Chapter 50: Prostate Disorders

Benign prostatic hyperplasia represents a common condition characterized by nodular tissue growth primarily in the transition zone surrounding the urethra, affecting the majority of men by their eighth decade of life with risk factors including advancing age and obesity. The pathophysiology involves both static obstruction from tissue accumulation and dynamic obstruction from increased smooth muscle tone mediated by adrenergic stimulation, alongside hormonal influences from dihydrotestosterone and estrogen. Clinical manifestations are classified as obstructive symptoms such as hesitancy and weak urinary stream, or irritative symptoms including nocturia and urinary frequency, with severity assessed using standardized scoring instruments like the American Urological Association Symptom Index. Management follows a progressive approach beginning with observation for mild cases, advancing to pharmacological interventions using alpha-adrenergic blockers to relax the bladder outlet or five-alpha-reductase inhibitors to reduce prostate volume, and culminating in surgical options such as transurethral resection when symptoms severely impact quality of life or complications develop. Prostatitis encompasses multiple clinical presentations ranging from acute bacterial infections presenting with fever and systemic symptoms to chronic conditions that may lack bacterial etiology, with diagnosis confirmed through urinalysis and culture while avoiding aggressive manipulation during acute infection due to sepsis risk. Antibiotic therapy with fluoroquinolones or trimethoprim-sulfamethoxazole forms the cornerstone of bacterial treatment, whereas nonbacterial forms require supportive care strategies. Prostate cancer constitutes the most frequently diagnosed malignancy in American men and represents a significant cause of cancer mortality, with screening using prostate-specific antigen remaining controversial given its lack of cancer specificity. Current diagnostic approaches emphasize informed patient decision-making regarding screening, confirmation through transrectal ultrasound-guided tissue sampling, and staging using the Gleason scoring system to assess tumor differentiation and aggressiveness. Treatment planning incorporates patient age, life expectancy, and disease risk stratification, employing curative surgical or radiation approaches in younger candidates while reserving observation or hormone-blocking therapies for older individuals or those with low-risk disease presentations.