Study of hypoechoic nodule diagnosis of BPH in outer gland of the prostate by TRUS and autopsy

To investigate the possibility of benign prostatic hyperplasia (BPH) in prostatic outer gland by transrectal ultrasound (TRUS) and autopsy examination.Methods Fifty-nine patients were biopsied by TRUS guided in sagittal and longitudinal sections,respectively,because hypoechoic nodules were found in the outer glands of the prostates.The specimens were stained by HE methods.The whole prostate specimens obtained from 16 men at autopsy were studied.Sonogram of the specimens was investigated by putting them in water.Them the specimens were sliced down perpendicularly to the urethra,histologically processed and stained by HE methods.Results Pathologically,22 of the 59 specimens were of benign prostate hyperplasia (BPH),29 of prostate cancer (PCa),1 of prostatic intraepithelial neoplasia (PIN) and 7 of tuberculosis (TB).A clear-cut interface between inner gland and outer gland,and multiple calculi and cysts were found on sonogram.Pathological diagnosis of BPH of the outer glands was made in all HE-stained autopsied specimens with varying degrees of hyperplasia of the glands,small muscles and stroma.Conclusion It is suggested that hypoechoic nodules in outer gland of the prostate by TRUS on sonogram may be benign hyperplastic nodules besides PCa,PIN,and TB.10 refs,5 figs.

Lipogenic effects of androgen signaling in normal and malignant prostate

Prostate cancer is an androgen-dependent cancer with unique metabolic features compared to many other solid tumors,and typically does not exhibit the“Warburg effect”.During malignant transformation,an early metabolic switch diverts the dependence of normal prostate cells on aerobic glycolysis for the synthesis of and secretion of citrate towards a more energetically favorable metabolic phenotype,whereby citrate is actively oxidised for energy and biosynthetic processes(i.e.de novo lipogenesis).It is now clear that lipid metabolism is one of the key androgen-regulated processes in prostate cells and alterations in lipid metabolism are a hallmark of prostate cancer,whereby increased de novo lipogenesis accompanied by overexpression of lipid metabolic genes are characteristic of primary and advanced disease.Despite recent advances in our understanding of altered lipid metabolism in prostate tumorigenesis and cancer progression,the intermediary metabolism of the normal prostate and its relationship to androgen signaling remains poorly understood.In this review,we discuss the fundamental metabolic relationships that are distinctive in normal versus malignant prostate tissues,and the role of androgens in the regulation of lipid metabolism at different stages of prostate tumorigenesis.

Robotic surgery in giant multilocular cystadenoma of the prostate:A rare case report

BACKGROUND Giant multilocular cystadenoma(GMC)of the prostate gland is a very rare benign tumor.Although the benign nature has been known,complete surgical excision is the major treatment consensus because of its high recurrence rate.We report a rare case of GMC with accompanying lower urinary tract symptoms and repeated urine retention initially thought to be symptoms of benign prostatic hyperplasia,which was treated with robot-assisted laparoscopic radical prostatectomy.CASE SUMMARY A 65-year-old man presented with a 2-year history of lower urinary tract symptoms that had deteriorated gradually within the previous six months,even though he had received treatment with a selective alpha-blocking agent.He had undergone two transurethral resections of the prostate(TURP)at a local hospital during a 4-mo interval because initial ultrasound imaging and prostatic core needle biopsy showed benign prostate hyperplasia.Upon the third recurrence,the patient underwent TURP with a green-light laser at our institution.The diagnosis was a tumor composed of variously sized dilated glandular and cystic structures lined by blended prostatic type epithelia positive for prostate-specific antigen;the final diagnosis was giant multilocular cystadenoma.Magnetic resonance imaging showed a large multilocular retrovesical mass 8.0 cm×7.3 cm×6.4 cm,with heterogeneous enhancement.A coexisting malignant part could not be excluded.Considering the high recurrence rate,risk of coexisting malignancy,and possible sequelae of open surgery for radical excision,the patient decided to undergo robot-assisted radical prostatectomy,with good outcomes at the 2-year follow-up.CONCLUSION Robot-assisted surgery for the treatment of prostate GMC provides another choice for simultaneous attention to disease-control and postoperative quality of life.

Bipolar Transurethral Prostate Resection: A Study of 112 Cases

Background: With the advancement of technology, prostate resection can be performed nowadays using endoscopic techniques, which include monopolar and bipolar transurethral prostate resection. This study aimed to evaluate the results of bipolar transurethral prostate resection in a single urology center in Cameroon. Materials and Methods: This was a retrospective study carried out over two years (2015-2017) involving 112 patients with symptomatic prostate diseases who underwent transurethral prostate resection with the help of a bipolar Olympus generator. Results: The ages of the participants ranged from 44 years to 85 years, with a mean age of 64.41 ± 9.5 years. Fifty-six (50%) patients presented with only obstructive symptoms, five (4.46%) had only irritative symptoms, twenty (17.86%) presented with both obstructive and irritative symptoms, eight (7.14%) presented with macroscopic hematuria, seven (6.25%) with urinary tract infections, and sixteen (14.29%) with acute urinary retention. Digital rectal examination was unremarkable in 74 (66.07%) findings and was positive in 38 (33.93%) patients. The median prostate diameter was 70 [59 - 86.5] mm. The mean preoperative IPSS was 24.46 ± 5.68. The mean surgery duration was 77.61 ± 23.87 minutes. The mean volume of irrigation fluid used during surgery was 24.84 ± 6.40 ml. The differences between the preoperative and postoperative mean IPPS score, maximum urine flow rate, and quality of life were statistically significant (all P Conclusion: Bipolar transurethral prostate resection is a viable alternative to open surgery or laparoscopic surgery for large prostate glands. This technique is also associated with a reduction in prostate-related morbidity.