Prostatic Disease

Question 1

describe what happens to the prostate with aging?

Answer 1

1. increase in size and vascularity with aging
2. due to androgens: 5 alpha reductase: converts testosterone to dihydrotestosterone

Question 2

what happens to the prostate with castration?

Answer 2

1. atrophy within days!
2. will decrease in size by 50% within 3 weeks!!
   -Bartges said know this number
3. within 9 weeks, will have decreased in size by at least 70%
4. in six months, complete atrophy

Question 3

describe signalment of prostatic disease

Answer 3

1. older intact male dogs
2. mean age 8-9 years
3. increased incidence in dobermans and german shepherds
4. in castrated male dogs, neoplasia common!!!
   -a big prostate in a dog castrated more than 6 months ago is cancer until proven otherwise!

Question 4

describe clinical signs of prostatic disease

Answer 4

1. can be none
2. urogenital: hematuria, dysuria, preputial discharge, recurrent UTI, urethral obstruction, incontinence, infertility
3. polysystemic: vomiting, abdominal pain, fever, anorexia, lethargy, tenesmus, HL stiffness

Question 5

describe diagnosis of prostatic disease

Answer 5

1. observe: blood spots on the floor, penile discharge
2. palpate rectally during physical exam
3. 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)

4. UA: can be very helpful, sometimes all you need
5. 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
6. 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
7. traumatic catheter biopsy: pass catheter up urethra to prostate, rub really hard to try to get a sample

Question 6

describe benign prostatic hypertrophy etiology and signalment

Answer 6

1. 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
2. as prostate grows, can cause complete obstruction! (even though technically benign disease)
3. seen in middle-aged and older intact males
   -NOT in castrated males

Question 7

describe physical exam, labs, imaging, and diagnosis of BPH

Answer 7

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

Question 8

describe treatment of BPH

Answer 8

1. castration is curative!!
   -50% reduction in size within 3-4 weeks
   -should be small within 6 months
2. 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
3. flutamide (FYI)
4. estrogens: NOT GOOD
   -complications: increases prostate size and volume, feminization, aplastic anemia
5. progestogens: also not good
   -some short term benefit, but 50% relapse within a year
   -complications: diabetes mellitus, polyphagia, feminization

Question 9

remember that prostate can get bacterial infections

Answer 9

cool, see other lecture; recall acute versus chronic

Question 10

describe paraprostatic cysts

Answer 10

1. adjacent to prostate gland
2. cause LUT signs and tenesmus
3. usually require surgical attention