Prostate Flashcards
Normal prostate volume
<30cc
What area is the prostate located?
retroperitoneum
The prostate is bordered: \_\_\_\_\_\_\_\_ by the public bone \_\_\_\_\_\_ by the rectum \_\_\_\_\_\_ by the urinary bladder \_\_\_\_\_\_\_ by the urogenital diaphragm
anteriorly
posteriorly
superiorly
inferiorly
What are teh three major vessels that provide arterial blood to the prostate?
internal pudendal
inferior vesical
middle rectal arteries
apex
inferior portion of the gland situated superior to the urogenital diaphragm
base
superior portion of the gland situated below the inferior margin of the urinary bladder
seminal vesicles
two sac-like outpouchings of the vas deferens
situated adjacent to the sup/post aspect of the prostate,
b/w the urinary bladder and rectum
located post/inf to the bladder
ejaculatory ducts
duct that passes through the central zone and empties into the urethra
originates from the combination of the vas deferens and the seminal vesicle
verumontanum
longitudinal ridge within the urethra in which the orifices of the ejaculatory ducts are located on either side
corpora amylacea
calcifications commonly seen in the inner gland of the prostate
surgical capsule
demarcation between the inner gland (central and transitional zone) and the outer gland (peripheral zone)
eiffel tower sign
shadowing created by edge artifact or calcification of the prostatic urethra
The original concept of a 5 lobed prostate has been replaced the McNeal’s concept of zonal architecture, what are the glandular zones?
peripheral
central
transitional
fibromuscluar stroma
Peripheral zone
posteriorly/lat located portion of the prostate
extends into the apex of the prostate
containing 70% of the prostatic tissue, thus teh location of most prostate ca
Central Zone
superiorly located
contains 25% of tissue
ejaculatory ducts pass through from the seminal vesicles to the urethra
Transitional zone
5% of the tissue
origin of benign prostatic hyperplasia
Fibrosmuscular Stroma
anteriorly located
non-glandular portion of prostate, hence not affected by prostate ca or hyperplasia
classification or grading of prostate ca is established from the ____ ____ system.
Gleason Grading system
based on microscopic appearance, predominant pattern and second most common pattern are given a grade between 1-5 and the score is the sum
higehr the score the more aggressive
In TRUS the image is inverted so that the rectum is displayed at the ______ of the screen.
bottom
The incidence of prostate ca increases with the incidence of
age
family hx
race (at least 60% more common and 2-3 x more deadly among black men; If father or brother had it, then 2x risk, especially if brother
-lifetime risk is about 15% (1 in 6..67)
Prostate specific antigen is a single-chain glycoprotein, what are the limits?
<4ng/mL = NML
4-10 = poetntially malig
>10 = most liekly ca
*PSA Velcoity - levels normally go up with age but they go up faster with ca
*PSA density - level/vol = higher indicates greater risk of ca
PSA may be elevated from
infection, treated with antibiotics 4-6wks
Classic appearance of prostate ca
varied
can be focal or diffuse
usually hypoechoic and peripherally orientated lesion
-can also appear hyperechoic or isoechoic
-not all hypo are cancerous
so….
the larger the lesion and the higher the PSA,more likely that a hypo lesion is ca
Pre exam prep for TRUS
cleansing enema
pre and post prophylactic antibiotics
Methods of prostate Bx
Lesion directed Bx- infreq used due to porr detection rate
Systematic Sextant Bx- 3 on RT and LT
Parasagittal Sextant Bx-including additional cores, 10, in eth lateral aspects of the peripheral zone
Prostate staging 1-4
1-clinically nonpalpable
2-palpable nodule within prostate
3-palp extending through capsule
4-METs
BPH
enlargement of the transitional zone of the prostate
Symptoms of BPH
diffiuclt urination or voiding
urinary frequency
small stream
Prostate anomalies
seminal vesicle agenesis seminal vesicle cysts utricle cysts mulelrian duct cysts ejaculatory duct cysts
seminal vesicle agenesis
assoc with ipsilateral renal agenesis
seminal vesicle cysts
- post to bladder, arising from the seminal vesicles cephalic to the prostate
- unilateral seminal vesicle cyst result from cong atresia of ejaculatory duct and are often assoc with ipsilateral renal agensis
- seminal vesicle and wolfian duct cysts are lcoated off ML
- Bilateral seminal cysts assoc with ADPKD
Utricle cysts
-remnant of mulelrian duct in males which often presents as a sac with a slit like orifice at the apex of the verumontanum that prjects upward and backward int the substance of teh prostate
-tear drop shape at ML
assoc with hypospadies, crytorchidism, unilateral renal agenesis
mulelrian duct cysts
remnant of the caudal ends of the fused mulelrian duct, typically regresses in utero
ML, post to bLD
-do not communicate with the prostatic urethra
ejaculatory duct cysts
- lateral and occur due to obstruction, cong or acq
- resulting in hematospermia, ejaculatory pain and infertility
