Pathology of Prostate

1. CPC4.3- CPC4.3- MR 68y Carpenter
Lives in Kuranda. He attends the GP for a
‘check up’ and towards the end of the
consultation mentions casually: “I’ve also got
a few things happening with the old
waterworks, Doc.”
Urine frequency (4-5xday; 2xnight); Terminal
dribbling.
Worsening over months - ? couple of years’.

2. CPC4.3- CPC4.3- Matthew Rice 68y Carpenter
Urgencyyes, but then doesn’t pass much urine on
forcing. Cannot empty the bladder empty.
Urinary stream - poor
Urinary incontinence - occasional but embarrassing.
Dysuria, Haematuria No
Bowel habit no change, prone to slight constipation
Sexual history - heterosexual; 2nd wife Dawn,
monogamous for 23 years. Has early morning erections,
but difficulty sustaining an erection. No hx STIs

3. CPC4.3- CPC4.3- Differential Diagnosis
Benign prostatic hyperplasia (BPH)
Prostatitis, Cancer, stones, rectal tum.
Strictures, UTI, Diuretics,
Spinal injury, Autonomic neuropathy ???
What other causes of urinary obstruction?
urine retention , lack of urine, urinary dribbling
urinary urgency , urination pain , weak urination
reduced urine
(links to wrongdiagnosis.com)

4. PathologyPathologySymptomSymptom
Testicular tum Gynaecomastia
Testicular tum teratoma.Raised αFP/HCG
Prostate carcinomaRaised acid Phos.
Prostate carcinomaBone pain
STI, syphilisUlceration
UTI, urethritis, gonorrhoeaDischarge
Prostate, stone, stricture, tumorRetention
Prostate, UTI, PolyuriaFrequency
Bladder neck obstruction.
Prostate BPH (rarely stricture/tumor)
Poor stream /
dribbling.
Inflammation urethra, UTIDysuria

5. Causes of Obstructive UropathyCauses of Obstructive Uropathy
INTRINSIC:
Calculi - Lithiasis
Strictures – congenital,
inflammatory
Tumors – Transitional cell
Ca.
Blood clots – UTI,
Glomerulonephritis
EXTRINSIC:
Pregnancy
Inflammation- PID,
peritonitis, diverticulitis,
salphingitis.
Tumors: Prostate, rectum,
bladder, ovaries etc.

6. When you lose,When you lose,
don’t lose the lesson.don’t lose the lesson.
Lao Tzu
Everyone makes Mistakes,
only intelligent learn from it.

7. CPC 4.2: Core Learning Issues:CPC 4.2: Core Learning Issues:
Pathology Major CLI:
Nephrolithiasis – Types, Pathogenesis, clinical features.
Tumors of Kidney. – Renal cell carcinoma,
Nephroblastoma,
Disorders of Prostate – Prostatitis, BPH and carcinoma.
Urinary tract infection – Microbiology common
organisms and their lab diagnosis.
Pathology Minor CLI:
Differential diagnosis of hematuria.
Tumors of Urinary tract and bladder.
Cystic Diseases of Kidney
Hydronephrosis.
Recurrent UTIs
Congenital disorders of kidney.

8. Pathology of ProstatePathology of Prostate
Dr. Shashidhar Venkatesh MurthyDr. Shashidhar Venkatesh Murthy
Associate Professor & Head of Pathology

9. IntroductionIntroduction
Anatomy – 5 lobes.
Function – Semen, acid phosphatase.
Hormone response – Estrogen like
Median lobe – BPH
Lateral/Posterior lobes - Cancer)
Enlargement – Inflammation / growth
Neoplastic / Non neoplastic growth.
BPH / Cancer.

10. Male Urogenital System - anatomyMale Urogenital System - anatomy

11. Male Urogenital System - anatomyMale Urogenital System - anatomy
Ca
BPH

12. Zonal Histology:Zonal Histology:
BPHBPH
Ca. Ca.

13. Normal Histology: Fibro-Musclular-GlandNormal Histology: Fibro-Musclular-Gland
Two Layer Ep.
Fibromuscular stroma
Secretions

14. Enlargement of Prostate:Enlargement of Prostate:
Inflammations – infections
BPH – Benign Prostatic Hyperplasia
Neoplasms – Carcinoma.
SAPMorph -DRElocationIncidenceDisease
Raised.Adenocarcinoma
Hard stony, irregular,
fixed No median grove.
Posterior
subcapsular
Latent is
Common.
Clinical not.
Carcinom
a
normalNodular Hyperplasia,
Firm, smooth Median
grove
Central /
periurethra
>80% at 80yBPH

15. Prostatitis:Prostatitis:
Inflammation, edema, rectal pain, urinary
obstruction.
Acute suppurative prostatitis
E.coli, rarely Staph or N. gonorrhoeae
Chronic non-specific prostatitis
recurrent acute  fibrosis, lymph + plasma.
Granulomatous prostatitis-
BPH, infarction, post TURP, idiopathic, TB, or
allergic(eosinophilic).

16. Prostatitis:Prostatitis:

17. BPH-IntroductionBPH-Introduction
Common non-neoplastic hormone induced
hyperplasia.
75% among men aged 70-80years
Over 90% in people aged over 90y
Involves peri urethral & central zones.
Rare before the age of 40y.
Hormone induced – Androgens.
Castration  no BPH

18. Patho-Physiology: Patho-Physiology: Testosterone Testosterone  DHT DHT  GFGF
Finasteride

19. BPH-MorphologyBPH-Morphology
Microscopically, nodular prostatic
hyperplasia consists of nodules of glands
and intervening stroma. (both)
The glands variably sized, with larger
glands have more prominent papillary
infoldings, double layered epithelium (like
normal) some may be cystic with
secretions.
Nodular hyperplasia is NOT a precursor to
carcinoma.

20. Benign Prostatic Hyperplasia:Benign Prostatic Hyperplasia:

21. BPH-mechanism of obstruction:BPH-mechanism of obstruction:
•Median lobe (3
rd
lobe)
•Ball valve mechanism
•Obstruction.
•Urgency/hesitation..

22. BPH-Bladder Gross – Identify Cues?BPH-Bladder Gross – Identify Cues?
Trabeculations
Hypertrophy of wall
Stone - urolithiasis
Inflammation
Median lobe- ball valve.
Enlarged prostate.

23. BPH-Bladder morphology:BPH-Bladder morphology:
Hypertrophy of wall.
Trabeculation
Median lobe
protrusion (ball
valve)
Prostatic
enlargement.

24. Mucosal trabeculation: Muscular hypertrophyMucosal trabeculation: Muscular hypertrophy

25. Mucosal trabeculation: Muscular hypertrophyMucosal trabeculation: Muscular hypertrophy
Bulging BPH central Lobes

26. TURP-Bits (Diagnosis + Treat )TURP-Bits (Diagnosis + Treat )
Transurethral resection of
Prostate - TURP
Partial removal by
resectoscope.
Complications:
Hemorrhage,
Infection,
Granulomatous prostatitis
Retrograde ejaculation.

27. BPH: BPH: Nodular, Gland+stromal hyperplasiaNodular, Gland+stromal hyperplasia
Cystic Gl
Nodule of BPH
SecretionsSecretions

28. BPH - MorphologyBPH - Morphology
Corpora Amylacea

29. BPH-Complications:BPH-Complications:
1.Obstructive Uropathy
2.Bladder hypertrophy
3.Trabeculation
4.Diverticula formation
5.Hydroureter – bilateral
6.Hydronephrosis
7.Lithiasis / stone.
8.Secondary infection.
•Not a risk factor for
Carcinoma prostate.

30. Normal Normal – – ProstatitisProstatitis- BPH- BPH

31. Adenocarcinoma Prostate:Adenocarcinoma Prostate:
Most common cancer in elderly males.
Adenocarcinoma.
It is rare before the age of 50, but seen in
over 70% of men over 70y old.
Many of these carcinomas are small and
clinically insignificant. (Incidental ca)
Second common cause of death due to
cancer in males. (First is lung carcinoma)
Aetiology unknown - Hormones, genes &
environment most likely. (Not BPH)

32. Cancer Statistics – 2002 USACancer Statistics – 2002 USA

33. Cancer Statistics – 2002 USACancer Statistics – 2002 USA

34. Pathogenesis: Pathogenesis: PIN & carcinomaPIN & carcinoma
•Prostatic intraepithelial neoplasia (PIN) Multilayered,
pleomorphic (low & High grade).
•Malignancy is single layered, & well differentiated to
start with …!

35. Diagnosis:Diagnosis:
Clinical: Digital Rectal examination (DRE)
hard, gritty, fixed tumor.
Loss of median groove.
Imaging:
Ultrasonography (transrectal), CT Scan, MRI.
Laboratory:
Tumor Marker – PSA
Biopsy - TURP
Note: None of these methods can reliably detect small
cancers & microscopic occult cancers may remain in-
situ for several years. (PSA misleading*). Occult
cancer is more common than clinical ca.

36. BPH with Adenocarcinoma:BPH with Adenocarcinoma:

37. BPH with Adenocarcinoma:BPH with Adenocarcinoma:
Ca
Ca
BPH
BPH

38. ““The only gracious way to The only gracious way to
accept an insult is to ignore it. If accept an insult is to ignore it. If
you can’t ignore it, top it. you can’t ignore it, top it.
If you can’t top it, laugh at it. If If you can’t top it, laugh at it. If
you can’t laugh at it,you can’t laugh at it,
it’s probably it’s probably deserveddeserved...!...!” ”
–Joseph Russell Lynes

39. Adeno-Ca ProstateAdeno-Ca Prostate
•Posterior Lateral lobes: Carcinoma
•Rectal examination.
•Solid, hard, adenocarcinoma

40. Adeno-Ca ProstateAdeno-Ca Prostate

41. Adeno-Carcinoma + BPHAdeno-Carcinoma + BPH

42. Adeno Carcinoma + BPHAdeno Carcinoma + BPH
Stone Solid-Ca Cystic, soft BPH

43. Low grade PIN 
High grade PIN 
PIN: PIN:
Crowding, stratification
Pleomorphism
Nuclear enlargement.
Grade II - III 

44. Prostatic Carcinoma: grade 4

45. Adenocarcinoma Prostate: (High grade)Adenocarcinoma Prostate: (High grade)

46. Gleason Grading & Scoring of Prostatic Ca.Gleason Grading & Scoring of Prostatic Ca.

47. Prostate Cancer
Gleason Grading & Scoring.Gleason Grading & Scoring.
•Grade/Pattern 1 – well defined
glands with limited
infiltration of the surrounding
tissue.
•Grade/Pattern 2 – not well
demarcated, pleopmorphic
cells.
•Grade/Pattern 3 – Crowding of
glands, irregular glands.
•Grade/Pattern 4 – Fusion of
glands.
•Grade/Pattern 5 – cell clusters,
No clear gland structure.
•Gleason Score: Add to most
prominent grades in the slide.
E.g. 3+4=7

48. Gleason score – 1+1=2Gleason score – 1+1=2

49. Gleason score – 2+2=4Gleason score – 2+2=4

50. Gleason grade 3: Pleomorphic glands. There is considerable variation in size, shape, and spacing of the glands. The glands are haphazardly infiltrating
the stroma; however, they are still discrete (i.e. there is no fusion of glands - a hallmark of Gleason grade 4). Some of the glands have occluded or
abortive lumens.
Prostate Cancer – Gleason grade 3Prostate Cancer – Gleason grade 3

51. ? Gleason Grade? Gleason Grade4 – Gland Fusion, no stroma

52. Small irregular nests & ribbons - Gleason grade 4+4.
Prostate Cancer

53. Grade 5 – sheets, no attempts at gland or clustering.
Prostate Cancer-High grade.

54. Most prostatic tumours include components of two or more patterns and therefore current practice gives the grade of the two most common
components and their sum. This is known as the combined Gleason grade or score. For example, in this image many glands in this example are
fused (Gleason grade 4); others maintain individual outlines but are closely packed with their neighbours (Gleason grade 3). Therefore, the score is 7
(4+3).
Prostate Cancer High grade

55. Prostate Ad.Ca:Prostate Ad.Ca:
Benign:
Double layer,
Secretion (clear cytopl)
Uniform cells
Papillary folds
Malignant
Single / crowded.
Less/no secretion.
Uniform/Pleomorphic
No papillary folds. But
crowding & clustering.
Normal
Ca.
Normal
Ca.

56. Prostate Cancer Poorly differentiated:
Normal Gl.
Malignant cells

57. Adenocarcinoma – PSA IPx +ve :Adenocarcinoma – PSA IPx +ve :

58. Prognosis of Adenocarcinoma:Prognosis of Adenocarcinoma:
Grade & Stage  Prognosis.
Gleason score 2-4 – well differentiated.
Gleason score 8-10 – poorly differentiated.
Urinary obstruction
Metastasize to lymph nodes and bones.
Bladder, kidney damage - Hematuria.
Spread to rectum – bleeding.
Spread to Lungs or liver – rare.

59. Ca Prostate – Stage & Prognosis:Ca Prostate – Stage & Prognosis:
<10% Evident distant metastases D2
17-20%
Metastases to regional lymph nodes, or
extensive regional spread
D1
33-39% Invades seminal vesicle C2
40-50% Invades capsule of prostate C1
62% Larger palpable nodule B2
70-75%
Palpable nodule in one lobe but <1.5 cm
in diameter
B1
50%
Incidental, >5% of volume, or high
grade
A2
93-98% Incidental, <5% of volume A1
10y Survival Definition Stage

60. Transitional cell Neoplasms:Transitional cell Neoplasms:
90% of bladder ca.
Precursor – papilloma
Dysplasia, in-situ ca,
Papillary carcinoma.

61. “The weak can never forgive.
Forgiveness is the attribute of
the strong.”
–Mohandas Gandhi

62. Urinary Calculi:Urinary Calculi:
Dr. Shashidhar Venkatesh MurthyDr. Shashidhar Venkatesh Murthy
Associate Professor & Head of Pathology

63. NephrolithiasisNephrolithiasis
Usually unilateral, small 1-3 mm,
Flank pain & tenderness – renal
capsule.
Passage marked by Paroxysmal,
intense colicky pain in the back (loin)
with radiation to anterior (renal or
ureteral "colic“)
“writhing in pain, pacing about, and
unable to lie still”
Hematuria macro/micro
Larger stones that cannot pass
produce hydronephrosis or
hydroureter.

64. Levels - Clinical symptomsLevels - Clinical symptoms
Ureteropelvic junction - deep flank
pain No radiation. Distension of the
renal capsule. (Symp. T11-L2)
Ureter – Acute, severe, colicky pain in
the flank and ipsilateral lower abdomen
with radiation to the testes/vulva
(ilioinguinal n.). nausea / vomiting.
Upper ureter – cholecystitis.
Middle – appendicitis
Distal ureter – Pelvic Infl. Dis.
Ureterovesical junction - Cause
irritative voiding, urinary frequency
and dysuria.
Calcium Oxalate

65. Calcium Oxalate
Nephrolithiasis: Nephrolithiasis: Organic matrix(3%) + salts (97%) ~Organic matrix(3%) + salts (97%) ~
Calcium stones (80%):Calcium stones (80%): oxalate/phosphate/urate salts.
Increased gut absorption or defective tubular reabsorphtion
of calcium – Common, high pH.
Hyperparathyroidism (10%)
Hyperuricosuria – high pH
Struvite Stones (15%)Struvite Stones (15%) magnesium ammonium
phosphate (triple phos). Staghorn stone.
Chronic UTI with gram-negative rods (split urea) pH >7
Proteus, Pseudomonas, and Klebsiella (not E. coli).
Uric acid stones (6%):Uric acid stones (6%):
pH <5.5, high protein (meats), malignancy, 25% have gout.
Cystine stones (2%) Cystine stones (2%)
Genetic disorder - Failure of reabsorption

66. Small renal calculus that would likely respond to
extracorporeal shock-wave lithotripsy

67. Nephrolithiasis:Nephrolithiasis:
Hypercalciuria, Hypocitraturia - commonest
risk factor.
A positive family history in 54%.
UTI in 62%, recurrent UTI in 60% (T.Phosphate).
Significant association with citrate &
Phosphate excretion and UTI.
Stone analysis, together with serum and 24-
hour urine metabolic evaluation crucial for
management.

68. Staghorn: (Triple Phos/Struvite)Staghorn: (Triple Phos/Struvite)
10% of nephrolithiasis.
Large stone moulds to
pelvis and calyceal system.
Secondary to obstruction /
infection proteus sp.
Proteus – break urea to
form ammonia (alk. ph)
Triple (struvite) Phos.
magnesium ammonium
phosphate.
Chronic irritation, sq
metaplasia & sq carcinoma
rarely occur.

69. Staghorn Calculus:Staghorn Calculus:

70. Staghorn CalculusStaghorn Calculus

71. Complications:Complications:
Hydronephrosis
Renal failure
Ureteral stricture
Infection, sepsis
Urine extravasation
Perinephric abscess
Xanthogranulomatous
pyelonephritis

72. Hydronephrosis:Hydronephrosis:

73. CPC-4.3– REN–BPHCPC-4.3– REN–BPH
Pathology - Core Learning Issues:
Overview of gross & microscopic Pathology of Prostate BPH
& Prostatic cancer.
Laboratory diagnosis of prostatic tumors. (debate)
Occult prostatic cancers (Recent media report on a Pathology
report of cancer later denied).
Pathology overview of chronic urinary retention..
Pathology of Nephrolithiasis, common types & their clinical
presentation & Diagnosis.
Basic science - Core Learning Issues:
Anatomy & histology of Prostate gland.
Prostate gland function, hormonal control.

74. ““Pleasure & Pleasure & PainPain, ,
Happiness & Happiness & SufferingSuffering
are our teachers”. are our teachers”.
Through their impact Through their impact
on the mind on the mind
““CharacterCharacter” develops.” develops.

75. Prostate: MProstate: Most likely site ofost likely site of ? pathology ? pathology
1 2 3 4 5
15%
0% 0%
85%
0%
A.Benign Hyperplasia.
B.Prostatitis
C.Stone formation
D.Adenocarcinoma
E.Transitional carcinoma

76. 62y male chronic urinary retention. 62y male chronic urinary retention. ? Diagnosis? Diagnosis
1 2 3 4 5
6%
81%
4%
9%
0%
1.Prostatic carcinoma
2.Benign P.
Hyperplasia
3.Bladder carcinoma
4.Trabeculations
5.Bladder hypertrophy

77. BPH: BPH: what feature is shownwhat feature is shown??
1 2 3 4 5
0% 0% 0%
98%
2%
A.Bladder Wall Thickening
B.trabeculation
C.Stone formation
D.Ball valve obstruction
E.Enlarged lateral lobes

78. Kidney: What type of Kidney: What type of stonestone??
1 2 3 4 5
9%
7%
0%
83%
0%
A.Oxalate & calcium
B.Calcium phosphate
C.Pure Uric acid
D.Triple phosphate
E.Cystine

79. 74y M, dysuria, hematuria, prostate 74y M, dysuria, hematuria, prostate ? Diagnosis? Diagnosis
1 2 3 4 5
6%
71%
6%
2%
15%
A.Prostatitis
B.Benign Prostatic Hyperpl.
C.Low grade carcinoma
D.Transitional carcinoma
E.High grade Carcinoma.

80. 74y male, dysuria, hematuria, prostate 74y male, dysuria, hematuria, prostate ? Diagnosis? Diagnosis
1 2 3 4 5
4%
17%
37%
0%
43%
A.Prostatitis
B.BPH
C.Adenocarcinoma
D.Transitional
carcinoma
E.BPH with carcinoma

81. 74y male, dysuria, hematuria, prostate 74y male, dysuria, hematuria, prostate ? Diagnosis? Diagnosis
1 2 3 4 5
0%
37%
27%
0%
35%
A.Prostatitis
B.BPH
C.Adenocarcinoma
D.Transitional carcinoma
E.BPH with carcinoma

82. 70y backpain, DRE-rock-hard, enlarged prostate. 70y backpain, DRE-rock-hard, enlarged prostate.
X-rays show multicentric, osteoblastic lesions of X-rays show multicentric, osteoblastic lesions of
the lumbar vertebral bodies. An the lumbar vertebral bodies. An orchiectomyorchiectomy is is
performed. performed. What is the rationale for this surgical What is the rationale for this surgical
procedure?procedure?
1 2 3 4 5
0%
2%
94%
0%
4%
1.Leydig cells release tumor
chemotactic factors.
2.Prostate carcinomas frequently
metastasize to the gonads.
3.Sertoli cells release tumor
chemotactic factors.
4.The tumor is well known to
invade the testes.
5.Tumor cells exhibit androgen-
dependent growth.

83. 68y male, painless hematuria 4wk. Bladder 68y male, painless hematuria 4wk. Bladder
image. What is the most likely risk factor?image. What is the most likely risk factor?
1 2 3 4 5
0% 0% 0%
100%
0%
1.Bladder calculi
2.Chronic HPV infection
3.Diabetes mellitus
4.Exposure to Azo dyes
5.Previous catheterization.

84. 68y male, Image shows prostate biopsy. What is the 68y male, Image shows prostate biopsy. What is the
most likely most likely complication complication of this lesionof this lesion??
1 2 3 4 5
20%
50%
9%
0%
21%
1.Destructive vertebral lesions.
2.Bladder hypertrophy.
3.Calcium oxalate nephrolithiasis.
4.Gram negative septicaemia.
5.Lead to Prostatic carcinoma

85. 68y man elevated serum PSA (>6 ng/mL). Biopsy of
the prostate reveals a poorly differentiated
adenocarcinoma. Which of the following best
describes the putative precursor of this neoplasm?
1 2 3 4 5
6%
4%
89%
0%
2%
1.Basal cell hyperplasia
2.Chronic prostatitis
3.Obstructive uropathy
4.Nodular BPH
5.PIN.

86. 55y man, urinary urgency and frequency. 55y man, urinary urgency and frequency.
DRE enlarged prostate. PSA of 4.9 (normal = DRE enlarged prostate. PSA of 4.9 (normal =
0–4). Needle biopsy - two cancer-positive 0–4). Needle biopsy - two cancer-positive
needle cores: Gleason grades 4 and 5. Which needle cores: Gleason grades 4 and 5. Which
of the following is the appropriate diagnosis? of the following is the appropriate diagnosis?
1 2 3 4 5
84%
6%
2%
0%
8%
1.Adenocarcinoma
2.Nodular BPH
3.PIN-3
4.Squamous Carcinoma
5.Transitional
Carcinoma

87. 68y male, Image shows prostate biopsy. What is 68y male, Image shows prostate biopsy. What is
the most likely complication?the most likely complication?
1 2 3 4 5
7%
83%
0%
2%
7%
1.Destructive vertebral lesions.
2.Bladder hypertrophy.
3.Calcium oxalate nephrolithiasis.
4.Gram negative septicemia.
5.Infertility.

88. 68y male, Image shows Bladder & prostate. What 68y male, Image shows Bladder & prostate. What
complication is complication is notnot shown? shown?
1 2 3 4 5
4% 4%
5%
76%
11%
1.Invasive bladder cancer.
2.BPH.
3.Ball valve obstruction.
4.Bladder diverticula.
5.Tumor necrosis & hemorrhage.

89. Today is the First Day, Today is the First Day,
of Rest of Your Life...!of Rest of Your Life...!

90. CPC-4.3– KFP Questions:CPC-4.3– KFP Questions:
BPH – etiology, Pathogenesis, morphology &
complications.
Testosterone, DHT, Fenosteride.
TURP – brief notes.
Prostatic carcinoma – etiology, Pathogenesis,
morphology & spread, metastases.
Staging, Grading & Prognosis.
Urolithiasis : Renal stones
Other obstructive uropathy.

91. Referral - if >5 mm or has
not passed after two weeks.
US
X-Ray
no contrast
Helical CT
Management

92. 70y male70y male
Problems passing urine.
Difficult to start even though he badly
needs to go. After passing.. He feels the
urge but cannot pass..
High frequency, 2-3 times in the night.
For several months getting slowly worse
Now urine dribbles, Added to this, the
force with which he can urinate is very
much reduced and it is difficult for him
to avoid soiling his clothing.

93. 70y male70y male
What are differential diagnosis?
What complication he has?
Should PSA be tested for all?
When is biopsy indicated?
Does BPH lead to Carcinoma?
What is the best screening test for Ca?
What investigations are available?

94. Prostatic neoplasms: OverviewProstatic neoplasms: Overview
RareNormalMicroscopic
focus of
adenocarcin
oma
Any siteCommoner
than
clinical
carcinoma;
80% of
glands over
75 years
Latent
(incidental)
carcinoma
Bone
Lymph
node
Lung
Liver
Raised in
approximately
60% of cases
Infiltrating
adenocarcin
oma
Posterior
subcapsular
zone
Common
tumour;
peak 60-85
years
Clinical
(symptomatic)
carcinoma
NoneNormalNodular
hyperplasia
of glands
and stroma
Peri-urethral
zone
75% of men
>70 years
Benign
nodular
hyperplasia
Metastas
es
Serum acid
phosphatase
MorphologyLocation in
gland
IncidenceCondition