Prostate Conditions

Acute prostatitis

This is acute inflammation of the prostate, which usually occurs in infection


– STIs e.g. Chlamydia trachomatis + Neisseria Gonorrhoeae (sexually active)

– E. Coli in older adults


UTI, retention with pain and haematospermia

– Dysuria with fever and chills


DRE gives tender prostate and secretions reveal bacteria


Antibiotics e.g. levofloxacin (Quinolone) or Trimethoprim

Benign prostatic hyperplasia (BPH)

This refers to hyperplasia of prostate which naturally occurs with age and is common

– It does not give increased risk for cancer, as it is the central zone which enlarges, not peripheral layer

– Testosterone Is converted to DHT by 5-a-reductase –> binds androgen receptors causing growth



– Voiding –> weak flow, hesitancy, terminal dribbling

– Storage –> Increased urgency, Frequency

– Microscopic haematuria

– Impaired bladder emptying gives increased risk of bladder diverticula + UTI



– Lifestyle changes –> avoid caffeine and alcohol + train bladder to control urgency

– a1 antagonists (Terazosin) –> relaxes smooth muscle and also lowers blood pressure

– 5a reductase inhibitors (Finasteride) –> blocks conversion of testosterone to DHT to reduce size

– If unresolving, then surgery – Transurethral resection of the prostate (TURP)

Prostate Cancer

This is a malignant proliferation of the prostate glands, that arises from the posterior zone of the prostate

– This means that it does not give the urinary symptoms very early on unlike BPH

– It is the most common cancer in men and 2nd most common cause of cancer deaths.

– It often spreads to lumbar spine and pelvis, giving bone metastases which increase alkaline phosphatase, PSA and prostatic acid phosphatase and gives hypercalcemia


Risk factors:

Age (80% in men > 80)

Family history

– Race (high in blacks)

– Diet high in unsaturated fat



Can be asymptomatic until cancer has progressed

– Urinary symptoms – nocturia, hesitancy, poor stream, dribbling and microscopic haematuria

– Weight loss and bone pain –> due to metastases



– Prostate serum antigen –> a serum PSA >10ng/mL suggests cancer

– Decreased % free-PSA suggests cancer, and the cancer makes bound PSA

– DRE –> gives hard, irregular prostate (non-tender)

– 1st line imaging is MRI –> can be followed by transrectal US and biopsy to confirm carcinoma

– Staging done by MRI –> if back pain is present, need a spine MRI to check for metastases



This is done using the Gleason grading system, based on architecture – higher score is worse

– A score (1-5) is given for two separate areas on biopsy, based on how abnormal the cells appear.



– Definitive treatment is surgical removal (Radical prostatectomy)

– Anti-testosterone therapy Flutamide (androgen receptor antagonist) and continuous GnRH analogs shut down pituitary gonadotrophs e.g. Leuprolide