Prostate disease

•  Prostate anatomy
• Supported anteriorly by puboprostatic ligaments, central portions of the pubococcygeus, part of the levator ani muscles (anterior pelvic diaphragm)
• Supported inferiorly by the urogenital diaphragm (transversus perinei muscle and fascia), through which the urethra passes

• Aspects of TURP	Top
  Post-TURP Syndrome: hyponatremia secondary to irrigation; can precipitate seizures and cerebral edema Most common site of primary carcinoma: posterior lobe Most common site of distal metastasis: bone, with osteoblastic lesions showing increased density on CT and radiograph Increases in serum alkaline phosphatase seen with extracapsular carcinoma and metastases

   

  Staging and Treatment ↓

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  Tumor/node/metastasis (TNM) system used Gleason scoring system: additional scoring (1-5) from well differentiated (least aggressive) to poorly differentiated (most aggressive) Transrectal ultrasonography (TRUS) can provide an accurate image of the gland and guide needle biopsies CT can provide evidence of prostatic pathoanatomy, lymphadenopathy, and metastases Optimal treatment for localized prostate cancer remains controversial Intracapsular tumors, no metastases (on T1 and T2 MRI): irradiation, radical prostatectomy with pelvic lymph node excision, or no treatment depending on age, specifics Extracapsular tumors with metastases: hormonal treatment with luteinizing hormone releasing hormone blocker or testosterone blockers, potential orchiectomy; irradiation for pain of bony metastases, chemotherapy for hormone-resistant disease “Chemical castration”: luteinizing hormone releasing hormone (LHRH) antagonists suppress testosterone production in androgen-dependent tumors LHRH antagonists are also called GnRH antagonists (gonadotropin releasing hormone blockers) Alternatives or complements to prostatectomy: x-ray or particle beam therapy, brachytherapy (implanted radiation sources), and cryotherapy