Module 8 : Prostate

Question 1

prostate location

Answer 1

• inferior to bladder
• surrounds neck of bladder nd urethra
• posterior to pubis
• anterior to rectum
• levator ani muscle posterior
• fibrous capsule

Question 2

prostate shape

Answer 2

• ovoid
• inverted pyramid
• apex = caudal
• base = cephalic

Question 3

prostate size

Answer 3

• length = 3-3.5cm
• width = 4cm
• AP = 2-2.5cm

Question 4

prostate weight

Answer 4

• younger under 50 = 20grams 20ccs

- older over 50 = 40 grams 40ccs

Question 5

prostate function

Answer 5

• secretes alkaline fluid
  + 1/3 of semen volume
  + aids in sperm motility and activating sperm
  + neutralizes acid environment of vagina, uterus and Fallopian tubes
• produces prostate specific antigen PSA
  + increases with age

Question 6

anatomy

Answer 6

• zonal anatomy
• 4 zones in relationship to urethra and ejaculatroy duct
• useful in localization of cancer
• based on histological components

Question 7

peripheral zone

Answer 7

• largest zone
• most common site of cancer
• surrounds distal urethra
• surgical capsule separates it form transition and central zone
• posterior lateral and apical regions
• benign prostatic hyperplasia (BPH) does not affect here

Question 8

transition zone

Answer 8

• two small glands on either side of proximal urethra segment
• site of origin of benign prostatic hyperplasia
• ducts end in proximal urethra at level of verumontanum

Question 9

central zone

Answer 9

• base of prostate
• ejaculatroy ducts pass through it
• resistant to disease process
• zone terminates near verumontanum

Question 10

periurethral glands

Answer 10

• 1% of gland volume
• embedded in the longitudinal smooth muscle of pros urethrea
• internal prostatic sphincter

Question 11

fibromuscular stroma

Answer 11

• non glandular area
• anterior surface of prostate
• one third of prostate
• smooth connection tissue
• NOT PART OF ZONES

Question 12

outer/peripheral gland

Answer 12

• peripheral and central

Question 13

inner gland

Answer 13

• transition zone
• fibromuscular stroma
• urethral sphincter

Question 14

seminal vesicles

Answer 14

• paired ovoid
• posterior to bladder
• superior to prostate
• SV + vas deference = ED
• ED empty into urethra
• 3-4cm in length 1-3cm in thickness

Question 15

indications for US

Answer 15

• • DRE
• increased PSA
• urine infrequency , nocturne, decreased urine stream
• male infertility
• biopsy guidance
• blood or pus in urine or semen

Question 16

transabdominal exam

Answer 16

• only for size and volume of prostate

- need full bladder

Question 17

prostate on US

Answer 17

• ovoid
• low to moderate echoes
• homogenous
• echogenic interface from urethra

Question 18

trans rectal TRUS

Answer 18

• variety of types
• end firing (viewing) probe most common
  + multiplane imaging
  + biopsy capability
• probes covered in condom (latex or non latex)
• ## ASK PATIENT IF LATEX ALLERGY

Question 19

TRUS scan technique

Answer 19

• empty bladder
• LLD position with legs bent to chest
• DRE performed prior to TRUS
• systemic approach axial and transverse

Question 20

TRUS scan orientation

Answer 20

• rectum at the bottom of screen

- sag = anterior abdominal wall at top

Question 21

peripheral zone sonographic appearance

Answer 21

• homogeneous and isoechoic

Question 22

surgical capsule US look

Answer 22

• hypo echoic line

Question 23

central zone US look

Answer 23

• hyper echoic or isoechoic to peripheral zone

Question 24

transition zone US look

Answer 24

• isoechoic to peripheral zone

- hypo echoic with BPH

Question 25

corpora amylacea

Answer 25

echogenic foci = collection of protein

Question 26

periurethral glandular area US look

Answer 26

- hypo echoic - blend with urethr - prominent in young men

Question 27

anterior fibromuscular stroma

Answer 27

- hypechoic

Question 28

seminal vesicle

Answer 28

- hypo echoic - symmetrical - AP 10mm

Question 29

what area used for standard echogenicity

Answer 29

peripheral zone

Question 30

lab tests

Answer 30

- PSA - PSA density - Acid phosphate - alkaline phosphate

Question 31

prostate specific antigen PSA

Answer 31

- enzyme almost exclusively in prostate - secreted and disposed of through ducts in prostate - elevated in BPH infection carcinoma - not specific to cause - normal < 4ng/ml - biopsy if >10ng/ml

Question 32

PSA density

Answer 32

- PSA / prostate volume - cancerous tissue produces more PSA - density > 0.12 warrants a biopsy

Question 33

acid phosphate

Answer 33

- found in prostate and semen | - increased in carcinoma that has spreadbeyon prostate capsule

Question 34

alkaline phosphate

Answer 34

- produced in osteoblasts (bone) will increase if increase in osteoblast activity - prostate cancer spread to bone

Question 35

blood supply

Answer 35

- prostaticovesicle arteries | - brach of IIA

Question 36

benign ductal ectasia

Answer 36

- 1-2mm tubular structure in peripheral zone - hypoechoic - can be mistaken for prostate cancer

Question 37

calcifications

Answer 37

- incidental findings | - benign calcifications often coarser in appearance than malignant calcifications