Prostate Abnormalities PDF

Prostate Abnormalities DMUT 2050 Topic 10 Topic Outline ⚫ Prostate cancer screening ⚫ DRE, PSA, Serum Acid Phosphatase ⚫ Prostate biopsy ⚫ Normal variants of prostate ⚫ Inflammatory Processes of prostate ⚫ Cysts of male pelvis ⚫ Benign Prostatic Hyperplasia...

Prostate Abnormalities DMUT 2050 Topic 10 Topic Outline ⚫ Prostate cancer screening ⚫ DRE, PSA, Serum Acid Phosphatase ⚫ Prostate biopsy ⚫ Normal variants of prostate ⚫ Inflammatory Processes of prostate ⚫ Cysts of male pelvis ⚫ Benign Prostatic Hyperplasia ⚫ Prostate Cancer Digital Rectal Exam (DRE) ⚫ Physical exam done during yearly check-up ⚫ Usually begins at age 40-50 depending on risk factors ⚫ Assessment for any palpable lesions or general prostate enlargement ⚫ Used with PSA to determine patients who need further evaluation ⚫ TRUS – transrectal ultrasound Prostate Cancer Screening Tests ⚫ To detect prostate cancer in asymptomatic men at an early stage ⚫ Allows for curative therapy in most men ⚫ Begin at age 50 (40 if family history of prostate cancer) ⚫ Annual digital rectal exam (DRE) ⚫ Annual PSA test ⚫ Serum acid phosphatase test ⚫ Cease at age 75 ⚫ Takes ~10 years to cause death, screening in men >75 y.o. is not indicated Serum Acid Phosphatase ⚫ Acid phosphatase is an enzyme secreted by the prostate, normally found in semen ⚫ Prostate dysfunction may cause detectable amounts in the bloodstream (serum) ⚫ Nonspecific ⚫ Also produced by the liver, spleen, blood cells and bone marrow Prostate Specific Antigen (PSA) ⚫ Tremendous advance in diagnosis and management of prostate cancer ⚫ Elevated levels occur in: ⚫ PSA is an enzyme secreted by ducts ⚫ Cancer of prostate ⚫ Can also have normal PSA levels ⚫ Assists in liquefying ejaculate ⚫ BPH ⚫ Normal level < 4ng/mL ⚫ Inflammation ⚫ Biopsy ⚫ Cystoscopy ⚫ Prostate manipulation ⚫ Draw blood for test prior to DRE Prostate Biopsy ⚫ Usually done at time of TRUS ⚫ If negative, biopsy can be cancelled ⚫ Pre-biopsy ⚫ Antibiotics are prescribed (and taken) prior to the biopsy ⚫ Anticoagulant medication must be stopped for several days ⚫ Similar to other core biopsy procedures ⚫ Requires informed consent ⚫ Local anesthetic is administered ⚫ Multiple samples are taken ⚫ 18- or 14-gauge needle typically ⚫ Patients should stay in department for ~1 hour ⚫ This is left to the discretion of the Radiologist Normal Variants of Prostate Gland Normal Variants - Prostate ⚫ Benign Ductal Ectasia ⚫ Prostate Calcifications ⚫ More common with advancing age ⚫ More common with advancing age ⚫ Prostate tissue atrophies and ducts dilate ⚫ Sonographic Appearance ⚫ Sonographic Appearance ⚫ Bright, echogenic foci within prostate ⚫ Seen as 1-2mm tubular structures ⚫ May demonstrate twinkle artifact and/or ⚫ May appear as a hypoechoic mass cause shadowing (groups of ducts) Inflammatory Processes of Prostate Gland Prostatitis ⚫ Inflammation of the prostate and seminal vesicles ⚫ Acute or chronic ⚫ Clinical Symptoms ⚫ Acute presents with typical inflammatory symptoms ⚫ Fever, chills, pain, dysuria ⚫ Chronic presents with more non-specific symptoms ⚫ Dysuria, frequency, urgency, hematospermia, pain Acute Prostatitis ⚫ Role of US is limited ⚫ Severe pain ⚫ TRUS and DRE are difficult ⚫ Sonographic Appearance ⚫ Significant abnormalities mimicking carcinoma ⚫ Hypoechoic gland ⚫ Geographic strikingly hypoechoic areas ⚫ Increased vascularity on color Doppler ⚫ May see evidence of abscess formation ⚫ Anechoic mass with or without internal echoes Acute Prostatitis Chronic Prostatitis ⚫ Associated with: ⚫ Chlamydia or Mycoplasma organisms ⚫ No apparent cause ⚫ Termed prostatodynia ⚫ Sonographic Appearance ⚫ Focal masses of variable echogenicity ⚫ Ejaculatory duct calcifications ⚫ Capsular thickening or irregularity ⚫ Dilation of periprostatic veins ⚫ Distended seminal vesicles Chronic Prostatitis – focal masses Chronic Prostatitis - calcifations Cysts of the Male Pelvis Prostatic Utricle Cysts Mullerian Duct Cysts Ejaculatory Duct Cysts Seminal Vesicle Cysts Prostate Utricle small pouch on posterior aspect of prostatic urethra Prostatic Utricle Cysts ⚫ Caused by dilation of the prostatic utricle ⚫ Midline, small, blind-ending pouch on posterior aspect of prostatic urethra ⚫ Associated with renal agenesis ⚫ Rarely contain spermatozoa ⚫ Sonographic Appearance ⚫ Simple cyst criteria ⚫ Usually tear-drop shaped ⚫ Always midline location Mullerian Duct Cysts ⚫ Arise from remnant of Mullerian duct ⚫ Never contain spermatozoa ⚫ Sonographic Appearance ⚫ Simple cyst criteria ⚫ May have calcifications ⚫ Usually tear-drop shaped ⚫ Pointed end directed towards verumontanum (called seminal colliculus) located on posterior wall of prostatic urethra ⚫ May be anywhere ⚫ Midline to lateral Ejaculatory Duct Cysts ⚫ Caused by: ⚫ Cystic dilation of an obstructed ejaculatory duct ⚫ Diverticulum of the duct ⚫ Usually contain spermatozoa ⚫ Associated with infertility ⚫ Sonographic Appearance ⚫ Simple cyst criteria ⚫ Tend to be fusiform in shape ⚫ Typically pointed at both ends Seminal Vesicle Cysts ⚫ Arise from remnant of Wolffian duct ⚫ May be associated with renal agenesis ⚫ Sonographic Appearance ⚫ Simple cyst criteria ⚫ May become large ⚫ Require aspiration Benign Prostatic Hyperplasia (BPH) Benign Prostatic Hyperplasia (BPH) ⚫ Benign enlargement of the prostate ⚫ Common cause of symptoms in older males ⚫ Urinary outlet dysfunction ⚫ Hesitancy ⚫ Starting and stopping ⚫ Frequent urination ⚫ Oliguria ⚫ Hematuria BPH Sonographic Appearance ⚫ Enlargement of the prostate gland ⚫ Specifically inner gland (Transition zone) ⚫ May also see: ⚫ Calcifications ⚫ Well circumscribed hypoechoic nodules ⚫ Degenerative or retention cysts in the transition zone Trans Urethral Resection of the Prostate ⚫ AKA – TURP ⚫ Surgical procedure where portions of an enlarged prostate (BPH) are removed via the urethra ⚫ May see a large defect in prostate Prostate Cancer Prostate Cancer ⚫ Most commonly diagnosed cancer in men ⚫ 2nd leading cause of cancer deaths in men (after lung cancer) ⚫ Generally affects males >50 y.o. ⚫ Risk factors ⚫ African-American population ⚫ Family history Prostate Cancer ⚫ Locations ⚫ Clinical Symptoms ⚫ 70% occur in the peripheral zone ⚫ Frequency ⚫ 20% occur in the transition zone ⚫ Hesitancy ⚫ 10% occur in the central zone ⚫ Starting and stopping ⚫ Urgency ⚫ Weak stream Prostate Cancer Sonographic Appearance ⚫ Best seen with TRUS ⚫ 30-40% of prostate cancers are undetectable on TRUS ⚫ Biopsy if DRE or PSA are suspicious ⚫ Most cancers are hypoechoic ⚫ Lesions may be isoechoic or hyperechoic ⚫ Occasionally shows increased vascularity on Doppler interrogation Prostate Cancer Sonographic Appearance Prostate Cancer Treatment ⚫ Watchful waiting ⚫ Patients with low-grade tumors ⚫ Often takes into consideration 10 year life expectancy ⚫ Radical prostatectomy ⚫ Surgical removal ⚫ Infertility and incontinence are major side effects ⚫ Radiation therapy ⚫ External beam ⚫ Traditional radiation therapy ⚫ Brachytherapy ⚫ Radiation seeds implanted into tumor with US guidance ⚫ Palliative therapy