Ch 113 - Prostate Flashcards

1
Q

What is the normal size of the prostate?
What breed can have a healthy larger prostate?

A
  • 0.64-0.96g/kg
  • Scottish Terriers
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2
Q

Is the prostate peritoneal or retroperitoneal?

A

Both! Its ventral aspect is retroperitoneal

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3
Q

What nervous input increases glandular secretion?

A

Parasympathetic suppy from the pelvic nerve

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4
Q

What are the 2 forms of acinar dilation seen within the mature prostate?

A
  • Simple dilatation: Many dilated acini with or without luminal oesionphilic secretions which no not compress adjacent acini
  • Focal glandular ectasia: Focal dilatation of a few acini with oesinophilic content and compression of the adjacent prostatic parenchyma
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5
Q

List the functions of the prostatic secretions

A
  • Promote spermatozoa motility and viability
  • Increase uterine perfusion
  • Modulate neutrophil-induced inhibition of spermatazoa attachment to uterine epithelium
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6
Q

What hormone is relaease from the prostate gland during ejaculation?

A

Large amounts of PGE2

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7
Q

What substances are found within prostatic secretion?

A
  • High concentration of zinc and zinc-binding proteins
  • Acid phosphatase (also produced by epididymis)
  • Canine prostate-specific esterase (90% total protein)
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8
Q

What is glandular BPH?

A
  • predominates in younger dogs
  • Secretory cells increase in number and size leadng to symmetric enlargement
  • Testosterone is metabolised by 5alpha-reductase in the prostate to 5alpha-dihydrotestosterone
  • Regulates gene expression in the nuclei to control prostatic growth
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9
Q

What is complex BPH?

A
  • Most common form, predominates in older dogs
  • As the prostate increases in size, 5alpha-dihydrotestosterone concentrations decrease
  • Paralleled by increase in metabolism of androgens within the prostate and increasing numbers of nuclear androgen receptors (increases responsiveness to androgens and decrease in apoptosis)
  • Asymmetric enlargement, envolving both glandular and prominent stromal elements
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10
Q

How is oestrogen throught to play a role in BPH?

A
  • Increases the sensitivity of the prostate to dihydrotestosterone bu inducing nuclear dihydrotestosterone receptors and promoting stromal and collagen synthesis
  • May also exert inhibitory role on cell death
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11
Q

Which form of prostatic disease may not cause enlargement?

A

Neoplasia

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12
Q

What is regarded as the primary imaging tool of the prostate?

A

Ultrasound

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13
Q

What are the Tx options for BPH?

A
  • Castration - resolution within a few days

Medical:
- Antiandrogens - delmainone acetate. Progestogen with antiandrogenic and antioestrogenic activity by suppressing interstitial cell function. Flutamide binds to dihydrotestosterone receptors
- LH Inhibitors - Megestrol acetate, medroxyprogesteronei - progesterone derivatives that inhibit LH release and suppress 5alpha-reductase. May induce squamous metaplasia
- GnRH agonists/analogues - block pituitary receptor sites, causing reduction in natural LH-RH and decline in testicular secretion of testosterone. Can be given as long acting injection or implant
- 5alpha-reductase inhibitor - Finasteride
- Oestrogens - Can cause BM aplasia and prostatic metaplasia…

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14
Q

List the natural defense mechanism against bacterial prostatitis

A
  • SHedding or uropathogens bound to exfoliating urethral cells
  • bacterial trapping by secreted mucous
  • Intermittent washout by urine
  • Local immunoglobulins, cytokines and defensins
  • Mobilisation of leucocytes
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15
Q

What is the most common bacterial cause of prostatitis?

A

E.Coli

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16
Q

What is the pathognomonic appearance of prostatic abscesses on ultrasound?

A

Multiloculated appearance of capsular tissue surrounding material with a flocculent fluid signal

17
Q

List the surgical options for prostatic abscessation

A
  • Castration and ABx
  • marsupialisation (rarely done)
  • Active or passive drainage (20% mortailty)
  • Omentalisation (consistently sucessful, low complications)
  • Partial prostatectomy (risk of incontinence and severe haemorrhage)
18
Q

What ABx have good penetration of the blood-lipid barrier of the prostate?

A
  • Enrofloxacin
  • Marbofloxacin
  • TMS
  • Chloramphenicol

Barrier is likely less functional in the inflamed prostate so this is of unclear significance

19
Q

What are the surgical options for prostatic cysts?

A
  • Complete resection if small and minimally attached
  • Partial resection and omentalisation
20
Q

What is the most common form of prostatic neoplasia?

A

Adenocarcinoma

Androgen receptor negative - castration is not an effective Tx

21
Q

What gene has been associated with an increased risk of prostatic carcinoma?

A

short CAG-1 repeats in the andorgen receptor gene

22
Q

How can prostatic carcinomas be subclassified?

A

Differentiation
- glandular
- urothelial
- squamoid
- sarcomatoid

Growth patterns:
- papillary
- cribiform
- solid
- small acinar/ductal
- signet ring
- mucinous

Consistent aggressive with high met rate 80% and 20% mets to axial skeleton

23
Q

What % of prostatic carcinoma cells express COX-2?

A

75%

24
Q

What are the Tx options for a prostatic carcinoma?

A
  • Tube cystotomy or urethral stenting for palliation
  • NSAIDs - improve survival
  • Partial or complete prostatectomy
  • Radiation
  • Nd:YAG partial prostatectomy
25
Q

What causes prostatic metaplasia?

A

Abnormally increased circulating oestrogens
- Sertoli cell tumour
- seminoma
- exogenous

26
Q

What is the main complication with total prostatectomy?

A
  • Likely urinary incontinence
  • Possibility of significant haemorrhage - required temporary aortic occlusion
27
Q

List anatomical differences of the feline prostate

A
  • Only partially encircles the urethra (dorsolaterally)
  • Can have some prostatic tissue disseminated within the urethral wall caudal to the prostate