Prostate Flashcards
Rectum is ____ to the prostate
Posterior
What 4 factors assoc with inc PSA (prostate specific antigen)
Patient age
Prostate volume inc
Benign prostatic hyperplasia
Prostate cancer
Zone most likely involved with cancer
Peripheral zone
70%, Cancer is hypo peripherally oriented lesion
BPH is in what zone
Transitional zone
Trans rectal US image patient position
LLD
Lab test for prostate cancer
PSA prostate specific antigen
MC symptoms of Prostatism
Difficult initiation of voiding
Nocturia
Small stream
Indication for transrectal
Abnl digital rectal exam
Abnl lab indicating prostate cancer
Guidance for biopsy
Monitor prostate cancer treatment
Color Doppler in transrectal exam
Allows improved perception of pathologic vessels assoc with cancer
US appearance of prostate cancer
Hypo, hyper, Iso lesions
Patient prep for transrectal biopsy
A cleansing enema immediately prior to exam and antibiotics given before and after exam.
Prostate gland anatomic classification used
Zonal anatomy
The prostaticovesical arteries that supply prostate are branches off the
Internal iliac arteries
Display of prostate with transrectal US
The rectum is shown at the bottom of the screen
Transrectal prostate sag plane. The most lateral images of the gland show
The peripheral zone
Frequency for transrectal imaging
7-8MHz
Seminal vesicles in transrectal US looks
Hypoechoic, symmetrical, irregular shape
US appearance of BPH
Enlarged prostate gland, focal or diffuse
Cyst associated with infertility
Ejaculatory duct cyst
Acute prostatitis with an anechoic mass
abscess
4 zones of Prostate
Peripheral zone (prostate cancer) Transitional zone (BPH) Central zone Fibromuscular stroma (nonglandular region)
What area in the prostate Is not affected by cancer
Fibromuscular stroma
Not affected by cancer, prostatitis, or hyperplasia
Fibromuscular Stroma
Non glandular anterior part of prostate. Not affected by cancer, prostatitis, or hyperplasia.
Benign Prostatic Hyperplasia (BPH)
Enlargement of inner prostate gland. Hypo to peripheral zone.
95% in transitional zone
Originates from inner gland
Ejaculatory ducts pass through ___ and empty into urethra
The central zone
Seminal vesicles are 2 sac-like out pouchings of the vas deferans situated adj to the ____ aspect of the prostate between the urinary bladder and rectum
Superior / posterior
The base of the prostate is the ____ part of the gland
Superior
The apex of the prostate is the __ part of the gland
Inferior
The demarcation between the inner gland and the outer gland is called the
Surgical capsule
The prostate is situated in the retroperitoneum and is bordered ant by _____, post by _____, sup by _____, and inf by ______
Ant by the pubic bone
Post by the rectum
Sup by the urinary bladder
Inf by the urogenital diaphragm
Prostate-Specific Antigen PSA
Produced by prostate acinar cells. Rises in relationship to the amount of tissue (benign or malignant)
Rises with patient age, prostate volume, BPH, and prostate cancer
PSA rises 10 times more in cancer than BPH
1.5-4 ng/mL inc risk cancer
Black, old men, fam hx, prior disease, prior prostate bx
Fibromuscular stroma is ___ to prostate
Anterior
Denovilliers fascia is located ___ to the prostate
Posterior
When see a solid testicular mass evaluate
Periaortic region for lymphadenopathy
Function
Fluid transport for sperm mobility
Prostate size
Oval/cone shape
Walnut size
4 x 3.8 x 3 cm
Base (sup)
Apex (inf)
Prostate Cancer
MC cancer in men
2nd cancer death after lung
Vasectomy
Remove vas deferens
Blood supply
Internal iliacs art and vein
Surgical capsule
Boundary between central and peripheral zones
Patient prep
Cleansing enema
Urethra is in center of prostate
Cysts
Müllerian duct cysts: MC pelvic cyst, above base of gland. Connect to prostate by stalk. May have cancer.
Utricle cysts: midline close to verumontanum. Assoc with hypospadias (urethra under penis). May have cancer.
Seminal vesicle cyst: assoc with ipsilateral renal agenesis. Sup to prostate.
Prostatic cyst: congenital/acquired. Lat to prostate.
Ejaculatory Duct cyst
BPH
MC prostate disease
90% of males over 80 yrs
95% in transition zone
Bladder outlet obstruction, hesitancy, dribbling, urine retention, nocturia
Hypo/hyper hetero/homo well defined. May compress central and peripheral zone.
Calculi
2nd to prostatitis, BPH, urine, ca+ of corpora amylacea
Incidental finding
Ejaculatory duct Ca+
Periuretheral duct Ca+
Prostatitis
Inflammation of prostate
forms in acinar prostate primarily in peripheral zone
Fever chills discomfort when void. Low back pain. Painful perineum/rectum
Hard swollen tender prostate
Acute: hypo rim surrounding periuretheral tissue. Hetero.
Chronic: diffuse/focal hetero, focal hypo, abscess, ca+
Granulomatous prostatitis
Prostate Cancer
Most common cancer in men. MC adenocarcinoma > 50 yrs Develops in acinar tissue 80% in peripheral gland.
2nd MC cause of cancer death besides lungs
Fam hx, hormone, age, environmental
Micrurition, uremia, weak stream, bone pain, weak, obstruction, urgency, change in bowel habits, wt loss.
Hypo peripheral lesion with poor margins. Hyper-Iso. Asymmetry. Ca+. Inc color. Hypervascular
Prostatectomy
Prostatic acid phosphatase PAP
Not 100% specific for cancer
Dx with biopsy/excision/surgery
Largest zone
Peripheral
