Carsinoma prostate and is most commonly diagnosed malignancy of urinary tract after the second most common bladder malignancy in American men. Of all malignancies; prevalence of prostate cancer increased most rapidly according to age. Prostate malignancy is usually discovered at the age above 50 years and rarely under 50 years old.
In Indonesia there are no exact numbers about the incidence and mortality from prostate cancer, but based on the observations of experts urology; incidence of prostate cancer tended to increase. Handling of prostate cancer in Indonesia is still far from adequate when compared to developed countries. The cause is due to patient factors; manager; infrastructure and service system. And only patients who were diagnosed in early stages and getting adequate treatment that has a hope of a cure. Patients with advanced prostate cancer, either local or systemic handling only a palliative.
The incidence of prostate cancer in geographic and racial, occurs more frequently in blacks in California compared to Country address on the Shanghai or Chinese populations (Robin). African-American people at greater risk for prostate cancer than men putib skin. In addition, African-American men tend to exhibit more severe stage of disease than white men (Morton & Terrell). The problems faced in prostate cancer is early detection, because the character of "sub clinical" and most often resulted after the autopsy examination of the prostate gland or prostatectomy on prostate hiperplasi (Douglas E. Johnson). Many researchers using digital rectal examination, ultrasound trans (then) and Prostate Specific Antigen examination for early diagnosis of prostate cancer. This check is felt most good and economical.
Anatomy of the prostate gland
The prostate is an inverted cone-shaped gland that is wrapped by a fibro-muscular capsule located in the inferior of the bladder. Normal weight: 18-20 grams, in which there are long posterior urethra 2.5 cm, 3.5 cm in size of the prostate on transverse cuts on the base and 2.5 cm pieces and Antero-posterior vertical. Prostate tissue in the front buffer is the ligament on the inferior puboprostatikum and urogenital diaphragm. Prostatic ducts in the rear penetrated ejakulotorius running oblique to penetrate veromontanum prostatic urethra at the base, just diproksimal of the external urethral sfinkter.
In macroscopic prostate consists of smooth muscle and connective tissue, this organ produces secretions which provide the distinctive smell of semen. Sections:
- Apex: the lower part of the prostate, located approximately 12 cm from the bottom edge symphisis posterior pubis.
- Base: the prostate is located in the horizontal plane as high as the mid symphisis pubis.
- Inferolateral surfaces: a convex part which is separated from the urogenital diaphragm by facies superior plexus venosus. anterior surface: separated from fat tissue symphisis by retro-pubic legamentum pubo prostatikum attached to the medial anterior surface of this.
- Posterior surface: flat and where there is a triangular median groove, the posterior surface can be palpated by digital rectal.
Prostate lobe
According to the classification of Lowsley, the prostate is divided into five Lobos, namely:
- The anterior lobe
- The posterior lobe
- Medial lobes
- Right lateral lobe
- The left lateral lobe
Me, while according to Neal, the prostate is divided
- Peripheral zone
- Central zones
- Transitional zone
- The anterior segment
- Pre prostatik sfinkter zone
Microscopic: prostate gland consists of 30-50 branched tubulo-alveolur who issued sekretnya into prostalika urethra during ejaculation. Wrap prostate fibro-elastic capsule which contains smooth muscle, epithelial layer of cylindrical pseudo complex or until kuboid low, depending on gland secretion, basal laminae thin, and underneath there is smooth muscle tissue.
Vascularities
Prostate receive blood from: A.pudenda internal, inferior A.vesikalis which is one branch of A. iliaca intema, entered into the prostate at the border of the prostate and VU, and A. Hemorholdalls medius. Venous blood flowed back through the plexus venosus prostaticus are then forwarded to the V. internal iliaca.
Lymphe
Lympe flow from the prostate mostly channeled to the Inn. iliaca internal, but there are some who go to the Inn iliaca externa. A small entrance into the Inn sacralis.
Innervation
Prostate diinervasi by nervosus prostaticus plexus.
PHYSIOLOGY prostate gland
The prostate is an organ which is subject to endocrine influence. Knowledge about the nature of this endocrine still uncertain, but it is clear that castration causes reduced prostate gland. In animal experiments, if appointed, the pituitary gland prostate will shrink, atrophy can be prevented by administration of testosterone. Subsequent experiment showed that the prostate will be enlarged after the administration of estrogen in the castrated animals. Estrogen-sensitive part is the middle part, while the edge is sensitive to androgens. Therefore, in older people who experience hiperplasi tengahlah part due to reduced androgen secretion so that the relative increase in estrogen levels. Prostate gland cells can form the enzyme acid phosphatase were the most active work at ph 5. Prostate gland to secrete a milky white fluid and is alkaline. This fluid contains citric acid, acid phosphatase, calcium, and coagulation and fibrinolysis. During discharge the prostate, prostate capsule will contract along with the contraction of the vas deferen and prostatic fluid out of cement mixed with others.
70% prostate fluid is ejaculate fluid volume and function is to provide food and keep spermatozon spermatozon not die quickly in the body of women, vaginal secretions, which is very acidic (pH: 3.5 to 4). Thus sperm can live longer and can continue the journey to and perform tubal uterine insemination.
Aetiology AND RISK FACTORS
The etiology of prostate carcinoma is not known with certainty, but with the suspected cause of the epidemiology of prostate carcinoma on someone not entirely clear. Some risk factors that include:
1. Genetic factors
Presumably if the family such as father / brother (first degree relative) and grandparents / uncles (second degree relative) got the risk of prostate malignancy karsinorna prostate three times (Robin).
Blacks in the United States have a mortality rate twice and whites (Douglas E Johnsons).
But whether environmental factors influence the genetic factors are also difficult to determine.
2. Hormonal factors
Androgen action in prostate epithelial cells, testosterone-free entry into the cell with the help dehidrotestosteron enzyme 5 alpha reductase. Steroid receptor complex with specific DNA will niengakibatkan m RNA and protein synthesis has the effect of metabolic and proliferative (Ronijn)
3. Dietary and environmental factors
Dietary factors ie diet contains a lot of animal fat and the difference in prostate cancer incidence in populations with different race and environment, as for example the second and third generation Japanese people residing in America have the same incident with the people in North America, while the incidence of prostate cancer in Japan only 10% of the incidents in America.
4. Factor infection
Presumably the bacteria and viruses can affect the occurrence of prostate ca, but this factor is still a debate.
Among these risk factors, risk factors for hereditary (genetic) and dietary factors have been shown to be a risk for prostate carcinoma. If there is one line of men who suffer from family relationships prostate carcinoma, prostate carcinoma is likely to be hit 2 times and when there are two male line of prostate carcinoma suffer then it is likely to be affected by prostate carcinoma in 5 to 11 times.
For dietary risk factors, which contains a lot of animal fat. Japanese men rarely suffer from prostate carcinoma, but after moving into the mainland United States and changed his diet, the consumption pattern of prostate carcinoma incidence in Japanese immigrants with white American society.
Histological
Prostate malignancy is usually a small gland acinus mengilfiltrasi in the form beraturan.karsinoma irreguler and not originating from the prostate gland becomes hipertropik decade at the age of five to seven. Seems to have started the process of becoming malignant prostate tissue is still young. The most common prostate carcinoma (60-70%) occurred in the peripheral zone, while 10-20% originated 50-10% transition zone and in central zones.
The degree of malignancy (histopathologizal grading) is based on the system developed by Gleason. Based on the architecture of the network rather than on the picture Carsinoma prostate cells individually. Prostate is histological Carsinoma usually shows five architectural patterns. Gleason score is the sum of primary and secondary architectural patterns are dominant. This score ranged from 2 to 10 examples of 3 +4 = 7. SCOR Gleason 2-10 range is strongly correlated with the number survavilitas rough, survavilitas tumor free, and causa survavilitas spisifik-time predictor for recurrence after radical prostatectomy
CLINICAL PICTURE
Prostate cancer symptoms vary, but the principle is there:
1. Blader out flow obstruktion (BOO) such as: frequency, hesistensi, poor stream.
2. local extension of tumor.
Clinical features in accordance with the staging of prostate Ca:
1.Ca prostate is still terlokalisr:
1. asimptomatic
2. PSA increase
3. poor stream
4. sensation of residual urine
5. frequency of
6. urgency
2.Ca locally advanced prostate
1. Hematuri
2. Disuri
3. Suprapubic and perineal pain
4. Impotence
5. Incontinence
6. kidney failure symptoms
7. haemospermia.
Who had metastatic prostate 3.Ca
1. Bone pain or isialgia
2. paraplegi
3. lymph node enlargement
4. anuri
5. lethargy (anemia, uremia)
6. losing weight and caceksia
7. intestinal bleeding and skin
In Indonesia there are no exact numbers about the incidence and mortality from prostate cancer, but based on the observations of experts urology; incidence of prostate cancer tended to increase. Handling of prostate cancer in Indonesia is still far from adequate when compared to developed countries. The cause is due to patient factors; manager; infrastructure and service system. And only patients who were diagnosed in early stages and getting adequate treatment that has a hope of a cure. Patients with advanced prostate cancer, either local or systemic handling only a palliative.
The incidence of prostate cancer in geographic and racial, occurs more frequently in blacks in California compared to Country address on the Shanghai or Chinese populations (Robin). African-American people at greater risk for prostate cancer than men putib skin. In addition, African-American men tend to exhibit more severe stage of disease than white men (Morton & Terrell). The problems faced in prostate cancer is early detection, because the character of "sub clinical" and most often resulted after the autopsy examination of the prostate gland or prostatectomy on prostate hiperplasi (Douglas E. Johnson). Many researchers using digital rectal examination, ultrasound trans (then) and Prostate Specific Antigen examination for early diagnosis of prostate cancer. This check is felt most good and economical.
Anatomy of the prostate gland
The prostate is an inverted cone-shaped gland that is wrapped by a fibro-muscular capsule located in the inferior of the bladder. Normal weight: 18-20 grams, in which there are long posterior urethra 2.5 cm, 3.5 cm in size of the prostate on transverse cuts on the base and 2.5 cm pieces and Antero-posterior vertical. Prostate tissue in the front buffer is the ligament on the inferior puboprostatikum and urogenital diaphragm. Prostatic ducts in the rear penetrated ejakulotorius running oblique to penetrate veromontanum prostatic urethra at the base, just diproksimal of the external urethral sfinkter.
In macroscopic prostate consists of smooth muscle and connective tissue, this organ produces secretions which provide the distinctive smell of semen. Sections:
- Apex: the lower part of the prostate, located approximately 12 cm from the bottom edge symphisis posterior pubis.
- Base: the prostate is located in the horizontal plane as high as the mid symphisis pubis.
- Inferolateral surfaces: a convex part which is separated from the urogenital diaphragm by facies superior plexus venosus. anterior surface: separated from fat tissue symphisis by retro-pubic legamentum pubo prostatikum attached to the medial anterior surface of this.
- Posterior surface: flat and where there is a triangular median groove, the posterior surface can be palpated by digital rectal.
Prostate lobe
According to the classification of Lowsley, the prostate is divided into five Lobos, namely:
- The anterior lobe
- The posterior lobe
- Medial lobes
- Right lateral lobe
- The left lateral lobe
Me, while according to Neal, the prostate is divided
- Peripheral zone
- Central zones
- Transitional zone
- The anterior segment
- Pre prostatik sfinkter zone
Microscopic: prostate gland consists of 30-50 branched tubulo-alveolur who issued sekretnya into prostalika urethra during ejaculation. Wrap prostate fibro-elastic capsule which contains smooth muscle, epithelial layer of cylindrical pseudo complex or until kuboid low, depending on gland secretion, basal laminae thin, and underneath there is smooth muscle tissue.
Vascularities
Prostate receive blood from: A.pudenda internal, inferior A.vesikalis which is one branch of A. iliaca intema, entered into the prostate at the border of the prostate and VU, and A. Hemorholdalls medius. Venous blood flowed back through the plexus venosus prostaticus are then forwarded to the V. internal iliaca.
Lymphe
Lympe flow from the prostate mostly channeled to the Inn. iliaca internal, but there are some who go to the Inn iliaca externa. A small entrance into the Inn sacralis.
Innervation
Prostate diinervasi by nervosus prostaticus plexus.
PHYSIOLOGY prostate gland
The prostate is an organ which is subject to endocrine influence. Knowledge about the nature of this endocrine still uncertain, but it is clear that castration causes reduced prostate gland. In animal experiments, if appointed, the pituitary gland prostate will shrink, atrophy can be prevented by administration of testosterone. Subsequent experiment showed that the prostate will be enlarged after the administration of estrogen in the castrated animals. Estrogen-sensitive part is the middle part, while the edge is sensitive to androgens. Therefore, in older people who experience hiperplasi tengahlah part due to reduced androgen secretion so that the relative increase in estrogen levels. Prostate gland cells can form the enzyme acid phosphatase were the most active work at ph 5. Prostate gland to secrete a milky white fluid and is alkaline. This fluid contains citric acid, acid phosphatase, calcium, and coagulation and fibrinolysis. During discharge the prostate, prostate capsule will contract along with the contraction of the vas deferen and prostatic fluid out of cement mixed with others.
70% prostate fluid is ejaculate fluid volume and function is to provide food and keep spermatozon spermatozon not die quickly in the body of women, vaginal secretions, which is very acidic (pH: 3.5 to 4). Thus sperm can live longer and can continue the journey to and perform tubal uterine insemination.
Aetiology AND RISK FACTORS
The etiology of prostate carcinoma is not known with certainty, but with the suspected cause of the epidemiology of prostate carcinoma on someone not entirely clear. Some risk factors that include:
1. Genetic factors
Presumably if the family such as father / brother (first degree relative) and grandparents / uncles (second degree relative) got the risk of prostate malignancy karsinorna prostate three times (Robin).
Blacks in the United States have a mortality rate twice and whites (Douglas E Johnsons).
But whether environmental factors influence the genetic factors are also difficult to determine.
2. Hormonal factors
Androgen action in prostate epithelial cells, testosterone-free entry into the cell with the help dehidrotestosteron enzyme 5 alpha reductase. Steroid receptor complex with specific DNA will niengakibatkan m RNA and protein synthesis has the effect of metabolic and proliferative (Ronijn)
3. Dietary and environmental factors
Dietary factors ie diet contains a lot of animal fat and the difference in prostate cancer incidence in populations with different race and environment, as for example the second and third generation Japanese people residing in America have the same incident with the people in North America, while the incidence of prostate cancer in Japan only 10% of the incidents in America.
4. Factor infection
Presumably the bacteria and viruses can affect the occurrence of prostate ca, but this factor is still a debate.
Among these risk factors, risk factors for hereditary (genetic) and dietary factors have been shown to be a risk for prostate carcinoma. If there is one line of men who suffer from family relationships prostate carcinoma, prostate carcinoma is likely to be hit 2 times and when there are two male line of prostate carcinoma suffer then it is likely to be affected by prostate carcinoma in 5 to 11 times.
For dietary risk factors, which contains a lot of animal fat. Japanese men rarely suffer from prostate carcinoma, but after moving into the mainland United States and changed his diet, the consumption pattern of prostate carcinoma incidence in Japanese immigrants with white American society.
Histological
Prostate malignancy is usually a small gland acinus mengilfiltrasi in the form beraturan.karsinoma irreguler and not originating from the prostate gland becomes hipertropik decade at the age of five to seven. Seems to have started the process of becoming malignant prostate tissue is still young. The most common prostate carcinoma (60-70%) occurred in the peripheral zone, while 10-20% originated 50-10% transition zone and in central zones.
The degree of malignancy (histopathologizal grading) is based on the system developed by Gleason. Based on the architecture of the network rather than on the picture Carsinoma prostate cells individually. Prostate is histological Carsinoma usually shows five architectural patterns. Gleason score is the sum of primary and secondary architectural patterns are dominant. This score ranged from 2 to 10 examples of 3 +4 = 7. SCOR Gleason 2-10 range is strongly correlated with the number survavilitas rough, survavilitas tumor free, and causa survavilitas spisifik-time predictor for recurrence after radical prostatectomy
CLINICAL PICTURE
Prostate cancer symptoms vary, but the principle is there:
1. Blader out flow obstruktion (BOO) such as: frequency, hesistensi, poor stream.
2. local extension of tumor.
Clinical features in accordance with the staging of prostate Ca:
1.Ca prostate is still terlokalisr:
1. asimptomatic
2. PSA increase
3. poor stream
4. sensation of residual urine
5. frequency of
6. urgency
2.Ca locally advanced prostate
1. Hematuri
2. Disuri
3. Suprapubic and perineal pain
4. Impotence
5. Incontinence
6. kidney failure symptoms
7. haemospermia.
Who had metastatic prostate 3.Ca
1. Bone pain or isialgia
2. paraplegi
3. lymph node enlargement
4. anuri
5. lethargy (anemia, uremia)
6. losing weight and caceksia
7. intestinal bleeding and skin
0 comments:
Post a Comment