Superficial Structures: Prostate

what is the normal range of PSA

0-4 ng/ml

Constitutes about 25% of the glandular tissue of the prostate, located between peripheral zone and transition zone

central zone

Inflammation of prostate of unknown etiology Incidence is eight times higher than bacterial prostatitis

chronic pelvic pain syndrome

what is the most common type of BPH?

combination of stromal and glandular hyperplasia

Form due to stasis when results in concentration and calcification of fluid in the ducts May cause symptoms such as hematospermia or painful ejaculation

ejaculatory duct calcifications

Cystic dilation of ejaculatory duct Contains spermatozoa

ejaculatory duct cyst

Found within the substance of prostate Form from prostatic fluid True prostatic stones

endogenous calcifications

Arise from remnants of mullerian duct and may extend lateral to midline and can be large

mullerian duct cyst

what type of male pelvic cyst can be associated with same side renal agensis?

seminal vesicle cyst

Paired saccular structures that lie obliquely and caudally to prostate that secrete fluid into the ejaculatory duct and contributes to semen

seminal vesicles

prostate abscess are associated with what?

1. acute bacterial prostatitis 2. diabetes

forms of treatment for BPH

1. balloon dilation 2. transurethral resection of the prostate 3. prostatectomy

common complaints associated to chronic bacterial prostatitis

1. discomfort in penis 2. dysuria 3. relapsing UTI

symptoms of prostate abscess

1. fever 2. chills 3. frequent urination 4. dysuria

signs and symptoms of acute bacterial prostatitis

1. fever 2. perineal pain

describe the US appearance of prostate abscess

1. focal or diffuse complex area 2. hypervascularity on color flow

signs and symptoms of BPH

1. frequent urination 2. nocturia 3. feeling of fullness in bladder 4. hematuria

normal US appearance of the prostate

1. homogenous 2. bright linear echoes of fibrous capsule

describe the US appearance of prostatitis

1. hypoechoic halo 2. enlargement of gland 3. increased vascularity

what are the four prostate zones?

1. peripheral 2. central 3. transition 4. periurethral

signs and symptoms of prostate carcinoma

1. weight loss 2. back pain 3. blood in urine/ semen 4. trouble urinating

what is the most common site of involvement of BPH

transition zone

an increase in PSA can be an indication of what pathologies?

1. BPH 2. chronic prostatitis 3. carcinoma 4. UTI

endogenous calcifications are associated with what?

1. BPH 2. prostatitis

Best system for early detection of prostate cancer is a combination of

1. PSA 2. digital rectal exam 3. transrectal ultrasound

An increase in PSA of ______ between 2 years, even if total PSA is normal, can be an indication for transrectal ultrasound (TRUS) and biopsy

20%

normal prostate size: width= length= height=

3.9-5.3cm 2-4 cm 2.1-3.4 cm

what is the average size of the prostate?

4 x 3 x 2

______ % of prostate carcinoma cases arise from the ___________ zone

70, peripheral

Produced by osteoblasts; therefore, level will rise whenever there is an increase in osteoblastic activity

Alk phos

Asymptomatic No evidence of bacterial infection or leukocytosis DRE often normal Typically diagnosed by biopsy which shows infection in cells

Asymptomatic Inflammatory Prostatitis

Prostate enlarges due to nodular formation within the transition zone Most common symptomatic tumor-like condition in male population

BPH

what lab value is the most sensitive single indicator of the presence of prostate cancer

PSA

Found in prostate gland and semen in high concentration Levels increase in carcinoma

acid phosphatase

type of prostatitis: Associated with large numbers of gram-negative bacteria in urine Prostate may feel hard, swollen, and very tender on DRE Treated with antibiotics

acute bacterial prostatitis

Found in urethra Formed primarily from urine May produce "eiffel tower" appearance

exogenous calcifications

what is the abnormal PSA level associated with prostate carcinoma?

greater than 4 ng/ml

the periurethral zone is also known as _______________

internal prostatic sphincter

what is the change in echogenicity of the transition zone due to BPH

it becomes more hyperechoic

large tumors associated with prostate carcinoma exhibit _______ resistance flow

low

Areas of hypervascularity in peripheral zone associated with isoechoic to hypoechoic definable lesions is an appearance seen with _________

prostate carcinoma

Most common cancer in American men 70% of cases are diagnosed in men over age 65 African Americans have 60% greater risk than Caucasians

prostate carcinoma

what vessels supply the prostate?

prostaticovesical arteries

patient prep for transabdominal vs transrectal exam

transabdominal: full bladder transrectal: empty bladder

Glandular grouping at crest of verumontanum

utricle

Due to dilation of prostatic utricle associated with unilateral renal agenesis

utricle cyst

Tubes that carry sperm from the testicles to the seminal vesicles

vas deferens

Longitudinal ridge on posterior wall of prostatic urethra Located at midpoint of prostatic urethra near apex Laterally flanked by openings of the ejaculatory ducts

verumontanum

what is the most common location for carcinoma and prostatitis?

within the peripheral zone