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