prostate

Base

Superior portion of the prostate gland, located below the inferior margin of the urinary bladder.

when does prostate begin to form?

11th week of gestation

normal size of prostate

4 cm x 3 cm x 2 cm

Corpora Amylacea

Calcifications commonly seen in the inner gland of the prostate.

Surgical Capsule

Demarcation between the inner gland (central and transitional zones) and the outer gland (peripheral zone), which normally appears hypoechoic, but may be echogenic if corpora amylacea or calcifications occur.

Penile Cross-Sectional Anatomy (slide)

Dorsal (posterior) side is touching the belly Ventral (anterior) side is the scanning surface When in the scanning position (penis pulled toward abdomen) the corpus spongiosum is directly under the transducer.

Ejaculatory Ducts

Duct that passes through the central zone and empties into the urethra; originates from the combination of the vas deferens and the seminal vesicles.

Apex

Inferior portion of the prostate gland, located superior to the urogenital diaphragm.

Verumontanum

Longitudinal elevation or ridge within the prosthetic urethral wall where the orifices of the ejaculatory ducts are located on either side.

most common of the pelvic cystic masses

Mullerian duct and utricle cysts

Seminal Vesicles

Pair of tubular glands that extend from the outpouching of the vas deferens; located superior and posterior to the prostate, between the bladder and the rectum.

Vas Deferens

Reproductive Duct that extends from the epididymis to the ejaculatory duct; also known as the ductus deferens.

Eiffel Tower Sign

Shadowing created by calcification in the area of the urethra and verumontanum.

base

cephalic portion of the gland

Most accurate method to calculate prostate function is-

calculating prostate specific antigen density (PSAD) (sometimes used for men with large prostate glands)

apex

caudal end of prostate

Paramesonephric aka

mullerian ducts (responsible for female reproductive system)

glandular tissue produces-

prostate specific antigen (PSA)

function of alkaline fluid

provides fluid transport for sperm

testosterone and dihydrotestosteron function

regulate prostate growth and function

capsular vessels

supply 2/3 of the glandular tissue (urethral arteries supply the other 1/3)

prostate-specific antigen (PSA)

the most common blood test utilized to identify men at risk of prostate cancer

internal iliac arteries bifurcate into-

the prostatic artery and inferior vesicle artery

Mesonephric aka

wolffian ducts (responsible for male reproductive system)

prostate cancer

• African American's have a 60% greater risk than Caucasians of developing prostate cancer, with a 2.3 times higher mortality rate. • PSA has become the primary test for identifying patients at risk of prostate cancer. However, it can be elevated in BPH and prostatitis as well. • Classically presents as a hypoechoic lesion. • Adenocarcinoma is the most commonly diagnosed prostate cancer with a vast majority arising from the peripheral zone.

priapism

• An erection that lasts longer than 4 hours; usually painful • Ischemic priapism happens when blood gets trapped in the erection chambers. • Drugs that may cause priapism: drugs for depression/mental illnesses, erectile dysfunction medication, marijuana, and cocaine.

anterior fibromuscular stroma

• Anteriorly located non-glandular region. • Not affected by cancer, prostatitis or hyperplasia because it is non-glandular.

Diverticulum of the Ejaculatory Duct or Vas Deferens

• Can occur due to distal obstruction of the spermatic ducts system by a congenital abnormality or inflammation.

peyronie's disease

• Caused by scar tissue (plaque) that forms inside the penis. This can result in a bent, rather than straight, erect penis. • Associated with connective tissue and autoimmune disorders such as Dupuytren's disase (trigger finger), plantar fasciitis, scleroderma, systemic lupus erythematosus, Sjogren's syndrome, and Behcet's syndrome.

prostatitis

• Color Doppler may be useful in detecting hyperemic flow, which is often associated with infection • Inflammation of the prostate as demonstrated by an increased number of leukocytes in prostatic fluid.

periurethral glandular zone (PG)

• Composes less than 1% of all prostatic glandular tissue and is embedded in the smooth muscle wall of the urethra. • Calculi often appear in the area and are thought to be secondary to reflux of urine into these ducts.

central zone (CZ)

• Comprises 25% of the glandular tissue.

transition zone (TZ)

• Comprises 5% of the glandular tissue. • Benign prostatic hypertrophy (BPH) originates in this zone. • 20% of cancers originate in this zone.

peripheral zone (PZ)

• Comprises 70% of glandular tissue. • Largest zone. • Most common site for prostate cancer and prostatitis.

prostate calcifications

• Extremely common, rarely give rise to any symptoms.

penile trauma

• Penile fracture is the traumatic rupture of the corpus cavernosum. Traumatic rupture of the penis is relatively uncommon and considered a urological emergency.

glandular tissue zones (2/3 of prostate)

• Peripheral zone • Transitional zone • Periurethral zone • Central zone

prostate surrounding structures

• Pubic bone - Anteriorly • Rectum - Posteriorly • Urinary bladder - Superiorly • Urogenital diaphragm - Inferiorly

Benign Prostatic Hyperplasia

• The most common symptomatic tumor-like condition in the male population Three types of BPH: • Homogeneous stromal hyperplasia, which is sonographically hypoechoic. • Glandular hyperplasia, may look hypoechoic or hyperechoic, depending on the cystic changes and gland size. • A combination of the other two types, stromal and glandular hyperplasia. This form is the most common and is heterogeneous in appearance.