Prostatic disease

Question 1

What are three ways to get a sample of prostatic fluid or cells?

Answer 1

Ejaculate sample,

prostatic wash or urethral brushing, or biopsy

Question 2

Briefly describe how to collect a sample from a prostatic brushing.

Answer 2

a catheter with a small brush on the end is inserted into the urethra to the level of the prostate, and the prostate is stimulated rectally to give off fluid. That fluid is then collected through the catheter into a syringe.

Question 3

What signs of neoplasia might you see in cells?

Answer 3

Clustering and different sizes of nuclei

Question 4

In dogs, which part of the prostate tends to hypertrophy?

Answer 4

The glandular part. It grows from the inside out, and presses up on the colon.

Question 5

Why does prostatic Hyperlasia happen with age?

Answer 5

Static estrogen levels as androgens falls with age. The change in the ratio of testosterone to estrogens

Question 6

What are some signs of prostatic hyperplasia?

Answer 6

Tenesmus (straining to poo), hematuria, discharge, infertility

Question 7

What is the generally reccomended treatment for hyperplasia/cysts?

Answer 7

Castration- prostate should shrink palpably within 10 days.

Question 8

What types of drug can be used to treat hyperplasia if the owner is unwilling to neuter?

Answer 8

5-a reductase inhibitors- blocks conversion of testosterone to DHT (Finasteride)
-Progestins- suppresses LH release by negative feedback and decreased androgen receptors

Question 9

What will happen if you stop treatment with a 5-a reductase inhibitor?

Answer 9

The prostate will return to pretreatment size within weeks.

Question 10

How do progestins and fiasteride affect libido and sperm qualtiy?

Answer 10

They are minimally affected

Question 11

What are the disadvantages to using progestins long term?

Answer 11

Diabetes mellitus
mammary tumors
development of female characteristics

Question 12

How do prostatic cysts form?

Answer 12

Glandular tissue proliferates and increases secretion, the connective tissue also becomes disorganized and secretions get blocked up and form fluid bubbles

Question 13

What are the three presentations of prostatic infections?

Answer 13

Acute bacterial prostatitis
Chronic bacterial prostatitis
Prostatic abscess

Question 14

What are the signs of acute bacterial prostatitis?

Answer 14

Dog will be very sick- fever, lethargy, vomiting, etc.
Will have neutrophilia and and slightly high liver enzymes and bilirubin
Urinalysis will suggest infection (active sediment)

Question 15

What further tests do you need to confirm acute bacterial prostatitis?

Answer 15

NONE- don’t want to do a wash, etc to avoid spreading infection so treat based on history, signs and urinalysis

Question 16

What is the treatment for acute bacterial prostatitis?

Answer 16

initial antimicrobials IV
Supportive care
Long term oral antibiotics
Castration strongly reccomended after acute illness is resolved

Question 17

What are the signs of chronic bacterial prostatitis?

Answer 17

Mild clinical signs
enlarged prostate
Possible mineralization on imaging
Localized to prostate gland

Question 18

Should you want to do a brushing or aspirate if you suspect chronic bacterial prostatitis?

Answer 18

You sure would.

Question 19

What is an additional consideration when dealing with chronic bacterial prostatitis?

Answer 19

There is probably an underlying disease condition causing the chronic infection.

Question 20

What might you worry about with a prostatic abscess?

Answer 20

The abscess rupturing and spilling its contents into the abdomen.

Question 21

What causes prostatic abscesses?

Answer 21

Assumed to be a sequela to prostatitis and is favored by hyperestrogenism (sertoli cell tumor or iatrogenic)

Question 22

What prostatic disease might you expect if a dog has PU/PD

Answer 22

a prostatic abscess because the E. coli infection has a toxin that can cause PU/PD

Question 23

What is the treatment of prostatic abscesses?

Answer 23

surgical drainage

Antimicrobials

Question 24

What type of drugs are better at entering the prostate?

Answer 24

Non-ionized weak bases
Lipid soluble
and poorly protein bound

Question 25

Give one example of a drug that can enter the prostate and one that generally cannot

Answer 25

Fluorquinolones (esp enrofloxacin) can, penicillins and cephalosporins cannot (but those two are often used for UTI’s, so be careful)