Ch. 44 Prostate Flashcards
What is the normal length of the feline prostate and why is is not visible on radiographs?
10mm - it’s small and located on the dorsolateral surface of the urethra
Which extraprostatic disease can cause prostatomegaly?
- androgen producing testicular tumours (Leydig cell / interstitial tumours, others to lesser degrees - Sertoli cell, seminoma)
- orchitis
What causes benign prostatic hyperplasia?
increased volume of the INTERcellular and ductal spaces (as opposed to increased cell number or volume of the cell itself) >
what causes cysts in BPH?
What is a sequela of prostatic cysts?
infection; large cysts are frequently infected
Why is prostatitis tricky to treat and what are risk factors?
Many atbs do not penetrate the prostate well
Cystic and hypertrophied prostates are less resistant and may be a reservoir for recurrent infections
Where do the bacteria come from, in bacterial prostatitis?
bladder, testes, or from the prostate itself
What is a paraprostatic cyst?
when a prostatic cyst becomes so large that it is not contained within the prostate
What is uterus masculinus?
are osteocollagenous retention cysts a continuation of cystic hypertrophy?
No
Prostatic adenocarcinoma is common - true or false?
false, it’s relatively uncommon in dogs (much higher incidence in people)
Prostatic adenocarcinoma:
a) more common in intact dogs
b) more common in neutered dogs
c) equal incidence
c) equal incidence
Where does prostatic adenocarcinoma metastasize?
regional lnn, pelvis, liver, lungs
why might prostatic neoplasia be difficult to diagnose?
overlap with prostatitis; Large prostatic neoplasms are often secondarily infected or necrotic, and affected dogs may therefore have clinical signs of prostatitis, and there is a tendency of clinical sign of cystitis or prostatitis to overshadow those of neoplasia.
Why might a dog with prostate disease be seen by orthopedics?
A less common sign of prostate gland disease is a pelvic limb gait abnormality. The animal may refuse to climb stairs and jump. Owners often believe the animal has developed osteoarthritis, but such animals may have severe, active septic prostatitis.9,12 The pain caused by the prostatic infection is exacerbated by walking, climbing, and jumping. Both pelvic limbs are usually affected. These animals are also usually sensitive to palpation of the caudal abdomen. Gait abnor- malities are seen rarely in uncomplicated benign prostatic hypertrophy.
Which part of the prostate is enlarged?
With ventral prostatomegaly the urinary bladder neck may be elevated
Asymmetric prostatomegaly occurs with?
Neoplasia and large cysts usually
Rare in BPH and prostatitis
What are the more common clinical signs of prostate disease?
Stranguria, hematuria, pyuria
Dyschezia with small or ribbon-like stools
Other than the prostate itself causing cranial displacement of abdominal organs when it becomes huge, what else could cause this?
The urinary bladder; if prostate disease causes urethral stricture or compression, then secondary urinary distension may displace surrounding organs.
Which of the following do not typically cause severe enlargement?
A) Acute prostatitis
B) Neoplasia
C) Hypertrophy
D) Cyst formation
A) Acute prostatitis
B) Neoplasia
Prostatic size that exceeds ___% of the distance from the pubis to the sacral promontory is suggestive of a mass lesion (cyst, abscess, or neoplasm)
90
What can the margins of an enlarged prostate gland tell you?
Smooth and distinct margin =
Rough or indistinct margin =
smooth distinct margin = benign or is slowly progressing, e.g. benign hypertrophy and low-grade or chronic prostatitis
Rough or indistinct margin (in the presence of adequate abdominal fat) = acute or aggressive process e.g. neoplasia or acute prostatitis
What does calcification in the prostate gland signify?
Chronic prostatitis or neoplasia
What kind of calcification has a strong PPV for neoplasia in dogs neutered at a young age?
wispy or indistinct calcification
What is the significance of non-iatrogenic prostatic gas?
unfavorable prognostic sign; occurs due to gas-forming (e.g. coliform, clostridial) bacterial prostatitis, which, even if not fatal, usually results in permanent scarring, which leads to sterility and urinary retention or incontinence.
What is an iatrogenic way of introducing gas into the prostate, besides FNA?
reflux from the urinary bladder during a negative- or double-contrast cystogram
What is the value of doing a retrograde positive contrast urethrogram, in a dog with prostate disease?
This procedure allows evaluation of the urethra itself and the position of the urethra in relation to suspected prostatic disease. Asymmetric positioning of the urethra within the prostate indicates an asymmetric disease process within the prostate gland such as a tumor or abscess , with abscesses being more common.
Also - invasion or stricture of the urethra in association with a prostatic mass
If the prostatic ducts fill with contrast, how should this be interpreted?
Extravasation of contrast medium into the prostate gland should not be interpreted as abnormal as long as only the prostatic ducts fill with contrast medium. This appearance is often seen in animals with a normal prostate gland.
When should contrast (what appearance) within the prostate be considered abnormal?
When there is pooling, rather than having a striated appearance
What is the colliculus seminalis?
Where is the colliculus seminalis located?
dorsal wall of the central prostatic urethra
What is the risk of prostatic FNA?
Seeding tumours into the peritoneal or pelvic cavity
Which is more accurate for asserting urethral involvement in prostatic disease - US or urethrography?
urethrography
Which part of the prostate is likelier to enlarge more?
a) dorsal
b) ventral
c) right lateral
d) left lateral
a) dorsal
What kind of calcification (shape) is considered likelier to be associated with malignancy?
linear and irregular
Is calcification a sign of prostatic neoplasia?
Not necessarily, as can occur with chronic prostatitis
Peak enhancement of the prostate occurs _____ after IV contrast administration.
30 seconds
** shorter in prostatic carcinoma
How does level and speed of contrast enhancement differ with BPH, prostatitis and carcinoma?
BPH, prostatitis - same level and speed as a normal gland
carcinoma - greater and earlier enhancement
a) BPH
D) Chronic prostatitis
D) Neoplasia and chronic prostatitis
a) BPH
b) increased peak intensity with a shorter time to peak enhancement
C: Located dorsolateral surface of the mid pelvic urethra
A: Increased in size due to increased intracellular volume
B: Chronic prostatitis
D: Prostatic neoplasia
