Clinicopathological study of associated lesions in benign prostatic hyperplasia and prostatic adenocarcinoma in surgical biopsy specimens

Benign prostatic hyperplasia and prostatic adenocarcinoma are the two principle conditions involving prostate among elderly men in urology practice. It accounts for more than 90% of all prostatic diseases. The prostate undergoes significant growth during fetal development, puberty and in most men during late middle age. At the end of puberty the prostate reaches approximately 26 g. Benign prostatic hyperplasia occurs in individuals with intact testis and it is an androgen dependent disorder. The clinical incidence of this disease is only 8% during fourth decade, but it reaches 50% in the fifth decade and 75% in the eighth decade. BPH remains one of the major cause of obstructive urologic symptoms of patients coming to the urology out patient department. Transurethral resection of prostate remains the gold standard of treatment against which all other treatments of benign prostatic hyperplasia are measured. It is one of the most common procedure performed by urologists. After the introduction of screening for prostatic specific antigen, transrectal ultrasound and MRI prostate trucut needle biopsy became one of the most common urologic procedure to detect prostatic carcinoma. Among all the surgical specimens received for the study period of two years in the Institute of pathology, the most common were TURP specimens with benign prostatic hyperplasia (92.1%) constituting the commonest histological category. Adenoarcinomas were found in 7.9% of cases. Most of the adenocarcinomas were diagnosed in trucut needle biopsy (56%). About more than 90% of prostatic lesions studied were found in sixth to eighth decade. All cases of focal acinar/cystic atrophy showed increase in trend towards increasing age in decades. Among the hyperplastic lesions, basal cell hyperplasia was found to be the most common epithelial lesion (26 cases) compared to the other lesions such as postatrophic hyperplasia, clear cell cribriform hyperplasia etc. Transitional cell metaplasia was found to be the most common metaplastic lesion (23 cases) and about half of the cases were found in association with chronic prostatitis. About one fourth of the cases of squamous cell metaplasia were found in the periphery of areas of an infarct.