Chapter 113 Prostate Flashcards

1
Q

What is embryonic origin of prostate

A

Endodermal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LAbel the diagram

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is normal weight of prostate as proportion of BW

A

064 - 0.96 g/kg

>this invariably associated with histo abnormalities

(bigger in scotties)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where in the prostate is the urethra positioned?

A

Closer to dorsal surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where do vas deference enter prostate and urethra?

A

Enter prostate dorsally then into urethra via slits on each side of colliculus seminalis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is blood supply to prostate?

And to prostatic urethra?

A

Prostatic artery (cranial, middle and caudal branches)

Prostatic urethra supplied by independent branch of prostatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What veins drain the prostate?

Which LNs

A

Prostatic and urethral veins

Medial and internal iliac LNs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is parasymathetic and sympathetic nervous supply to prostate

With which vessel does each nerve course prior to entering pelvic plexus?

A

Hypogastric = sympathetic. Runs with artery of deferent duct

Pelvic = parasympathetic. Runs with prostatic artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Histologically speaking, what types of tissue are there in the prostate?

A

Epithelial, fribrous, elastic, smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the pH of canine prostatic fluid

A

6.1 - 6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List 3 proposed funtions of prostatic fluid

A
  1. Promote spermatozoe motility + viability
  2. Increase uterine perfusion
  3. Modulate neutrophil induced inhibition of spermatozoa attachment to uterine epithelium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What mechanism drives continued prostatic enlargement

A

ANDROGEN DRIVEN

(INCREASE IN NUMBER OF DIHYDROTESTOSTERONE RECPETORS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the two types of BPH

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What other condition should be checked for when performing rectal for BPH?

A

Perineal hernia

(present in 10%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What additonal blood test should be considered in prostatitis cases?

A

Brucella canie titre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 3 ways to sample prostatic fluid?

A

Transurethral wash

Ejaculate sampling

FNA (US guided - blind reported but US better, obviously)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When are biopsy samples of prostate inducated?

A

Only to confirm neoplasia if FNA inconclusive

18
Q

What radiographic chanhes might be seen with prostatic disease and what do they indicate

A
  • 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
19
Q

What is the ultrasonographic appearance in the following conditions

  • BPH
  • Prostatitis
  • Prostatic cysts
  • Neoplasia
A
  • 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.
20
Q

What type of needle shoudl be used for prastatic aspirate/

A

22G spinal (stylet so not sampling unwanted tissues)

21
Q

What condition in young dogs, with enlarge protate could cause blooy urethral discharge?

A

Juvenile haematocysts (under BPH heading) within prostatic parenchyma

22
Q

List 2 options for medical management of BPH

A

“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.

23
Q

What is most common bacteria in prostatic abscess

A

E coli (by far)

(If orchitis is present can be Brucella canis)

24
Q

Name aparasite that has been seen in prosttic cyst

A

Ecchinococcus multilocularis

25
Q

What is most common presenting sign for prostatic cyst

A

Abdominal distention/mass

26
Q

What is most common neoplasm of prostate

A

Adenocarcinoma

27
Q

Comment on cells

A

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

28
Q

List 5 neoplastic ddx for prostate

A
  • Adenocarcinoma
  • SCC
  • TCC
  • Undifferentiated carcinoma
  • Lymphoma
  • Leiomyoma
  • Leiomyosarcoma
  • HSA
29
Q

What gene mutation has been associated with increased risk for prostatic carcinoma

A

GAG-1 repeats in androgen receptor gene

30
Q

How are prostatic carcinomas differentiated (i.e. 6 different types/growth patterns)

A
  • Papillary
  • Cribriform
  • Solid
  • Small acinar/ductal
  • Signet ring
  • Mucinous
31
Q

What subtype of prostatic carcinoma is more common in castreated dogs?

A

Ductal or urothelial origin

32
Q

COX-2 isnt normally expressed in prostatic tissue, but what % of prostatic cracinoma cells express it?

A

75%

33
Q

WHat % of prostatic carcinoma cases have axial mets?

A

20%

i..e consider nuclear scintigraphy

34
Q

How is prostatic neoplasia managed?

A
  • 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
35
Q

What caused prostatic metaplasia?

A

High circulating oestrogens i.e. Sertoli cell tumour or seminoma

36
Q

How is inadvertent prostatectomy managed (2 techniques)

A
  • 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.
37
Q

What surgical ‘step’ is recommended when preformring ventral drainage for prostatic abcess to reduce risk of urethrocutaneous fistula

A

2 drains (one each side) raher than one looping over urethra

20% mortality, drain loss, urethrocutaneous fistula

38
Q

WHat addiitonal surgical step is recommended when performing partial prostatectomy

A

Temporary occlusion of aorta caudal to renal areteries

(US aspirator recommended)

Test urethra for signs of leakage

39
Q

What is size of feline prostate?

How does anatomy differ from canine

What prostatic diseases have been reported in cats

A

10 mm

Doesnt fully encircle urethra - not there ventrally.

Neoplasia and periprostatic cyst

40
Q

Name a management option for cat with prostatic neoplasia

A

Prostatectomy + prepubic urethrostomy

41
Q

List management options for prostatic abcess.

And for prostatic cyst.

A

Prostatic abcess:

  1. US drainage
  2. Omentalisation
  3. Marsupialization
  4. Partial prostatectomy
  5. Ventral drainage

Prostatic cyst:

  1. US drainange (+ ablation with 95% alcohol in a case report)
  2. Partial resection + omentalization (recommended)
  3. Marsupialization
  4. Partial prostatectomy
  5. Compete resection