Pathology of the prostate
• Prostate is walnut-sized tissue and sits below bladder
• Increasing size with age due to hyperplasia
• Urethra runs throughs centre
• Function – produces prostatic fluid which contains PSAP (hydrolase) and PSA (reverses clotting) to
aid fertilisation
• 25-30% of semen volume
• Neutralising agents
• Enzymes used to break down ball of spermatocytes that arrives at ectocervix
• Forms component of ejaculate – everything mixed in urethra
o Spermatocytes
o Seminal fluid
o Bulbourethral gland fluid
o Prostatic fluid (25-30%)
• Prostate fluid – thin, milky, slightly acidic fluid (pH6.4)
• Prostate gland
o Secretes high levels of citrate, Ca2+, K+, Zn2+ and proteolytic enzymes – fibrinolysin, PAP, PSA
o PSA liquefies clotted seminal fluid
▪ Spermatocytes gelled by seminal vesicles fluid to facilitate fertilisation
▪ Promote motility following sticking to cervix (15-30mins)
o Citrate levels very low in prostate cancer patients
o PAP levels very high in metastatic prostate cancer patients
• Testosterone drives changes in prostate
• As testosterone levels don’t change, process is steady (unlike oestrogen in women)
• Prostate investigation strategies
o Digital rectal examination
o Ultrasonography – TransRectal Ultrasound (TRUS) takes biopsies
▪ TRUS needle biopsy
• Very common minimally invasive
• Good mapping
• Adequate sampling
• Biopsy core is tiny and may miss cancer mass
▪ TURP (transurethral resection of prostate)
• Very common
• Usually for relief of urinary symptoms
• Good quantity of material for analysis
• Potentially curative
o Blood test – serum PSA (depends on age and ethnicity for normal range)
o Common IHC
▪ PSAD enzyme only made by epithelial cells of prostate
▪ AMACR more specific than PSAD
▪ 34BE12 – looks at basal layer, if disrupted or absent = invasive cancer as basement
membrane disrupted
• Inflammation
o Acute bacterial causes
▪ UTI – E.coli, Enterococci, Staphylococcus
▪ Intraprostatic reflux of urine – splashed back into urine and bacteria colonises
▪ Surgical manipulation/catheterisation
▪ Histology of acute bacterial causes
• Minute abscesses
• Focal necrosis or diffuse oedema
• Prostate is walnut-sized tissue and sits below bladder
• Increasing size with age due to hyperplasia
• Urethra runs throughs centre
• Function – produces prostatic fluid which contains PSAP (hydrolase) and PSA (reverses clotting) to
aid fertilisation
• 25-30% of semen volume
• Neutralising agents
• Enzymes used to break down ball of spermatocytes that arrives at ectocervix
• Forms component of ejaculate – everything mixed in urethra
o Spermatocytes
o Seminal fluid
o Bulbourethral gland fluid
o Prostatic fluid (25-30%)
• Prostate fluid – thin, milky, slightly acidic fluid (pH6.4)
• Prostate gland
o Secretes high levels of citrate, Ca2+, K+, Zn2+ and proteolytic enzymes – fibrinolysin, PAP, PSA
o PSA liquefies clotted seminal fluid
▪ Spermatocytes gelled by seminal vesicles fluid to facilitate fertilisation
▪ Promote motility following sticking to cervix (15-30mins)
o Citrate levels very low in prostate cancer patients
o PAP levels very high in metastatic prostate cancer patients
• Testosterone drives changes in prostate
• As testosterone levels don’t change, process is steady (unlike oestrogen in women)
• Prostate investigation strategies
o Digital rectal examination
o Ultrasonography – TransRectal Ultrasound (TRUS) takes biopsies
▪ TRUS needle biopsy
• Very common minimally invasive
• Good mapping
• Adequate sampling
• Biopsy core is tiny and may miss cancer mass
▪ TURP (transurethral resection of prostate)
• Very common
• Usually for relief of urinary symptoms
• Good quantity of material for analysis
• Potentially curative
o Blood test – serum PSA (depends on age and ethnicity for normal range)
o Common IHC
▪ PSAD enzyme only made by epithelial cells of prostate
▪ AMACR more specific than PSAD
▪ 34BE12 – looks at basal layer, if disrupted or absent = invasive cancer as basement
membrane disrupted
• Inflammation
o Acute bacterial causes
▪ UTI – E.coli, Enterococci, Staphylococcus
▪ Intraprostatic reflux of urine – splashed back into urine and bacteria colonises
▪ Surgical manipulation/catheterisation
▪ Histology of acute bacterial causes
• Minute abscesses
• Focal necrosis or diffuse oedema
