter that is responsible for passive urinary control. The prostate is composed of branching tubuloalveolar glands arranged in lobules and surrounded by a stroma. The acinal unit includes an epithelial compartment made up of epithelial basal and neuroendocrine cells and a stromal compartment that includes fibroblasts and smooth-muscle cells. The compartments are separated by a basement membrane. Prostate-specific antigen PSA and acid phosphatase are produced in the epithelial cells. Both prostate epithelial cells and stromal cells express androgen receptors and depend on androgens for growth. .

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