Prostate & Penis

What is the prostate?

Cone shaped retroperitoneal organ

Identify this image.

1. Prostatic apex

2. Prostatic base

What is the transitional zone of the prostate?

Central zone composed of two lobes of glandular tissue surrounding proximal prostatic urethra

What is the verumontanum?

Part of prostate located near transitional zone where ejaculatory ducts enter urethra

What is the central zone of the prostate?

Glandular tissue located at base of gland posterior to urethra

Which prostatic zone is the largest?

Peripheral zone (70%)

What is the peripheral zone of the prostate?

Glandular tissue located posterolateral to distal prostatic urethra

What is the periurethral glandular zone of the prostate?

Glandular tissue that lines proximal prostatic urethra

What is the fibromuscular stroma or anterior region of the prostate?

Fibromuscular sheath covering entire anterior prostate surface

Identify this image.

1. Central zone

2. Peripheral zone

3. Transitional zone

4. Periurethral glandular zone

5. Verumontanum

6. Urethra

7. Ejaculatory duct

8. Fibromuscular region

What is prostate specific antigen (PSA)?

Protein used to assess increasing levels of benign or malignant tissue produced by acinar cells

What is the normal lab value for prostate specific antigen (PSA)?

0 - 4 ng/ml (> 10 ng/ml indicates malignancy)

What position is required for transrectal prostate exam?

LLD or lithomy

What is the normal sonographic appearance of the prostate?

1. Homogenous

2. Medium-level gray

3. Smooth capsule

What is the Eiffel tower sign?

Shadowing created by dense tissues in area of urethra and verumontanum

Identify this image.

1. Peripheral zone

2. Central and transitional zone

3. Urethra

What is benign prostatic hypertrophy (BPH)?

Enlargement of prostate that causes urinary infrequency and nocturia

Where is the most common location for benign prostatic hypertrophy (BPH)?

Transitional zone (95%)

What lab value is elevated in someone with benign prostatic hypertrophy (BPH)?

PSA

What is the sonographic appearance of benign prostatic hypertrophy (BPH)?

1. Diffuse prostatic enlargement with volume > 30 mL

2. Punctate calcifications or corpora amylacea

3. Nodule and cystic formation

4. Hypervascular inner gland

What is prostatitis?

Inflammation of prostate

What is the most common malignancy diagnosed in men?

Extra-capsular prostatic carcinoma

What is extra-capsular prostatic carcinoma?

Prostate cancer most commonly seen in African America men 65 years old

What is the most common location for extra-capsular prostatic carcinoma?

Peripheral zone (70%)

Identify this image.

Prostatic cancer

What is brachytherapy?

Surgical implantation of radioactive seeds in those with non-aggressive in situ prostate cancer

Identify this image.

Brachytherapy

What are corpus cavernosa?

Two main erectile structures of penis

What is the corpus spongiosum?

Singular penile structure that consists of urethra and urethral arteries

Identify this image.

1. Corpus spongiosum

2. Corpus cavernosum

Identify this image.

1. Aorta

2. Common iliac artery

3. External iliac artery

4. Internal iliac artery

5. Gluteal artery

6. Internal pudendal artery

7. Dorsal artery

8. Cavernosal artery

9. Bulbourethral artery

10. Gonadal arteries

Identify this image.

Cavernosal arteries

What is erectile dysfunction?

Inability to achieve a full and persistent erection due to vascular insufficiency

What is priapism?

Unwanted painful erection that lasts more than four hours

What is Peyronie disease?

Development of scar tissue and plaque involving tunica albuginea that causes curvature of affected side of penis during erection

Identify this image.

1. Thin tunica albuginea

2. Plaque formation seen with Peyronie disease

Identify this image.

Peyronie disease

What is the most common cancer to affect the penis?

Squamous cell carcinoma

Where is penis cancer most commonly located?

Glans penis or foreskin of uncircumcised men

What is the most common portion of the penis affected by trauma?

Corpus cavernosum

What are the values for penile brachial index (PBI)?

1. ≥ 0.75: Normal

2. 0.65-0.75: Marginal reduction

3. < 0.65: Abnormal

What is the normal sonographic appearance for a penile Doppler?

1. Cavernosal artery PSV > 30 cm/sec

2. Cavernosal artery EDV < 1 cm/sec

3. Cavernosal artery diameter increases by at least 75%

4. Cavernosal artery RI > 0.99

5. Clinical response to Papaverine injection is greater than 90 degrees