prostate
Terms
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- tubuloalveolar gland composed mainly of fibromuscular tissue that surrounds the neck and the bladder and urethra
- prostate
- prostate is located directly beneath the __between the symphysis pubis and the rectum; it encircles the neck of the bladder and ___ which goes through the prostate; it is an oval-shaped, retroperitoneal structure with a base and __.
- bladder, urethra, apex
- normal size of prostate is __X___X___
- 3.8X3X4 (LWH)
- relational anatomy of prostate: superiorly the base is conitnuous with the neck of the ___. inferiorly the apex lies on the upper urogenital __. anterior is the __ and posterior is the anterior surface of the rectal __. lateral margins include the __ m
- bladder, diaphragm, pubis symphysis, ampulla, obturator internus
- zonal anatomy divides the prostate into four glandular zones surrounding the prostatic urethra. what are the four zones
- peripheral, central, transitional, periurethral
- represents 70-75% of the glandular tissue; largest of the glandular zone; occupies the posterior, lateral, and apical regions of the prostate; most cancer starts here
- peripheral zone
- represents 25% of glandular tissue; located like a midline wedge at the prostate base between the peripheral and transition zone; ducts of the vas deferens and seminal vesicles enters this zone forming the ejaculatory duct
- central zone
- area where the ejaculatory duct joins the urethra, where the central zone terminates
- verumontanum
- presents 5% of the glandular tissue; BPH starts here
- transition zone
- 1% of the glandular tissue
- periurethral gland
- represent non glandular tissue, the anterior portion of the prostate
- fibromuscular stroma
- blood flow to the prostate is supplied by the __ arteries arising from the ___ arteries on each side. these vessesls then give rise to the __ and __ arteries.
- prostaticovesicle arteries, internal iliac arteries, prostatic, vesicle
- the prostatic artery gives rise to the __ and __ arteries. the __ artery supplies the bladder base, seminal vesicles, and ureter. the __ supplies about 1/3 of the prostate, whereas the __ branches supply the remainder fo the gland
- urethral and capsular*inferior vesicles artery*urethral*capsular branches
- what is the main function fo the prostate
- sore and secret a clear, slightly alkaline (ph7.29) fluid that constitutes 25-30% of the volume of the seminal fluid, that, along with spermatazoa, constitutes semen
- the fluid secreted by the prostate contains a large amount of __, which liquefies teh previously gelatinous mixture and it helps the protect and nourish the sperm during intercourse.
- PSA
- the PSA levels should be <__
- 4 (prostate also contains some smooth muscles that help expel semen during ejaculation
- the american cancer society recommends that all men over the age of __ and earlier if they are at a high risk, be screened for prostate cancer by a digital rectal exam and PSA levels.
- 50
- enzyme whose purpose is to break down coagulated semen; made exclusively within the prostate; the most accurate method to calculate prostate function
- prostate specific antigen (PSA)
- to calculate the PSA levels, you divide the laboratory PSA by the __ of the prostate which is calculated by LWH X 1.57. normal levels are __ng/mL and abnormal is >__ng/ml
- volume, 4, 10
- elevated PSA indicates one of these three:
- cancer, infection, BPH (the higher the PSA, the larger the tumor burden and the higher the risk for spread beyond the prostate
- patient prep: patients require an enema _to_ hours before exam which reduces the risk of contamination of the prostate and eliminates fecal material that might affect the quality of the image. patients are placed in __ position
- 1-2 hours, LLD
- transrectal probe is __ to __ mhz. latex condom is placed over the probe to ensure cleanliness. a rectal exam before probe insertion can ensure no abnormalities that could create a problem with a scan. previous DRE is suggested to rule out any __ to pr
- *5-10 *obstruction *cephalad
- scan planes: coronal and axial: probe is rotated __ and __ to evaluate the lateral aspect of the gland, and moved cephalad and caudad to evaluate the whole gland from __ to __ aspect. this is the preferred plane for assessment of lateral portions and sym
- *clockwise, counter-clockwise *superior, inferior *width
- scan plane: sagittal: probe is again rotated to image the outermost aspects of the gland. preferred plane to exam __ and __ of gland
- base, apex
- minimum protocol: thoroughly image prostate and __ in coronal/axial and sagittal scan planes; asses prostate for shape, __, symmetry, and echogenicity. measure the gland; assess seminal vesicle for size, shape, __, symmetry, and echogenicity; evaluate th
- *seminal vesicles *contour *position *perirectal
- is located superoposterior to prostate; always document in cor and sag planes
- seminal vesicles
- paired structures lying superior to the prostate, posterior to the bladder, and lateral to the ductus deferens; transports sperm from the vas deferens to the ejaculatory duct
- seminal vesicles
- the seminal vesicles are __ cm long and __ to __ cm thick
- 3, 1-3
- secrete a significant portion of the fluid that ultimatley becomes semen; composes about 65% of semen; the high fructose concentrations provide nutrient energy for the spermatozoa as they travel through the female reproductive system
- seminal vesicles
- sono appearance: bilateral hypoechoic, multiseptated structures surrounding the rectum are seen; slightly less echogenic than prostate, often without distinct borders; seen superior to the prostate
- seminal vesicles
- axial anatomy: the __ urethra and its surrounding smooth muscle and glandular areas appear relatively hypoechoic and can be quite prominent measuring 2 cm in diameter. the inner gland is separated from the peripheral zone by the __. often __ (calcificat
- *anterior *surgical capsule *corpora amylacea *transition
- sagittal anatomy: the base of the gland, the seminal vesicles are seen immediately adjoin to the __ and __ zones
- peripheral, central
- indications for transrectal ultrasound (8)
- bladder outlet obstruction, urinary frequency, nocturia (nighttime urination), dribbling, enlarged prostate on DRE, pain in lower back, upper thighs, and pelvis, pus or blood in urine and semen, abnormal PSA
- indications for prostate biopsy (3)
- presence of hypoechoic lesion in both long and trv planes, palpable nodule on DRE, elevate PSA
- purpose is to obtain tissue for histologic dx; needle-guided system that clamps onto side of the probe with and automatic gun; enema prior to exam; informed consent is obtained prior to procedure
- prostate biopsy
- originates in transitional zone; enlarged prostate which is common in older patients; common cause of hydronephrosis because it compresses urethra
- BPH
- patient presents with frequent urination, dribbling, and nocturia
- BPH
- sono appears as an enlarge gland with hypoechoic inner region compared to the peripheral region; the central and peripheral zone may be compressed; enlarged AP diameter; calcification and some areas of cystic change may be seen; enlarged surgical capsule
- BPH
- prostate cancer is the__ leading cause of death in men after lung cancer, and it is the highest leading cause of death in men over the age of __. more common in __ males; commonly found in men over age of __. majority of the cancers are in __ which some
- 2nd, 75, african american, 50, PZ, TZ, CZ
- patient presents with micurition, urgency, dribbling, hematuria, and elevated PSA
- prostate cancer
- sono appears as small nodules located in the PZ with varied echogenicity; typically hypoechoic to some extent; protate may lose its smooth contour appearance in the area of the lesion; hydronephrosis may be seen; calcification are not usually present; ear
- prostate cancer