Abdomen: Prostate

What is PSA?

A protein produced exclusively by prostate cells. There is a simple blood test to measure your PSA level and this may help to detect early prostate cancer. The chance of having prostate cancer goes up as your PSA level increases.

BPH

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland . The prostate gland surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate gets bigger, it may squeeze or partly block the urethra.

4 zones of the prostate:

NON-GLANDULAR - Fibromuscular Stroma (FMS) GLANDULAR - Peripheral (PZ) - Central (CZ) - Transitional (TZ)

TURP

Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems due to an enlarged prostate. A combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The prostate surrounds the urethra. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking urine flow.

Central Zone (CZ)

o Comprises 25% of the glandular tissue o Located at the base of the prostate like a midline wedge b/t the peripheral and transition zones o Vas deferens and seminal vesicle ducts enter the central zone, and the ejaculatory ducts pass through to the verumontanum o Rarely affected by disease o Sono app ^More hyperechoic than that of the peripheral zone

Transitional zone (TZ)

o Comprises 5-10% of tissue and the periurethral glands o Consists of 2 small lobules found lateral to the prox urethral segment o Separated laterally and posteriorly from the other gland by the surgical capsule o Follow the long axis of the urethra toward the bladder neck o Most caudal segment is located at the vermontanum o BPH originates in this zone o 20% of cancers originate in this zone o Sono app ^Isoechoic to peripheral zone ^BPH may give zone a more hypoechoic appearance ^May see hyperechoic pattern of calculi that resembles the Eiffel tower

Peripheral Zone (PZ)

o Largest 70% of tissue o Most common site for prostate cancer and prostatitis o Occupies the posterior, lateral, and apical portions of the gland o Ducts of this zone enter the distal urethra b/t the verumontanum, a mound on the posterior wall of the prostatic urethra representing mid prostatic urethra, and apex o Sono app ^Homogeneous ^Isoechoic ^Separated from the central zone by a hyperechoic band called the surgical capsule

Danger Signs on DRE

• Firm to hard nodules • Irregularities, unequal lobes • Induration (process of becoming hard) • Stony hard prostate - Any palpable nodular abnormality suggests cancer and warrants investigation

TRUS (Trans Rectal U/S)

• PZ hyperechoic and homogenous - Echo poor inner gland - Normal anatomy changes with age • TZ enlargement compresses the PZ

What is a DRE?

• Prostate examined through the rectum with finger • DRE improves the value of PSA testing in early disease detection • DRE and PSA together are often able to detect prostate cancer better and sooner than either test alone

Prostate volume

• Three methods of calculating: • Height x Width x Length x 0.523 • 0.523 x [trans diam]3 • Step planimetry