Prostatic disease Flashcards
How do you treat BPH?
Castration
deslorelin if unable to GA/ not needed for breeding soon. Competitive inhibitor of GnRH
Osaterone - competitive binding to androgen receptors, blocks uptake of DHT and testosterone in the prostate. No effect on sperm production
Finasteride - 5 alpha reductase inhibitor - blocks conversion of testosterone to DHT. Most used in US. Must be continued for life. Doesn’t affect testosterone so libido and spermatogenesis not affected
Tardak - delmadinone - progestin, very potent antiandrogenic activity
Progestogens (not recommended)
What types of prostatic cyst are there?
Intraprostatic - small, multiple, associated with BPH
Retention cyst - intra or extra prostatic, thick walled, can be large, associated with squamous metaplasia
Paraprostatic cyst - moderate tp very large, up to 30cm diameter. Craniolateral or caudal to prostate. To do with mullerian duct remnant or uterus masculinus. Commonly calcified.
How may cysts appear?
Older dogs may be found incidentally Non painful can see normal prostate signs, abdominal distension May be assymetrical Thick walled
How do you treat prostatic cysts?
BPH Tx
needle aspiration only temporary Tx
If retention cyst - remove hormone causing the issue
If extra prostatic - may need surgical resection +/- ommentalisation/ marsupialisation
What is squamous metaplasia of the prostate?
Due to increased oestrogen, e.g. from sertoli cell tumour, adrenal gland tumour/ interstitial cell tumour/ exogenous hormones
Cuboidal collumnar epithelial cells become squamous
Leads to glandular stasis - retention cysts/ prostatitis
Not painful
Minimal enlargement
May be heterogenous on US
May see secondary hormonal changes - symmetrical alopecia/ hyperpigmentation/ gynecomastia/ attraction of male dogs/ firmer prostate/ penduclous prepuce.
Needs biopsy to confirm
How do you Tx squamous metaplasia?
Remove oestrogen source
ABs if infecction suspected
Outline acute prostatitis
Can be severe - pain, lethargy, v+, prostate signs
Swollen prostate, may be asymmetric
Can lead to diskspondylitis
Inflammatory on bloods
Can see high ALKP/ other hepatic signs
Electrolyte abnormalities
Pyuria/ haematuria
US - heterogeneity, +/- cavitating areas containing hyperechoic fluid
When culturing the fluid - most commonly e.coli
Normally only really seen in intact dogs
How do you Tx acute prostatitis
Ideally IV ABs to start
Await culture. When acute disease and sick, blood prostate barrier not intact so can use things like co-amox. Otherwise fluoroquinolnes, can also do macrolides, TMPS
tx any co-existing prostate disease
antibiotic treatment be 4 weeks for acute cases and 6 weeks for chronic cases or cases with abscessation.
Outline chronic prostatits
May be incidental
Can be associated with recurrent UTI
Normal prostate signs
May not have enlarged prostate due to fibrosis
Commonly associated with other prostate disease
E.coli most common, can get brucellosis venereally, otherwise staph/ strep/ mycoplasma/ ureaplasma
Normal to enlarged prostate, can be symmetrical to assymetrical, normally non painful
Bloods wnl
Cytology - marked inflammation, intracellular bacteria. Chronic cases of prostatitis also have large numbers of macrophages, with plasma cells and lymphocytes
Can trial Tx with ampicillin prior to culture to differential UTI and prostatitis
How do you Tx chronic prostatitis?
Similar to acute, but blood prostate barrier normally intact
fluoroquinolones are often good as they are zwitter ions, but not good against anaerobes
Best to culture at the end of the course of ABs (4-6 weeks), 1m post treatment, 6 weeks post treatment
Outline prostatic abcesses
Cavitated lesion on US
Culture may be -ve if the abscess is walled off from the ducts
Surgical resection is the best treatmentm ideally with omentalisation
Outline prostatic neoplasia
Mostly adenocarcinoma, can be TCC, lymphosaarcoma, haemangiosarcoma, SCC
See severe signs - normal prostate signs, HL weakness, weight loss, firm prostate, can be painful
How do you dx prostatic neoplasia?
May see inflammation on bloods, high ALKP
Xray - large prostate, mineralisation, oesteoblastic reaction of dorsal surface of lumbar vertebrae
US - heterogenous, hyper-echoic foci, may have distal acoustic shadowing (mineralisation)
Needs biospy/ cytology to confirm dx but beware of seeding!
How do you treat prostatic neoplasia?
Poor prognosis
Not androgen dependent so castration won’t help
Can do prostatectomy but high risks of SE and no increase in survival time with this or radiotherapy/ chemotherapy
NSAID can decrease tumour growth - piroxicam has most evidence
Bisphosphonates (osteoclast inhibitors) strengthens bone, which reduces pain and the risk of fracture, therefore can decrease pain with bone mets, may decrease tumour growth
Consider tube cystotomy
MST 30d if not PTS at dx
Can you get haematuria with BPH?
Yes
Can also see signs of subfertility
