DMS The Prostate Gland

Diagnosis for prostatic cancer remains to be

controversial; early diagnosis is difficult to make

Acute Prostatitis is easily diagnosed by

a urine test.

TURP - will diminish fertility - less invasive and traumatic surgery than transabdominal

....

exogenous calculi

developing or originating outside; calculi found in the urethra

The mesonephric ducts are responsible for

development of the male reproductive system,

Common complaints of Chronic Bacterial prostatitis include

discomfort in the penis, scrotum, and perineum, with irritative voiding symptoms such as dysuria, urgency, and frequency.

Prostate cancer behaves differently in

each anatomic zone

Sonographic characteristics of prostate disease include changes in _______________, _______________ of the gland, and a distorted _______________.

echogenicity; asymmetry; capsule

Which structure travels within the central zone of the prostate gland and joins the urethra?

ejaculatory duct

A utricle cyst is _______________ in origin and is typically associated with genital anomalies such as _______________, _______________ testicles, and _______________ anomalies.

endodermal; hypospadias; undescended; renal

US appearance of Prostatitis:

hypoechoic halo in periurethral area

The prostaticovesical arteries course along the

medial and inferior surface of the bladder toward the prostate along the neurovascular bundle.

The _______________ ducts are responsible for development of the male reproductive system, whereas the _______________ form the female reproductive system.

mesonephric; paramesonephric

benign prostatic hypertrophy

noncancerous enlargement of the prostate gland

The majority of patients with seminal vesicle cyst also have ipsilateral _______________ _______________.

renal agenesis

vas deferens

reproductive duct that extends from the epididymis to the ejaculatory duct; also known as the ductus deferens

SURGICAL CAPSULE is a Hyperechoic band that

separates Peripheral Zone from Central Zone

The capsule of the prostate gland should appear _______________ and without _______________.

smooth; disruption

-DUCTUS DEFERENS -BLADDER

I;J

-ant. fibromuscular bundle -peripheral zone

I;J

The most common of the pelvic cystic masses are the _______________ duct and _______________ cysts.

Müllerian; utricle

Chronic Bacterial prostatitis is more difficult to diagnose then

acute bact. Prostatitis

corpora amylacea

calcifications commonly seen in the inner gland of the prostate

the paramesonephric ducts will form the

female reproductive system

What is the most common symptomatic condition to affect the prostate gland?

-BPH

Your patient states that he has had a transurethral resection or TURP procedure. What condition does this procedure treat?

-BPH

Calcifications are commonly seen in the prostate gland. What conditions can cause calcifications within the prostate?

-Calcifications are common and typically asymptomatic. -Corpora amylacea are the result of consolidation and calcification that occur w/ age. BPH or prostatitis can cause calcifications. Ejaculatory duct calcifications are also commonly seen, as are periurethral calcifications.

T/F:BPH affects the central zone of the prostate.

-False -BPH is a nodular formation within the transition zone of the prostate.

Prostate cancer is the second most deadly male cancer, making its diagnosis an important one. Describe the sonographic appearance of prostate cancer. Is ultrasound a good screening tool for prostate cancer? Why or why not?

-May appear isoechoic to surrounding tissue, making diagnosis by sonography alone difficult. This is the reason that TRUS cannot be used alone as a screening tool. The predictive value for TRUS alone is 6%. -The seminal vesicle beak sign may be seen when a tumor occurs in the central zone. -Most cancers appear hypoechoic sonographically; however, benign lesions typically appear hypoechoic as well. -Tumor may also replace the entire gland, making diagnosis difficult.

Which blood test is used to identify men at increased risk of prostate cancer?

-PSA

What is the sonographic appearance of the prostate gland in patients with benign prostatic hypertrophy?

-The appearance of BPH on an Ultrasound: hypoechoic hyperechoic heterogeneous •The first type of BPH is homogeneous stromal hyperplasia, which is sonographically hypoechoic. •The second type is glandular hyperplasia, which may look hypoechoic or hyperechoic, depending on the cystic changes and gland size. •The third is a combination of the aforementioned two types, resulting in a stromal and glandular hyperplasia. This form is the most common and is heterogeneous in appearance.

Describe the sonographic technique used to evaluate the prostate gland, including patient preparation, positioning, image orientation, and any contraindications to the study.

-The most common approach is: endorectal. It results in improved visualization of gland and surrounding structures. -Bladder must be empty. -Pt is left lateral decubitus position with the knees bent into the chest. Lubricating gel & probe cover are placed over the probe. -The transducer is then inserted into rectal cavity. -US image is inverted during a prostate exam w/ the near field at bottom of the image and the far field at top. -In the trans, rt lobe is at the left side of image and the left lobe is on the right. In sagittal, the base is at the left side of the image and the apex of is at the right. - Contraindications include: rectal fissures, rectal tumors, thrombosed hemorrhoids, and prostatitis, which may prevent insertion of the probe due to patient discomfort.

What are the most common indications for sonography of the prostate? Is TRUS of the prostate typically used for screening purposes?

-Transrectal ultrasound (TRUS) of the prostate is done to evaluate for malignancy, in cases of male infertility, and in patients with symptoms of prostatitis or chronic pelvic pain syndrome. -TRUS is commonly performed when a digital rectal examination or prostate-specific antigen is abnormal. -TRUS is also used to guide biopsy and treatment procedures. -TRUS is not typically done as a screening tool.

T/F: BPH causes the prostate to appear more rounded than normal.

-True -In contrast to a normal gland, the prostate no longer has a crescent shape but appears more rounded and can be up to four times its original size

T/F: BPH causes urinary symptoms of frequency, nocturia, and difficulty starting a stream.

-True -Since the urethra passes through the transition zone, these patients typically present with urinary symptoms -Symptoms include: frequency, nocturia, dribbling, and difficulty starting a stream.

T/F: Prostate biopsy is commonly done at known sites of anatomic weakness

-True -Sonographic guidance can be utilized to localize a nonpalpable, sonographically suspicious lesion, or as guidance for random biopsies of known sites of anatomic weakness: -(1) the seminal vesicle beak -(2) the invaginated extraprostatic space which follows the ejaculatory ducts to the verumontanum -(3) the trapezoid area.

T/F: BPH is commonly seen in men over the age of 40 with a peak incidence around 60.

-True -This condition is rarely seen in men under the age of 30 but is commonly seen in men over the age of 40 and peaks around the age of 60

Patients with prostate cancer may present with which of the following symptoms?

-an abnormal PSA level (prostate-specific antigen) -an abnormal DRE (digital rectal examination) -bladder outlet obstruction -Other symptoms include: bone pain, weakness, weight loss, anemia, and azotemia.

The base of the prostate is located superior to the verumontanum and is made up predominantly of which zone?

-central

Your patient presents for a sonography examination to evaluate for benign prostatic hypertrophy. Which zone is most affected by BPH?

-central zone

In which zone does prostate cancer and prostatitis most often occur?

-peripheral

The apex of the prostate is located inferior to the verumontanum and is made up predominantly of which zone?

-peripheral zone

Which of the glandular zones of the prostate is the largest?

-peripheral zone

What are the zones within the glandular tissue of the prostate gland?

-peripheral zone -central zone -periurethral zone -transition zone

A diabetic patient presents with fever, urinary frequency, low back pain, and hematuria. While scanning the prostate the gland, you notice a focal complex area that has increased blood flow. What is the most likely diagnosis given the patient's history?

-prostatic abscess

Which of cysts will contain spermatozoa?

-seminal vesicle cyst

Describe the method most commonly used for ultrasound-guided prostate biopsy, including patient preparation and technique.

-typically performed using endorectal approach. -nerve block and lidocaine are used to minimize discomfort. -Pt is given a cleansing enema and antibiotics to minimize the risk of infection w/ fecal material. - A targeted biopsy may be done on a suspicious lesion, but more commonly multiple random biopsies of known sites of anatomical weakness are performed.

A definitive diagnosis of prostate cancer can be made by which of the following procedures?

-ultrasound-guided biopsy

Which cysts are associated with genital anomalies such as hypospadias?

-utricle cyst

Which of the following cysts is associated with genital anomalies such as hypospadias?

-utricle cyst

-BLADDER -SEMINAL VESICLE

1&2

-Seminal Vesicle -Ureters

11;12

-Bladder -Seminal Vesicle

1;2

-Inferior Vesicle Artery -Prostatic Artery

1;2

What is the predictive value of TRUS alone for diagnosing prostate cancer diagnosis?

25 percent

-EJACTULATORY DUCT -URETHRA

3&4

-Ejactulatroy Duct -Prostatic Utricle

3;4

-urethral group of arteries -capsular group of arteries

3;4

-BASE OF PENIS -SPHINCTER MUSCLE

5&6

-Prostatic Ducts -Base of Penis

5;6

-median lobe -left lat. lobe

5;6

-PROSTATE

7

Peripheral Zone contains how much glandular tissue?

70%

-Branches from middle hemorrhoidal and pudenal arteries -BLADDER

7;8

-Sphincter Muscle -Urethra

7;8

-Verumontanum -Prostate

9;10

-BPH: The prostate gland is enlarged and is seen to indent into the urinary bladder. -Commonly seen in men over the age of 40 and peaks around the age of 60. -The nodules typically arise from the transition zone, with some arising from the periurethral zone

A 54-year-old patient presents with symptoms of urinary frequency and nocturia. What is seen in this image of the prostate gland? In what age range does this typically occur? Which zone is typically affected?

-Müllerian duct cysts and utricle cysts. -Typically found in male pelvis outside the prostate gland between the urinary bladder and the rectum. -attached to the prostate by a stalk. -Symptoms: partial urinary obstruction, hematospermia, low ejaculate volume, infertility, painful ejaculation, and rectal discomfort.

A cystic structure is demonstrated in this male pelvis between the bladder and the rectum. What is the likely diagnosis? What type of symptoms might the patient experience?

Sonography-Guided Endorectal Biopsy

A: On a sonographically guided endorectal biopsy, the echogenic appearing needle can provide a target distance marker. B: The needle is seen as an echogenic, linear structure (arrowhead) passing through the prostate gland.

-Anterior Fibromuscular Stroma -Urethra

A;B

-Central Zone -Ejactulatory Duct

A;B

-Ductus Defrens -Ampulla

A;B

-EPIDYDMIS -TESTES

A;B

-MULERIAN DUCT CYST -CYST OF SEMINAL VESICLE

A;B

-Urethra -Central Zone

A;B

-urethra -ejactulatory duct

A;B

acute prostatitis - Lt; Transverse - Rt; Sag -Sonograms of the mid gland were obtained on patients with acute prostatitis.

Acute inflammation of the prostate usually due to bacteria -A: A transverse image showing the heterogeneous echo texture of the peripheral gland. -B: A sagittal image of the left prostate gland on a patient with known prostatitis.

prostate cancer (grey scale)

B: This sonogram is of a hypoechoic malignant lesion (arrow) within the prostate.

transitional zone is a common location for

BPH

-CYST OF VAS DEFERENS -UTRICLE CYST

C;D

-Peripheral Zone -Central Zone

C;D

-Seiminal Vesicle -Ejactulatory Duct

C;D

-URETHRA -PROSTATE

C;D

-peripheral zone -transition zone

C;D

-seminal vesicle -Transition Zone

C;D

-Seminal Vesicle -Ejactulatory Duct

D;C

3 elements of criteria for biopsy:

DRE, PSA- best marker for prostate, TRUS

-Tansition Zone

E

-EJACTULATORY CYST -RETENTION CYST ABSCESS

E;F

-EJACTULATORY DUCT -SEMINAL VESICLE

E;F

-Ejactulatory Duct -Seminal Vesicle

E;F

-Urethra -Utricle

E;F

-urethra - ant. fibromuscular bundle

E;F

-Prostate

G

-Transition Zone

G.

-RECTUM -COCYX

G;H

-urethra -transition zone

G;H

Central Zone:

Greater echogenicity than PZ

-PENIS

K

-ejactulatory duct -central zone

K;L

Most common cancer in American men

PROSTATIC CANCER

_______________ calculi can produce what is known as the "Eiffel Tower" appearance.

Periurethral

Prostatic calculi - trv - ED

Small, multiple calcifications within the prostate, often visible radiographically -A sagittal sonogram with calculi (arrowhead) is identified lining the ejaculatory duct. These calculi provide for excellent viewing of the course of the ejaculatory duct.

Central Zone - The "Beak"

Superior portion 25% of organ's tissue Ejaculatory ducts pass thru here -A sagittal sonogram of a normal prostate demonstrates the "beak" (arrow) where the seminal vesicle and vas deferens enters the central zone

-Treated with: TURP or transurethral resection of the prostate gland. -This leaves a large defect that can be seen in the center of the gland. -Prostate tissue that is compressing the urethra and causing urinary retention is removed relieving the urethral compression.

This 55-year-old patient has a history of severe BPH. What could cause the changes seen in the center of this prostate gland? How does this work?

Small cysts within the prostate are typically retention cysts or come from cystic changes related to benign prostatic hypertrophy.

This image demonstrates cystic structures in the base of the prostate gland in an asymptomatic patient. What is a possible diagnosis?

-The seminal vesicles lie lateral and superior to the base of the prostate as imaged here. -They appear dilated, which can occur from obstruction or a lack of recent ejaculation.

This image was taken lateral to the base of the prostate. What structure is imaged here? Does this structure appear normal? If not, what could cause this?

TRUS is an acronym for _______________ _______________.

Trans Rectal Ultrasound

-Urethra -Peripheral Zone

U;P

The most common type of prostate cancer is _______________ and occurs most commonly in the _______________ zone. Most are _______________, as opposed to solitary lesions.

adenocarcinoma; peripheral; multifocal

prostate cancer -risk factors

age, ancestry, family history, farmers -C: A classic hypoechoic malignant lesion (arrow) is seen on this sonogram. This was a histologically proven cancer.

Overall, sonography is a useful mechanism of

assessing the prostate gland for a variety of abnormalities and for providing biopsy and treatment guidance.

The cephalic portion of the gland is the _______________, whereas the caudal portion is the _______________. The _______________ travels through the center of the prostate gland.

base; apex; urethra

prostate cancer

cancer of the prostate gland, usually occurring in men middle-aged and older -A: A transverse sonogram of the prostate gland is obtained at the level of the verumontanum. The hypoechoic lesion (arrow) is seen within the peripheral zone on the left side of the gland

-dorsal vein complex -transition zone -neurovascular bundle -levator muscles

dv;TZ; NVM; L -Transverse View

Prostatic calculi are divided into _______________ calculi and _______________ calculi. _______________ calculi are found within the prostate gland and form from _______________ fluid. _______________ calculi are found within the urethra and are derived from _______________.

endogenous; exogenous; endogenous; prostatic; exogenous; urine

Patients with acute bacterial prostatitis present with a _______________, along with _______________ _______________ and _______________ pain. Large numbers of _______________ _______________ will be present within the urine.

fever; low back; perineal; gram-negative bacteria

The prostate is shaped like a _______________ and measures _______________ on average.

funnel; 4 × 3 × 2 cm

Transitional Zone:

greater echogenicity than CZ & PZ

The peripheral zone appears

homogeneous and slightly hyperechoic relative to adjacent parenchyma.

Sonographically, the peripheral zone tissue is _______________ and _______________. The _______________ _______________ separates the peripheral zone from the central zone. The echogenicity of the central zone is _______________ than the peripheral zone.

homogeneous; isoechoic; surgical capsule; greater

Peripheral Zone is the most

hypoechoic

ovoid structures are symmetric in size, shape, and

hypoechoic echogenicity compared to the prostate.

The most common sonographic finding in patients with a history of prostatitis is a _______________ _______________ in the periurethral area. The peripheral zone may also have a _______________ echo pattern.

hypoechoic halo; heterogeneous

When performing an examination of the prostate, the image is typically _______________ with the near field at the _______________ of the image and the far field at the _______________ of the image. In the transverse plane, the right lobe of the gland is at the _______________ side of the image and the left lobe of the gland is on the _______________ side of the image.

inverted; bottom; top; left; right

TRUS utility as a screening tool for malignant lesions

is limited.

The prostate is infected by organisms ascending from the _______________ _______________. There is a greater incidence of prostatitis within the _______________ zone.

lower urethra; peripheral

TRUS of the prostate can be used to evaluate the prostate in cases of _______________, _______________, _______________ _______________ _______________ _______________, and _______________ abnormalities. It can also be used to guide _______________ and treatment procedures.

malignancy; infertility; chronic pelvic pain syndrome; congenital; biopsy

TRUS is the scanning approach

of choice.

Where does corpora amylacea occur most often?

posterior segment of the prostate -Corpora amylacea are a result of the prostatic acini progressing through their cycle of cell atrophy, degeneration, and death. -This occurs most often in the posterior segment of the prostate.

The most common cancer in American men is _______________ _______________. The majority are diagnosed in men over the age of _______________.

prostate cancer; 65

PSA is a protein that is specific to the

prostatic epithelium. -The higher the value, the more likely malignancy is present

Overall, sonography is a useful mechanism of assessing the prostate gland for a variety of abnormalities and for

providing biopsy and treatment guidance.

Chronic Bacterial prostatitis is characterized by

relapsing urinary tract infections

If distinguished sonographically, the vas deferens is medial to the

seminal vesicles with a similar echo texture and the ejaculatory duct will appear as bright double lines.

The central and transition zones usually are not

sonographically distinct.

Seminal vesicles should be ovoid structures that are

symmetric in size, shape, and hypoechoic echogenicity compared to the prostate.

The normal prostate gland should appear

symmetrical with the majority of the parenchyma appearing homogeneous with medium-level echoes.

One of the most common causes of endogenous calculi is

the consolidation and calcification of the corpora amylacea, which normally occurs with age

The prostate gland is retroperitoneal, anterior to

the rectum, and inferior to the urinary bladder.

The most common cysts are typically the result of BPH and are seen in the _______________ zone of the prostate.

transition

5% of prostate cancer originates in

transitional zones (TZ)

Benign Prostatic Hypertrophy-TRV

..........

Dilated Seminal Vesicle-Vas Deferens

-A.This patient had not ejaculated for 72 hours. The saccules (arrowheads) of the seminal vesicle are easily appreciated when it is dilated. Distance + = 22.0 mm; distance × = 8.9 mm. -B: On this transverse sonogram through the base of the prostate, a dilated vasa deferentia (arrows) is seen.

transverse sonogram showing normal and abnormal vasa deferentia

-A: A normal seminal vesicle (arrowhead) and a medially located vas deferens (arrow). -B: On this transverse sonogram through the base of the prostate, the dilated vasa deferentia (arrows) are seen.

Sagittal sonogram of the normal prostate -R. Lobe

-A: The midline section shows the urethra (arrow) coursing through the gland. -B: The right lobe of the prostate can be identified.

A transverse section demonstrates the normal seminal vesicles.

....

Midline Utricle Cyst-TRV

....

Mϋllerian Duct Cyst

....

Periurethral Vessels - Sag -sagittal, midline sonogram of the prostate gland demonstrates the periurethral vessels displayed by power Doppler. The vessels travel along the course of the urethra through the transition zone from the bladder (Bl) toward the apex (arrow).

....

Seminal Vesicle Cysts-TRV -normal appearance

.....

Transverse Normal Prostate - A: The base of the normal prostate gland is half-moon shaped. -B: The verumontanum (arrow) is visualized at the level of the mid gland. - C: The apex is the most inferior aspect of the prostate.

.....

Hyperplastic Nodule with Cystic Changes-TRV-BPH

......

Retention Cysts -TRV (Lt) -SAG (Rt)

.......

Weight of prostate:

20 +- 6g

What percentage of glandular tissue is in the central zone?

25%

Measurement of prostate:

4 x 3 x 2 cm

Transition Zone contains what percentage of glandular tissue?

5%

Periurethral Zone contains less than____% of glandular tissue.

<1%

normal prostate gland

A: A 22-year-old patient with a normal, crescent-shaped gland

Increased Vascularity -PZ

A: A sagittal sonogram of the left prostate gland showing increased vascularity in an area of a suspicious lesion. B: A transverse image demonstrating abnormal peripheral zone vascularity displayed by color Doppler (arrows).

Capsular Vessels Capsular A. (Lt) Periurethral A. (Rt)

A: A transverse sonogram demonstrates the capsular vessels shown in red (arrows), as displayed by color Doppler. These vessels travel throughout the capsule of the gland. B: On this transverse sonogram of the prostate gland, the periurethral vessel (arrow) is displayed by power Doppler.

Types of Prostatitis:

Acute bacterial, Chronic bacterial, Non bacterial, prostatodynia

NON-BACTERIAL PROSTATITIS has a higher incidence than

Bacterial Prostatitis

PERIPHERAL ZONE is the most common zone for:

Prostate cancer and prostatitis

shape of prostate

Funnel shape(cashew shape)

Majority of hypoechoic areas in US, within PZ, result from benign causes like:

Inflammation, Fibrosis, Infarction, BPH

exams used for prostate screening:

PSA, Direct Rectal Exam (DRE), Transrectal Ultrasound (TRUS) (Trus should not be used isolated for cancer screening)

Prostate Cancer Originates in which zones?

Peripheral (70%) and central (10%) zones

PROSTATE ZONES

Peripheral, Central, Transitional

Elevated PSA indicates:

Prostatic cancer, Prostatis, benign prostatic hyperplasia

Prostate develops from the

Urogenital Sinus

The third primary types of BPH is

a combination of the aforementioned two types, resulting in a stromal and glandular hyperplasia. This form is the most common and is heterogeneous in appearance

surgical capsule

a 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 along the line

PROSTATIC CANCER in ULTRASOUND Classically presents

a hypoechoic pattern that is directly related to degree of invasion of tumor

verumontanum

a longitudinal elevation or ridge of tissue on the posterior prosthetic urethral wall where the orifices of the ejaculatory ducts are located on either side

seminal vesicles

a pair of simple tubular glands that extend from outpouching of the vas deferens; they are located superior and posterior to the prostate, between the urinary bladder and rectum

TRUS is often utilized in evaluation of patients with an

abnormal digital rectal examination (DRE), Evaluation of size, shape and weight, Evaluation of rectum and seminal vesicles, palpable lump, asymmetry or area of induration on DRE, Abnormal lab tests for PSA and AKP, Assist in trust biopsy guidance, Evaluate prostatic inflammatory condition

The National Institutes of Health (NIH) lists four categories of prostatitis, including

acute bacterial, chronic bacterial, CPPS (including inflammatory and noninflammatory pelvic pain syndromes), and asymptomatic inflammatory prostatitis

Acute Prostatitis patients are typically

acutely ill, with a fever, low back pain, and perineal pain.

BPH is Caused by:

aging, hormones, genetic factors (decreased testosterone and increase estrogen production)

The clinical diagnosis of prostatitis is made by

an evaluation of expressed prostatic secretion (EPS) for either positive bacterial cultures or inflammatory cells.

Prostatitis refers to

an inflammation of the prostate as demonstrated by an increased number of leukocytes in prostatic fluid.

benign prostatic hyperplasia (BPH)

benign growth of cells within the prostate gland

Elevated ACID PHOSPHATASE (ACP):

carcinoma that has spread beyond prostate capsule, also after prostatic massage

endogenous calculi

developing or grown from within; calculi formation within the substance of the prostate

ejaculatory duct

duct that passes through the central zone and empties into the urethra; originates from the combination of the vas deferens and the seminal vesicle

a portion of each mesonephric duct will later develop into an

ejaculatory duct, vas deferens, and seminal vesicle.

Symptoms of BPH include

frequency, nocturia, dribbling, and difficulty starting a stream.

Upon DRE, with Acute Prostatitis the prostate will feel

hard, swollen, and very tender. Typically, a vigorous examination is contraindicated because it can precipitate bacteremia.

The first is primary type of BPH:

homogeneous stromal hyperplasia, which is sonographically hypoechoic.

Chronic Bacterial prostatitis appears on an Ultrasound as a

hyperechoic Halo in periurethral area heterogeneous pattern of peripheries

The prostate is supplied with blood from the

internal iliac arteries by the prostaticovesical arteries.

Eiffel Tower sign

is a shadowing artifact created in the area of the urethra and verumontanum

The second Primary type of BPH

is glandular hyperplasia, which may look hypoechoic or hyperechoic, depending on the cystic changes and gland size.

PROSTATIC CANCER is the SECOND most common

male cancer killer

BPH is rarely seen in men under the age

of 30 but is commonly seen in men over the age of 40 and peaks around the age of 60

prostatic cancer is usually found in men

older than 50

Urogenital Sinus is an

outpouch from the Urethra, that happens around week 11 of gestation

approximately 70% of prostate cancer arising from

peripheral zone

base superior

portion of the prostate gland, which is located below the inferior margin of the urinary bladder

apex inferior

portion of the prostate gland, which is located superior to the urogenital diaphragm

Only about 5% of prostate carcinomas arise in

the central zone

Hypoechoic lesion are not always specific for

prostate cancer in ULTRASOUND

Testosterone influences the growth of the

prostate gland

ACID PHOSPHATASE (ACP) is found in

prostate gland and semen

The artery on either side of the nerovascular bundle bifurcates into the

prostatic artery and inferior vesicle artery, which further branch into the urethral and capsular arteries.

Free PSA is a more specific marker when

regular PSA is elevated (more than 4) this free PSA can avoid a biopsy

Transurethral Resection

surgical removal of prostate gland tissue by inserting device called resectoscope through urethra and removing prostate tissue -This 65-year-old has a transurethral resection defect. The central gland has been removed (arrow) distorting the typical appearance of the mid gland

PROSTATIC SPECIFIC ANTIGEN(PSA) is normally secreted through tiny ducts, but in prostatic cancer or BPH

the ducts do not drain into urethra, it rather leaks into bloodstream

two paired sex ducts are

the mesonephric or wolffian ducts and the paramesonephric or müllerian ducts.

The nodules of BPH typically arise from

the transition zone, with some arising from the periurethral zone

Approximately 20% of carcinomas occur in

the transitional zone

In the 11th gestational week, the prostate begins to form from

the urogenital sinus, an endodermal derivative

PSA is considered a

tumor marker and a second line screening parameter for prostate

During embryogenesis, all embryos start out with

two paired sex ducts

NON-BACTERIAL PROSTATITIS is difficult to treat due to

unknown cause