C8: Prostate Flashcards
describe the location/relationships of the prostate
- inferior to bladder
- surrounds neck of the bladder and the urethra
- anterior to rectum
- antero-medial to levator ani
- seminal vesicles are superior
is the fibrous capsule of the prostate a true capsule?
no
whats the shade of the prostate?
where is apex and base?
ovoid, inverted pyramid
- base is superior (base of prostate touching base of bladder)
- apex is inferior
size of the prostate
length: 3-3.5 cm
width: 4cm
AP: 2-2.5cm
what are the 2 types of tissue that make up the prostate
-fibromuscular tiss and glandular tissue
what type of fluid does the prostate secrete and how much?
- alkaline fluid that makes up 1/3 of semen volume
- activates sperm and helps sperm motility
- neutralized acidity of vagina
does production of PSA increase with age
yes
list the 4 glandular zones of the prostate
what do they name correspond to? why are they helpful
- Peripheral
- Transition
- central
- periurethral glands
- named based on relationship to urethra, ED and histological components
- helpful to localize cancer
describe the peripheral zone
- largest
- common site of prostate cancer
- surrounds the distal urethra and occupies the posterior, lateral and apical regions
- has capsule that separated it from other zones
which zone does BPH not effect?
peripheral
describe the transitional zone
- makes up 5% of glandular tiss
- orgin site of BPH
- 2 sm glands on either side of the prox urethra
describe the central zone
- makes up 25% of glandular tiss
- resistant to disease
- ED passes through
- located at base of prostate and terminates near the verumontanum
what is the verumontanum
area where the EDs join the urethra
describe the periurethral glands
- makes up 1% of glandular tiss
- located in the smooth muscle of the prox urethra
- also called ‘internal prostatic sphincters’ which stop urine from flowing back into bladder
describe the fibromuscular stroma
- makes up 1/3 of prostate
- on anterior surface of prostate
- made of smooth muscle and c-tissue
can you differentiate the zones of a norm prostate on US?
no. ..
- peripheral/outer is the peripheral and central zone
- inner is transition, fibro-muscluar, urethral sphincter
where are the seminal vesicles (SV) located
- superior to prostate
- posterior to bladder
what 2 tubes form the ED? where does the ED dump into
- SV and vas deferens
- ED dumps into urethra
what do SV secrete?
-alkaline and viscose fluid which helps sperm viability
list indications for US of prostate
- DRE
- increased PSA
- nocturne, increased frequency of urination
- infertility
how is Trans abdominal US helpful for prostate
to see size and volume only… looks homogenous, low to moderate level echos, echogenic centre due to urethra
how do SV look on US
hypoechoic
what kind of TRUS probes are commonly used
do you need full bladder>
end-firing:
allow for multi-plane imaging and biopsy guidance
No
whats the orientation on the US screen for TRUS
rectum- bottom of image
in SAG and Trans, same orientation as we’re used to
SEE NOTES FOR US APPEARANCE OF AREAS
:)
which area is used as a standard for echogenicity in the prostate?
Peripheral zone
what the AP measurement of the SV
10mm
what is corpora amylacea
collection of protein material
what does an elevated PSA indicate?
is it specific to cause?
what are norm PSA valves? what value warrants a biopsy?
-BPH, infection carcinoma (2/4 of men with increased PSA dont have cancer)
No
-norm: <4 ng/ml…. >10 ng/ml warrants biopsy
what PSA density warrants a biopsy
> 0.12 density
what is an acid phosphatase lab test
what do increased valves indicate
- substance found in prostate and semen
- increased in metastatic cancer of prostate
what is an alkaline phosphatase lab test
what do increased valves indicate
- alk phase produced in osteoblasts
- increased value means prostate cancer has spread to bones
where does the prostate get its blood supply?
prostaticovesicular arteries which branch from internal iliac A
what Is benign ductal ectasia
dilated ducts in the peripheral zone of the prostate… can be mistaken for prostate cancer
how do benign calcifications of prostate compare to maligant ones?
benign: courser
malignant: sm and fine texture
