Prostatic Disease Flashcards
describe what happens to the prostate with aging?
- increase in size and vascularity with aging
- due to androgens: 5 alpha reductase: converts testosterone to dihydrotestosterone
what happens to the prostate with castration?
- atrophy within days!
- will decrease in size by 50% within 3 weeks!!
-Bartges said know this number - within 9 weeks, will have decreased in size by at least 70%
- in six months, complete atrophy
describe signalment of prostatic disease
- older intact male dogs
- mean age 8-9 years
- increased incidence in dobermans and german shepherds
- in castrated male dogs, neoplasia common!!!
-a big prostate in a dog castrated more than 6 months ago is cancer until proven otherwise!
describe clinical signs of prostatic disease
- can be none
- urogenital: hematuria, dysuria, preputial discharge, recurrent UTI, urethral obstruction, incontinence, infertility
- polysystemic: vomiting, abdominal pain, fever, anorexia, lethargy, tenesmus, HL stiffness
describe diagnosis of prostatic disease
- observe: blood spots on the floor, penile discharge
- palpate rectally during physical exam
- imaging:
-lateral radiographs: measure distance between sacral promontory and pubis; normal prostate in an intact male dog is less than 70% of this distance; will only show clinical signs once prostate is greater than 70% of this distance
-transverse ultrasound: should have a heterogeneous appearance throughout parenchyma
–abnormal: cysts or abscesses, mineralization (make suspicious of cancer, but not ALWAYS cancer)
- UA: can be very helpful, sometimes all you need
- ejaculate collection: will NOT work if painful or castrated!
-prostatic fraction usually clear, cloudy = abnormal
-use prostatic massage if castrated!
-or aspiration cytology (careful of peritonitis, ultrasound guided is good): 96% accurate for ID disease - if have endoscope: pass a brush through urethra and rub to try to get cells
-if disease not involve urethral lumen, won’t help duh - traumatic catheter biopsy: pass catheter up urethra to prostate, rub really hard to try to get a sample
describe benign prostatic hypertrophy etiology and signalment
- as prostate gets bigger and more vascular, tissues undergo hypertrophy, and certain areas that don’t get all the vessels start to necrose and form cysts
-intermittent and bloody or clear discharge at the beginning - as prostate grows, can cause complete obstruction! (even though technically benign disease)
- seen in middle-aged and older intact males
-NOT in castrated males
describe physical exam, labs, imaging, and diagnosis of BPH
PE: LUT signs, drips discharge, (could be normal/subclin), bilateral symmetrical increase in size, NOT painful
labs: normal, hematuria, NO UTI
imaging: bilateral symmetrical increase, small cysts
diagnosis: cytology/biopsy, hemorrhage, normal bloodwork
describe treatment of BPH
- castration is curative!!
-50% reduction in size within 3-4 weeks
-should be small within 6 months - finasteride (proscar): if stupid owner wants to keep intact
-5 alpha reductase inhibitor
-dose dependent reduction in prostate
-prostate decreases after 4 weeks and atrophy by 6-9 weeks
-does not alter fertility
-prostate returns to pre-diagnostic size within 7 weeks after discontinuation - flutamide (FYI)
- estrogens: NOT GOOD
-complications: increases prostate size and volume, feminization, aplastic anemia - progestogens: also not good
-some short term benefit, but 50% relapse within a year
-complications: diabetes mellitus, polyphagia, feminization
remember that prostate can get bacterial infections
cool, see other lecture; recall acute versus chronic
describe paraprostatic cysts
- adjacent to prostate gland
- cause LUT signs and tenesmus
- usually require surgical attention
