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