Prostate

Question 1

Normal prostate volume

Answer 1

<30cc

Question 2

What area is the prostate located?

Answer 2

retroperitoneum

Question 3

The prostate is bordered:
\_\_\_\_\_\_\_\_ by the public bone
\_\_\_\_\_\_ by the rectum
\_\_\_\_\_\_ by the urinary bladder
\_\_\_\_\_\_\_ by the urogenital diaphragm

Answer 3

anteriorly
posteriorly
superiorly
inferiorly

Question 4

What are teh three major vessels that provide arterial blood to the prostate?

Answer 4

internal pudendal
inferior vesical
middle rectal arteries

Question 5

apex

Answer 5

inferior portion of the gland situated superior to the urogenital diaphragm

Question 6

base

Answer 6

superior portion of the gland situated below the inferior margin of the urinary bladder

Question 7

seminal vesicles

Answer 7

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

Question 8

ejaculatory ducts

Answer 8

duct that passes through the central zone and empties into the urethra
originates from the combination of the vas deferens and the seminal vesicle

Question 9

verumontanum

Answer 9

longitudinal ridge within the urethra in which the orifices of the ejaculatory ducts are located on either side

Question 10

corpora amylacea

Answer 10

calcifications commonly seen in the inner gland of the prostate

Question 11

surgical capsule

Answer 11

demarcation between the inner gland (central and transitional zone) and the outer gland (peripheral zone)

Question 12

eiffel tower sign

Answer 12

shadowing created by edge artifact or calcification of the prostatic urethra

Question 13

The original concept of a 5 lobed prostate has been replaced the McNeal’s concept of zonal architecture, what are the glandular zones?

Answer 13

peripheral
central
transitional
fibromuscluar stroma

Question 14

Peripheral zone

Answer 14

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

Question 15

Central Zone

Answer 15

superiorly located
contains 25% of tissue
ejaculatory ducts pass through from the seminal vesicles to the urethra

Question 16

Transitional zone

Answer 16

5% of the tissue

origin of benign prostatic hyperplasia

Question 17

Fibrosmuscular Stroma

Answer 17

anteriorly located

non-glandular portion of prostate, hence not affected by prostate ca or hyperplasia

Question 18

classification or grading of prostate ca is established from the ____ ____ system.

Answer 18

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

Question 19

In TRUS the image is inverted so that the rectum is displayed at the ______ of the screen.

Answer 19

bottom

Question 20

The incidence of prostate ca increases with the incidence of

Answer 20

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)

Question 21

Prostate specific antigen is a single-chain glycoprotein, what are the limits?

Answer 21

<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

Question 22

PSA may be elevated from

Answer 22

infection, treated with antibiotics 4-6wks

Question 23

Classic appearance of prostate ca

Answer 23

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

Question 24

Pre exam prep for TRUS

Answer 24

cleansing enema

pre and post prophylactic antibiotics

Question 25

Methods of prostate Bx

Answer 25

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

Question 26

Prostate staging 1-4

Answer 26

1-clinically nonpalpable
2-palpable nodule within prostate
3-palp extending through capsule
4-METs

Question 27

BPH

Answer 27

enlargement of the transitional zone of the prostate

Question 28

Symptoms of BPH

Answer 28

diffiuclt urination or voiding
urinary frequency
small stream

Question 29

Prostate anomalies

Answer 29

seminal vesicle agenesis
seminal vesicle cysts
utricle cysts
mulelrian duct cysts
ejaculatory duct cysts

Question 30

seminal vesicle agenesis

Answer 30

assoc with ipsilateral renal agenesis

Question 31

seminal vesicle cysts

Answer 31

• 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

Question 32

Utricle cysts

Answer 32

-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

Question 33

mulelrian duct cysts

Answer 33

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

Question 34

ejaculatory duct cysts

Answer 34

• lateral and occur due to obstruction, cong or acq

- resulting in hematospermia, ejaculatory pain and infertility