Advertisement

Problema: malattie prostatiche (infezione, ipertrofia benigna e cancro della prostata)

  • S. Alan McNeill
  • Steve Ken Wing Leung
  • M. C. Bishop

Riassunto

L’ipertrofia benigna della prostata (Benign Prostatic Hyperplasia, BPH) e il cancro della prostata sono due malattie distinte che comunemente colpiscono la prostata degli uomini nella fase dell’invecchiamento. La prostata è una ghiandola sessuale accessoria, situata intorno all’uretra alla base della vescica, le cui dimensioni aumentano dopo la pubertà sotto l’influenza del testosterone. I tessuti ghiandolari della prostata sono organizzati in tre zone, come descritto da McNeal (1981,1988). Queste affezioni hanno la tendenza a colpire parti differenti della ghiandola. La BPH colpisce quasi esclusivamente la zona di transizione della prostata che circonda l’uretra. Benché possa anche sopraggiungere nelle zone centrali e di transizione, il cancro della prostata interessa il più delle volte la zona periferica della ghiandola, ragione per la quale l’esplorazione rettale (Digital Rectal Examination, DRE) è molto utile alla valutazione della prostata. Poiché queste malattie colpiscono di preferenza regioni distinte, non sorprende che la BPH tenda a presentarsi con sintomi legati all’ostruzione urinaria più precocemente del cancro della prostata, mentre i pazienti che presentano sintomi di ostruzione urinaria per cancro della prostata saranno spesso a uno stadio avanzato della malattia (Fig. 1.9.1).
Fig. I.9.1.

Anatomia regionale della prostata

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Bibliografia

  1. Albertsen PC, Hanley JA, Gleason DF, Barry MJ (1998) Competing risk analysis of men aged55 to74 years at diagnosis managed conservatively for clinically localized prostate cancer. JAMA 280:975–980CrossRefPubMedGoogle Scholar
  2. Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479PubMedGoogle Scholar
  3. Gleason DF, Mellinger GT (1974) Prediction of prognosis for prostatic adenocarcinoma by combined histological grading and clinical staging. J Urol 111:58–64PubMedGoogle Scholar
  4. Grimm PD, Blasko JD, Sylvester JE, Meier RM, Cavanagh W (2001) 10-year biochemical (prostate-specific antigen) control of prostate cancer with (125)I brachytherapy. Int J Radiat Oncol Biol Phys 51:31–40PubMedGoogle Scholar
  5. Han M, Partin AW, Zahurak M et al (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The5-year Johns Hopkins experience. Urol Clin North Am 28:555–565CrossRefPubMedGoogle Scholar
  6. Huggins C, Hodges CV (1941) Studies on prostate cancer I. The effect of castration, of estrogen and of androgen injection on serum phosphatase in metastatic cancer of the prostate. Cancer Res 1:293–297Google Scholar
  7. McConnell JD, Bruskewitz R et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 338:557–563CrossRefPubMedGoogle Scholar
  8. McConnell JD, Roehrborn CG et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349:2387–2398CrossRefPubMedGoogle Scholar
  9. McNeal JE (1981) The zonal anatomy of the prostate. Prostate 2:35–49CrossRefPubMedGoogle Scholar
  10. McNeal JE (1988) Normal histology of the prostate. Am J Surg Pathol 12:619–633CrossRefPubMedGoogle Scholar
  11. Meluch AA, Greco FA, Burris HA et al (2004) Weekly paclitaxel/estramustine phosphate plus carboplatin administered either weekly or every 4 weeks in the treatment of hormone refractory prostate cancer (HRPC): a randomised phase II trial of the Minnie Pearl Cancer Research Network. J Clin Onc 21(14S) (421s): Abstract No. 4659Google Scholar
  12. Mills N, Donovan JL, Smith M et al (2003) Perceptions of equipoise are crucial to trial participation: a qualitative study of men in the ProtecT study. Control Clin Trials 24:272–282CrossRefPubMedGoogle Scholar
  13. Perez CA, Michalski JM, Mansur D, Lockett MA (2002) Three dimensional conformal therapy versus standard radiation therapy in localized carcinoma of prostate: an update. Clin Prostate Cancer 1:97–104PubMedGoogle Scholar
  14. Reiter RE, de Kernion JB (2002) Epidemiology, etiology and prevention of prostate cancer. In: Campbell’s urology, 8th edn. WB Saunders, PhiladelphiaGoogle Scholar
  15. Roehrborn CG, Boyle P, Nickle JC et al (2002) Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 60:434–441CrossRefPubMedGoogle Scholar
  16. See WA, Wirth MP et al (2002) Bicalutamide as immediate therapy either alone or as adjuvant to standard care of patients with localized or locally advanced prostate cancer: first analysis of the early prostate cancer program. J Urol 168:429–435CrossRefPubMedGoogle Scholar

Bibliografia

  1. Anderson RU (2002) Management of chronic prostatitis-chronic pelvic pain syndrome. Urol Clin North Am 29:235–239CrossRefPubMedGoogle Scholar
  2. Barbalias GA (2003) Why alphablockers in prostatitis? Eur Urol Suppl 2:27–29CrossRefGoogle Scholar
  3. Brähler E, Wurz J, Unger U et al (1997) The Giessen Prostatitis Symptom Score. Standardisation of the questionnaire and prevalence of symptoms. J Urol 157:239Google Scholar
  4. Drach GW, Fair WR, Meares EM et al (1978) Classification of benign disease as associated with prostatic pain: prostatitis or prostatodynia? J Urol 120:266–269PubMedGoogle Scholar
  5. Elert A, Von Knobloch R, Nusser R et al (2000) Isolated candidal prostatitis. J Urol 163:244CrossRefPubMedGoogle Scholar
  6. Fall M, Baranowski AP, Fowler CJ et al (2004) EAU guidelines on chronic pelvic pain. Eur Urol 46:681–689CrossRefPubMedGoogle Scholar
  7. Hochreiter WW, Duncan JL, Schaeffer AJ (2000) Evaluation of the bacterial flora of the prostate using a 16SrRNA gene based polymerase chain reaction. J Urol 163:127–130CrossRefPubMedGoogle Scholar
  8. Krieger JN, Nyberg L, Nickel JC (1999) NIH consensus, definition and classification of prostatitis. JAMA 282:236–237CrossRefPubMedGoogle Scholar
  9. Krieger JN, Takahashi S, Riley DE (2003) Chronic prostatitis: role of uncommon organisms. Eur Urol Suppl 2:19–22CrossRefGoogle Scholar
  10. Leskinen M, Lukkarinen O, Marttila T (1999) Effects of Finasteride in patients with inflammatory chronic pelvic pain syndrome: a double blind, placebo controlled pilot study. Urology 53:502–505CrossRefPubMedGoogle Scholar
  11. Lummus WE, Thompson I (2001) Prostatitis. Emerg Med Clin North Am 19:691–707CrossRefPubMedGoogle Scholar
  12. McNaughton-Collins M, O’Leary MP, Litwin MS et al (2000b) Fowler FJ, Elliott DB et al (2000a) Diagnosing and treating prostatitis: do urologists do the four glass test? Urology 55:403–407CrossRefPubMedGoogle Scholar
  13. McNaughton-Collins M, Quality of life is impaired in men with chronic prostatitis: results from the NIH cohort study. J Urol 163 [Supp l]:23Google Scholar
  14. Meares EM, Stamey TA (1968) Bacteriologic localisation patterns in bacterial prostatitis and urethritis. Invest Urol 5:492–518PubMedGoogle Scholar
  15. Naber KG, Busch W, Focht J (2000) The German Prostatitis Study Group. Ciprofloxacin in the treatment of chronic bacterial prostatitis: prospective, non-comparative multicentre clinical trial with long term follow up. Int J Antimicrobial Agents 14:143–149CrossRefGoogle Scholar
  16. Nadler RB, Koch AE, Calhoun EA et al (2000) IL-1 beta and TNF-alpha in prostatic secretions are indicators in the evaluation of men with chronic prostatitis. J Urol 164:214–218CrossRefPubMedGoogle Scholar
  17. Nickel AC (1930) The bacteriology of chronic prostatitis and seminal vesiculitis and elective localisation of the bacteria as isolated. J Urol 24:343–346Google Scholar
  18. Nickel JC (1997) The role of the animal model in the study of prostatitis. In: Bergen T (ed) Urinary tract infections. Infectiology, vol. 1. Kager, Basel, pp 89–97CrossRefGoogle Scholar
  19. Nickel JC (1998) Effective office management of chronic prostatitis. Urol Clin North Am 25:677–684CrossRefPubMedGoogle Scholar
  20. Nickel JC (2000) Chronic prostatitis: an infectious disease? Infect Urol 13:31–38Google Scholar
  21. Nickel JC, Alexander R, Anderson R et al (1999) Prostatism unplugged? Prostatic massage revisited. Tech Urol 5:1–7PubMedGoogle Scholar
  22. Pewitt EB, Schaeffer AJ (1997) Urinary tract infection in urology, including acute and chronic prostatitis. Infect Dis Clin North Am 11:623–646CrossRefPubMedGoogle Scholar
  23. Potts JM (2000) Prospective identification of national institutes of health Category IV prostatitis in men with elevated prostate specific antigen. J Urol 164:1550–1553CrossRefPubMedGoogle Scholar
  24. Potts JM (2003) Alternative approaches to the management of prostatitis: biofeedback, progressive relaxation, the concept of somatic syndromes. Eur Urol Suppl 2:34–37CrossRefGoogle Scholar
  25. Schaeffer AJ (2003) Epidemiology and demographics of prostatitis. Eur Urol Suppl 2:5–10CrossRefGoogle Scholar
  26. Shahed A, Shoskes DA (2000) Oxidative stress in prostatic fluid of men with chronic pelvic pain syndrome: correlation with bacterial growth and treatment response. J Urol 163 Suppl:24Google Scholar
  27. Shoskes DA, Shahed A (2000) Presence of bacterial signal in expressed prostatic secretions predicts response to antibiotic therapy in men with chronic pelvic pain syndrome. J Urol 163 Suppl:23Google Scholar
  28. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J (1999) Quercetin in men with Category III chronic prostatitis: a preliminary prospective, double blind, placebo controlled trial. Urology 54:960–963CrossRefPubMedGoogle Scholar
  29. Shoskes DA, Mazurick C, Landis R et al (2000) Bacterial cultures of urine, prostatic fluid and semen of men with chronic pelvic pain syndrome: airole of culture for two vs five days. J Urol 163 (Suppl):24Google Scholar
  30. Tchetgen MB, Oesterling JE (1997) The effect of prostatitis, urinary retention, ejaculation and ambulation on the serum PSA. Urol Clin North Am 24:283–286CrossRefPubMedGoogle Scholar
  31. True LD, Berger RE, Rothman I et al (1999) Prostate histopathology and chronic prostatitis/chronic pelvic pain syndrome: a prospective biopsy study. J Urol 162:2014–2018CrossRefPubMedGoogle Scholar
  32. Weidner W, Ludwig M (2003) Common organisms in urogenital infections with special impact on prostatitis. Eur Urol Suppl 2:15–18CrossRefGoogle Scholar
  33. Weidner W, Jantos C, Schiefer HG et al (1991) Semen parameters in men with and without proven chronic prostatitis. Arch Androl 26:173–183CrossRefPubMedGoogle Scholar
  34. Weidner W, Ludwig M, Schiefer HG (1997) Chronic bacterial prostatitis — a clinical re-evaluation of old woes. In: Bergen T (ed) Urinary tract infections. Infectiology, vol. 1. Karger, Basel, pp 60–66CrossRefGoogle Scholar
  35. Weidner W, Ludwig M, Brähler E, Schiefer HG (1999) Outcome of antibiotic therapy with Ciprofloxacin in chronic bacterial prostatitis. Drugs 58 [Suppl 2]:103–106CrossRefPubMedGoogle Scholar
  36. Wenninger K, Heiman JR, Rothman I et al (1996) Sickness impact of chronic nonbacterial prostatitis and its correlates. J Urol 155:956–968CrossRefGoogle Scholar
  37. Wessely S, Nimnuan C, Sharpe M (1999) Functional somatic syndromes: one or many? Lancet 354:936–939CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2010

Authors and Affiliations

  • S. Alan McNeill
    • 1
  • Steve Ken Wing Leung
    • 2
  • M. C. Bishop
    • 3
  1. 1.Department of UrologyWestern General HospitalEdinburghUK
  2. 2.Prostate Research Group, School of Molecular and Clinical MedicineThe University of Edinburgh, Western General HospitalEdinburghUK
  3. 3.Department of UrologyNottingham City Hospital NHS TrustNottinghamUK

Personalised recommendations