The Prostate

Hormone Therapy for prostate cancer

in combination with radiation therapy. uses drugs to block natural hormones. In some cases the teste may need to be removed for this. Concers are impotence, hot flashes, lack of sex drive

Treatments for prostate Cancer

Surgery, Radiation Therapy, Hormone therapy, Chemotherapy

Prostatic Abscess

complex cystic appearance. untreated prostatitis. fecer chills urinary frequency, dysuria. May need to perform asperation

4 stages of prostate cancer

1- non palpable 2- palpable with in prostate 3- extends beyond prostate 4- mets

Transitional zone

- 5% of gland - consists of 2 small lobules located laterally to prox urethra -stroma is compact -Acini same as peripheral zone -BPH and cancer occur here 20% of the time

Central Zone

-25% of glandular tissue -located at base of prostate -Narrows to apex at verumontanum -surrounds ejaculatory ducts -separated from transitional zone by surgical capsule -Large with irregular bordered acini contrast to peripheral zone acini -Rarely affected by cancer

peripheral Zone

-70% of glandular tissue - posterior and lateral to urethra -apical portions of gland -acini are small and round and simple -Most common place for cancer

4 zones of the prostate

-peripheral zone -central zone (stems from Wolffian ducts) -transition zone -periurethral glandular zone

route the vasculature of the prostate

1. internal iliac arteries 2. inferior vesicular artery 3. urethral and capsular groups 4. venous drains through vas deferens 5. iliac veins

Normal Volume of adult prostate

15-30 ml

What constitutes semen

25-30% milky/white fluid from the prostate, along with spermatozoa and seminal vesicle fluid

Size of prostate

4 (sag) by 2 (AP) by 3 (trv)

How many need surgery for BPH

5-10% for relief of urinary tract infection, the gland changes configuration and obstructs urethra

How many lobes does the prostate have?

5; posterior, middle, anterior and 2 lateral they are not well defined some only divide it into median and two lateral

Name the zones and the percentage of tissue they make up

70% peripheral 25% central 5% transitional < 1% periurethral

Where do most cancers occur

75% occur in posterior lobe, mostly in peripheral and transitional regions

Peri-urethral glandular zone

<1% prostate tissue -embedded in smooth muscle of urethra -courses along most of the prostatic urethral segment -prone to calculi in the ducts because they open directly to urethra lumen

Which is more echogenic central or peripheral

Central

benign prostatic hypertrophy

Common in males over 50, 80% of males over 80 habe BPH. Large discrete nodules in the peri urethral region/ lateral or median lobes. Starts in transitional zone

Prostatic cyst

Congenital/ acquired. retention cysts seen in all glandular zones. simple anechoic, may see changes with BPH

Prostate Carcinoma

Most common reproductive structure to develop neoplastic groth in males. 2nd most common cancer in men. 3rd leading cause of death. 40-50% are over 70 yrs of age. More common in African American men

How does BPH affect the bladder

hypertrophy, trabeculation, and pseudodiverticuli

WHat is at the junction of seminal vesicles and vas deferens

The ejaculatory ducts

Mullerian duct cysts on ultrasound

anechoic with debris and or calcs, doesn't communicate with Wolffian duct, connects with bladder or seminal vesicle. Lateral from ML and superior to base of prostate gland

Anterior lobe of the prostate

anterior to the prostatic urethra

lateral lobes of prostate

are contiguous with other divisions dorsal to the urethra

Prostate cancer on ultrasound

asymmetric contour of gland, 2/3 of lesions are hypechoic and 1/3 are echogenic. TA has 80% sensitivity. Foci with shadowing may be seen

where is the bladder in regards to the prostate

cephalad

Surgical causes of prostate inflammation

catherterization, custoscopy, urethral dilation or resection

Where are peri-urethral vessels seen

centrally

D R E

digital rectal examination

Surgery on prostate cancer

early stages. removes all or part of the gland. concerns are impotence and urinary incontinence

Utricle cyst

endodermal in origin, associated with hypospadias, midline, smaller than Mullerian duct cyst, may have calcs, communicates with urethras=. Dribbling due to urinary retention.

BPH on ultrasound

enlarged and hypoechoic, focal disease may be mixed echogenicity

posterior lobe of prostate

extends from the ejaculatory ducts posteriorly

prostatic abscess on ultrasound

focal hypoechoic lesions with thickened walls involving any portion of the prostate

Prostatic inflammation

focal or diffuse inflammation; can create urinary retention.... caused by bacterial infection, resistance to antibiotics, irritation caused by backed up urine, chemical irritation, nerve issues, parasites

2/3 of the prostate is made of

glandular tissue

How does the prostate look?

homogeneous, trapezoid, low level echo texture, contour is smooth and well delineated

What does increased color signify

hyperplasic prostatitis - aka benign prostatic hypertrophy - common in men over 65

What supplies the prostate

inferior vesuculat artery which stems from internal iliac arteries, this terminates into the urethral and capsular groups, follows urethra and invades prostatic tissue

Volume equation

le ngth x width x height x 0.52

signs of prostate inflammation

low back pain, discomfort, dysuria, prostate enlargement. ultrasound would show enlarged gland with decreased internal echos

Mets of prostate cancer

may move to retroperitoneum and liver

Diverticulum of the ejaculatory duct of vas deferens

may occur due to distal obstruction of spermatic ductal system, this could be caused by congenital abnormality or inflammation. May be mistaken for seminal vesicle cyst. Seen between prostate and seminal vesicles. Calculi. Communicates with spermatic system.

Mullerian Duct Cysts

mesodermal in origin, caused by the failure of regression of Mullerian ducts, unilateral renal agenisis, arise off mid line between bladder and rectum and superior to base of prostate, stalk like... connectys with bladder or seminal vesicle

seminal vesicles

paired saccular structures, thin walled, vary in size and shape, hypoechoic. Reservoir for seminal fluid. Vas deferens adjacent. Should always visualize.

symptoms of Mullerian duct cysts

partial urinary obstruction, vague perineal pain

Most common location of prostate cancer

peripheral zone

Which zones have origins in the urogenital sinus

peripheral, transition, and periurethral

where are capsular vessels seen

peripherally

urtricle cyst symptoms

post void dribbling due to urinary retention

P V R

post void residual

transurethral resection of the prostate (TURP)

procedure of removing all or part of the prostate by the insertion of a resectoscope into the urethra, surgical cure for BPH. KEYHOLE SIGN.

P S A

prostatic specific Antigen

Pelvic cysts

rare, perineal pain and urinary retention occur. 4 kinds- Mullerian, seminal vesicle, prostatic, diverticulum of ED or VD

Where is the prostate located

retroperitoneum

verunontanum

ridge within the urethra where the ejaculatory ducts are coming in

prostatic specific antigen

secreted by the epithelial cells of the prostate gland; elevated with cancer and prostate disorders. 4-10 ng/ml

middle lobe of prostate

separated by the urethra anteriorly and the ejaculatory ducts posteriorly

Symptoms of BPH

symptoms include frequency, nocturia, overflow, dysuria and dribbling

what surrounds the prostate

thin fibrous capsule

What separates peripheral zone and central zone

thin hypoechoic band separating the two, surgical capsule that protects the central zone from cancer

Venous drainage of prostate

through veins leading to the vas deferens and into the iliac veins

What is the function of the prostate

to store and secrete a slightly alkaline fluid that usually constitutes 25-30% of the volume of the semen

T A

transabdominal

T R

transrectal

Seminal Vesicle Cyst

uncommon, renal agenesis is associated with it so look at both kidneys. Smaller than Mullerian duct cyst, located laterally

Eiffel tower sign

urethra shadowing on prostate ultrasound

Prostate carcinoma symptoms

urinary frequency, dysuria, enlarged prostate, elevated PSA, may be seen on CT, urography and ultrasound

Chemotherapy for prostate cancer

used for cancer that has spread and is not responding otherwise

Radiation therapy on prostate cancer

usually early stage or post surgery. either seeds or external. Seeds are apart of Brachytherapy. Concerns are impotence

over 10 p s a

very suspicious of cancer