Chapter 113 Prostate Flashcards
What is embryonic origin of prostate
Endodermal
LAbel the diagram
What is normal weight of prostate as proportion of BW
064 - 0.96 g/kg
>this invariably associated with histo abnormalities
(bigger in scotties)
Where in the prostate is the urethra positioned?
Closer to dorsal surface
Where do vas deference enter prostate and urethra?
Enter prostate dorsally then into urethra via slits on each side of colliculus seminalis.
What is blood supply to prostate?
And to prostatic urethra?
Prostatic artery (cranial, middle and caudal branches)
Prostatic urethra supplied by independent branch of prostatic artery
What veins drain the prostate?
Which LNs
Prostatic and urethral veins
Medial and internal iliac LNs
What is parasymathetic and sympathetic nervous supply to prostate
With which vessel does each nerve course prior to entering pelvic plexus?
Hypogastric = sympathetic. Runs with artery of deferent duct
Pelvic = parasympathetic. Runs with prostatic artery
Histologically speaking, what types of tissue are there in the prostate?
Epithelial, fribrous, elastic, smooth muscle
What is the pH of canine prostatic fluid
6.1 - 6.5
List 3 proposed funtions of prostatic fluid
- Promote spermatozoe motility + viability
- Increase uterine perfusion
- Modulate neutrophil induced inhibition of spermatozoa attachment to uterine epithelium
What mechanism drives continued prostatic enlargement
ANDROGEN DRIVEN
(INCREASE IN NUMBER OF DIHYDROTESTOSTERONE RECPETORS)
What are the two types of BPH
- Glandular = changes exclusively contained to secretory cells. Gland enlarges but histologic structure and arrangement remain orderly. Usually dogs <5 yrs
- Complex = involves primarily stromal elements . Older dogs
What other condition should be checked for when performing rectal for BPH?
Perineal hernia
(present in 10%)
What additonal blood test should be considered in prostatitis cases?
Brucella canie titre
List 3 ways to sample prostatic fluid?
Transurethral wash
Ejaculate sampling
FNA (US guided - blind reported but US better, obviously)
When are biopsy samples of prostate inducated?
Only to confirm neoplasia if FNA inconclusive
What radiographic chanhes might be seen with prostatic disease and what do they indicate
- Displacement/enlargement of colon due to prostatic enlargement
- Poor prostatic outline due to inflammation
- Mineralization likely neoplastic change if neutered but can be seen with prostatic cyst or prostatic calculi
- Emphysematous changes with prostatitis
- LN enlargement reactive vs mets
What is the ultrasonographic appearance in the following conditions
- BPH
- Prostatitis
- Prostatic cysts
- Neoplasia
- BPH:
- Increase in the overall gland size
- Heterogenous increase in echodensity
- Small focal areas of echolucency
- Cystic changes are also common with this condition, appearing as multiple areas of very low echogenicity. In young dogs the presence of fluid within the cystic areas may be associated with hematocystic lesions
- Prostatitis
- May develop in the presence of multiple cystic changes
- A combination of focal hyperechoic and hypoechoic areas. Some areas are intensely hyperechoic and surround pockets of fluid accumulation. Abscessation appears as a progression of this, with highly characteristic hyperechoic capsular and loculated tissue containing a fluid signal and hyperechoic flocculent material
- Prostatic cysts
- Hyperechoic fluid ultrasound appearance that may be difficult to distinguish from that of the bladder. The cyst may be separated from the bladder by a hyperechoic pedicle or intimately involved with the parenchyma with discernible urethral communication.
- Neoplasia
- Neoplastic infiltration of the gland results in heterogenous hyperechogenic changes.
- Concurrent cysts or abscessation may be present.
What type of needle shoudl be used for prastatic aspirate/
22G spinal (stylet so not sampling unwanted tissues)
What condition in young dogs, with enlarge protate could cause blooy urethral discharge?
Juvenile haematocysts (under BPH heading) within prostatic parenchyma
List 2 options for medical management of BPH
“Tardak” Delmadinone acetate = progestogen with antiandrogenic and antiestrogenic activity. It reduces testosterone production by suppressing interstitial cell function (=Leydig cell in testes), and its effects are rapidly reversed.
“Suprelorin” Deslorelin acetate = Gonadotropin-Releasing Hormone Agonists/Analogues (aka luteinizing hormone–releasing hormone agonists,) = mimic the action of GnRH and block pituitary receptor sites, causing a reduction in natural GnRH and a decline in testicular secretion of testosterone.
What is most common bacteria in prostatic abscess
E coli (by far)
(If orchitis is present can be Brucella canis)
Name aparasite that has been seen in prosttic cyst
Ecchinococcus multilocularis
What is most common presenting sign for prostatic cyst
Abdominal distention/mass
What is most common neoplasm of prostate
Adenocarcinoma
Comment on cells
Aspirate of a prostatic carcinoma in a dog. Cytologic preparation shows a scattering of neoplastic cells (arrows) surrounding a cluster of relatively normal, uniform prostatic cells (within red boundary). Carcinoma cells are large and pleomorphic and have marked anisocytosis and anisokaryosis, prominent nucleoli, and basophilic cytoplasm.
Normal shown below
List 5 neoplastic ddx for prostate
- Adenocarcinoma
- SCC
- TCC
- Undifferentiated carcinoma
- Lymphoma
- Leiomyoma
- Leiomyosarcoma
- HSA
What gene mutation has been associated with increased risk for prostatic carcinoma
GAG-1 repeats in androgen receptor gene
How are prostatic carcinomas differentiated (i.e. 6 different types/growth patterns)
- Papillary
- Cribriform
- Solid
- Small acinar/ductal
- Signet ring
- Mucinous
What subtype of prostatic carcinoma is more common in castreated dogs?
Ductal or urothelial origin
COX-2 isnt normally expressed in prostatic tissue, but what % of prostatic cracinoma cells express it?
75%
WHat % of prostatic carcinoma cases have axial mets?
20%
i..e consider nuclear scintigraphy
How is prostatic neoplasia managed?
- Manage urinary retention (cystostomy, stent, try Prazosin)
- NSAIDs
- Bisphosphonate of axial mets
- Not much evidence to support chemo
- Stereotactic radiotherapy
- Can consider partial prostatectomy IF small lesion (Nd;YAG laser reported) or total prostatectomy if is TCC NOT involving baldder enck
What caused prostatic metaplasia?
High circulating oestrogens i.e. Sertoli cell tumour or seminoma
How is inadvertent prostatectomy managed (2 techniques)
- Anastomos bladder neck with remaining urethra
- Bladder retrovesrion (i.e flipped upside down and back to front (i.e. moves trigone cranially so ureteral length not a limiting factor) then anastomosis of bladder apex to urethra.
What surgical ‘step’ is recommended when preformring ventral drainage for prostatic abcess to reduce risk of urethrocutaneous fistula
2 drains (one each side) raher than one looping over urethra
20% mortality, drain loss, urethrocutaneous fistula
WHat addiitonal surgical step is recommended when performing partial prostatectomy
Temporary occlusion of aorta caudal to renal areteries
(US aspirator recommended)
Test urethra for signs of leakage
What is size of feline prostate?
How does anatomy differ from canine
What prostatic diseases have been reported in cats
10 mm
Doesnt fully encircle urethra - not there ventrally.
Neoplasia and periprostatic cyst
Name a management option for cat with prostatic neoplasia
Prostatectomy + prepubic urethrostomy
List management options for prostatic abcess.
And for prostatic cyst.
Prostatic abcess:
- US drainage
- Omentalisation
- Marsupialization
- Partial prostatectomy
- Ventral drainage
Prostatic cyst:
- US drainange (+ ablation with 95% alcohol in a case report)
- Partial resection + omentalization (recommended)
- Marsupialization
- Partial prostatectomy
- Compete resection
