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The prostate gland is the only accessory sex gland in the male dog. It
is located just caudal to the bladder in the area of the bladder neck and
proximal urethra. Its purpose is to produce prostatic fluid as a transport
and support medium for sperm during ejaculation. Basal secretion of
prostatic fluid is constantly entering the prostatic excretory ducts and
prostatic urethra. When neither micturition nor ejaculation is occurring,
urethral pressure moves this basally secreted fluid cranially into the bladder
(prostatic fluid reflux).
Prostatic diseases are common in the older male dog. With aging, the
prostate gradually enlarges due to hyperplasia. Because of the prostate's
glandular nature, prostatic fluid cysts may develop. The prostate is subject
to infection from bacteria ascending the urethra. Hematogenous spread of
bacteria and spread from the kidneys and bladder via urine, or from the
testicle and epididymis via semen, are also possible. Bacterial prostatic
infections can be acute and fulminant or chronic and insidious, leading to
abscessation. The aging prostate gland is also subject to neoplastic transfor-
mation, most commonly adenocarcinoma. Probable avoidance of some of
these problems is one reason for advocating neutering of young male dogs.
Possible earlier detection of these diseases is one good reason for performing
a yearly rectal examination on all mature dogs.
DIAGNOSTIC TECHNIQUES
Veterinary Clinics of North America: Small Animal Practice-Vol. 16, No. 3, May 1986 587
588 }EANNE A. BARSANTI, AND DELMAR R. FINCO
will review the diagnostic tests available. The following sections will review
the various diseases in regard to which diagnostic tests are likely to be
most useful, their expected results, and therapy.
Prostatic Palpation
The prostate is best examined by concomitant rectal and abdominal
palpation. The hand palpating the caudal abdomen can evaluate the cranial
aspects of the gland and push the prostate into or near the pelvic canal for
better palpation per rectum. The dorsal median groove, the division
between the two lobes, is palpable per rectum. The prostate should be
evaluated for size, symmetry, surface contour, consistency, movability, and
pain. The normal prostate should be symmetric, smooth, movable, and
nonpainful. The size in a 2- to 5-year-old 25-lb dog was found to vary from
ovoid, 1. 7 em in length by 2. 6 em tranverse by 0. 8 em dorsoventral, to
spheroid, 2 em in diameter. However, size varies with age, body size, and
breed, so that the judgment as to whether size is normal is subjective. If
an increase in size is thought to be present, approximate measurements
should be recorded so that progression can be followed. Following castra-
tion, prostatic size decreases remarkably, with detectable reduction in 1
week. Therefore, if a large or "normal"-sized prostate gland is found in a
previously castrated male, prostatic neoplasia should be strongly considered.
Urethral Discharge
One must be sure that a discharge is truly urethral and not preputial
in origin. Careful examination of the prepuce will rule out balanoposthitis
or space-occupying masses such as a transmissible venereal tumor. If the
discharge is from the urethra, it should be examined cytologically. If
sufficient ure thral discharge is present or if the discharge increases with
prostatic palpation, the discharge can be collected in a sterile container for
culture after extending the penis and cleaning its surface. The culture
should always be quantitative because of possible contamination from small
numbers of the normal urethral flora.
CANINE PROSTATIC DISEASES 589
Semen Evaluation
An ejaculate is valuable in assessing prostatic disease because prostatic
fluid is the largest component of semen volume. Prostatic fluid is the last
fraction of the ejaculate and follows the sperm-rich fraction. To evaluate a
dog for prostatic disease using an ejaculate, we first allow the dog to urinate
to remove any urethral contents. Any preputial discharge is removed from
the penis with gentle, minimal cleansing using sterile gauze sponges. The
ejaculate is collected using a sterile funnel and test tube, a sterile large
plastic syringe case, or a sterile urine cup. If the ejaculate cannot be
collected manually, a teaser bitch in estrus or an anestrus bitch with the
dog pheromone methyl-p-hydroxybenzoate* applied to the vulva is used.
Part of the ejaculate is used for cytology, and part for quantitative culture.
Quantitative culture is essential, for the distal urethra has a normal bacterial
flora.
Both ejaculate cytology and culture must be assessed for accurate
interpretation. Normal dogs have occasional white blood cells and positive
bacterial cultures. Bacteria are present in less than 100,000 per ml and are
usually gram-positive. High numbers (more than 100,000 per ml) of gram-
negative organisms with large numbers of white blood cells indicate
infection. High numbers of gram-positive organisms with large numbers of
white blood cells probably also indicate infection if preputial contamination
did not occur. Lower numbers of gram-negative or gram-positive organisms
must be correlated with clinical signs and ejaculate cytology to determine
significance. Blood may be found in ejaculates in dogs with bacterial
infection, prostatic cysts, prostatic neoplasia, and possibly hyperplasia.
An abnormality in the ejaculate does not localize the problem to the
prostate, because the testicles, epididymis, deferent ducts, and urethra also
contribute to or transport the ejaculate. Collecting and comparing the early
fraction of the ejaculate, which is of testicular origin, with a late fraction of
prostatic origin may help to localize an abnormal finding.
Prostatic Massage
Sometimes semen cannot be collected from a dog with suspected
prostatic disease because of pain, inexperience, or temperament. An
alternative technique to collect prostatic fluid is prostatic massage. The dog
is allowed to urinate first to empty the bladder. A urinary catheter is then
passed to the bladder using aseptic technique. The bladder is emptied and
flushed several times with sterile saline to ensure that it is empty. The last
flush of 5 to 10 ml is saved as the preprostatic massage sample. The catheter
is then retracted distal to the prostate as determined by rectal palpation.
The prostate is massaged rectally, per abdomen, or both for 1 to 2 minutes.
Sterile physiologic saline is injected slowly through the catheter with the
urethral orifice occluded around the catheter to prevent reflux of the fluid
out the urethral orifice. The catheter is slowly advanced to the bladder
with repeated aspiration, especially from the area of the prostate as
determined by rectal palpation. The majority of the fluid will be aspirated
from the bladder. Both the pre- and post-massage samples are examined
by cytology and quantitative culture. We consider it very important to
compare the post-massage sample to the pre-massage sample to be sure
any abnormality was due to prostatic fluid and not pre-existing in the
bladder or urethra. Prostatic massage in normal dogs produces only a few
red blood cells and transitional epithelial cells.
Disadvantages of prostatic massage include the inability to determine
whether prostatic fluid has been obtained without comparison with a pre-
massage sample and the inability to determine if bacteria obtained were in
prostatic fluid if the bladder or urine are infected. In these cases, we have
administered antibiotics that enter the urine well but do not enter prostatic
fluid (for example, ampicillin). After a few days of antibiotic therapy, the
prostatic massage is done. The samples obtained must be cultured imme-
diately after collection so that the antibiotic in the urine does not kill any
bacteria in the prostatic fluid.
Potential adverse effects of prostatic massage in the face of prostatic
infection include induction of urinary tract infection and/or bacteremia.
Aspiration
The type of prostatic disease can also b~ evaluated by needle aspiration
or biopsy. Needle aspiration is most easily done in the dog by the perirectal
or transabdominal routes, depending on the location of the prostate.
Ultrasonography can help localize the prostate and visualize the needle
tract. The procedure is done aseptically using a long needle with a stylet,
such as a spinal needle. In the perirectal approach, the needle is guided
by rectal palpation. The procedures can be performed in most dogs with
mild tranquilization. Needle aspiration is probably best avoided in dogs
with abscessation because large numbers of bacteria may be seeded along
the needle tract. We do not perform aspiration in dogs with fever or
leukocytosis or before examining prostatic fluid obtained by ejaculation or
massage. In spite of these precautions, we have inadvertently diagnosed
abscessation in seven dogs by aspiration. The absence of evidence of
abscessation by other diagnostic techniques in these cases suggests that the
abscessed areas were not communicating with the urethra. In five dogs, no
complications of aspiration occurred; in two, the aspirations were perirectal;
and in three, the aspiration was transabdominal. In two dogs, localized
peritonitis developed after aspiration and required intravenous antibiotic
and fluid therapy. Because of the possibility of an occult abscess, aspiration
should always be performed prior to a closed biopsy. If an abscess is
aspirated, intravenous antibiotics should be given.
Biopsy
Prostatic biopsy can be performed perirectally or transabdominally, as
with aspiration, or can be done via a caudal abdominal surgical exposure.
Closed biopsy can be performed with tranquilization and local anesthesia.
We usually use a Tru-Cut needle.* If prostatic abscessation is being
considered in the differential diagnosis, aspiration should always precede a
PROSTATIC DISEASES
Benign Hyperplasia
Benign hyperplasia is a change that occurs with age in the male dog
and is associated with an altered androgen:estrogen ratio. The hyperplastic
592 }EANNE A. BARSANTI, AND DELMAR R. FINCO
prostate gland, may be present. A few affected dogs will have a stiff, stilted
gait. A constant or intermittent urethral discharge may be present.
Diagnosis. Prostatic palpation often elicits pain. The size, symmetry,
and contour of the prostate gland are often normal or mildly enlarged. The
enlargement is often due to hyperplasia in the older dog rather than a
direct result of infection. Hematology often shows a neutrophilic leukocy-
tosis with or without a left shift. Urinalysis usually has blood, white blood
cells, and bacteria. If the urinalysis indicates a urinary tract infection, a
quantitative urine culture and sensitivity testing should be performed on a
sample collected by cystocentesis or catheterization. A presumptive diag-
nosis is based on history, physical examination, hematology, prostatic fluid
evaluation, urinalysis, and urine culture.
Treatment. An antibiotic should be administered for 10 to 14 days.
The choice of the antibiotic can be based on urine culture and antibiotic
sensitivity testing. The blood-prostatic fluid barrier is usually not intact in
acute inflammation, allowing a wide choice of antibiotics. If the presenting
signs are severe, the antibiotic should initially be given intravenously along
with parenteral fluid support. Oral antimicrobials can be used once the
dog's condition stabilizes.
Because acute infections may become chronic, a recheck examination
should be performed 3 to 4 days after the antibiotics are finished. This
examination should include a physical examination, urinalysis, urine culture
(if the urine was infected on initial presentation), and examination of
prostatic fluid by cytology and culture.
Chronic Bacterial Prostatitis
Chronic prostatic infection may be a sequela to an acute infection or
may develop insidiously without a prior bout of clinically evident acute
infection. It may be secondary to urinary tract infection or urolithiasis or
due to changes in prostatic architecture that interfere with prostatic fluid
secretion, such as cysts, neoplasia, or squamous metaplasia from exogenous
or endogenous (Sertoli's cell tumor) estrogens.
Clinical Signs. Chronic bacterial prostatitis can be present without
causing any signs referable to the prostate gland. Instead, the dog may be
presented for recurrent episodes of cystitis or a urinary tract infection may
be found on a routine urinalysis. Chronic bacterial prostatitis is the most
common cause of recurrent urinary tract infection (UTI) in men and the
same may be true in the dog. Other dogs may be presented for a constant
or intermittent urethral discharge.
Diagnosis. On palpation, the prostate is not painful and size is variable
owing to the degree of hyperplasia and fibrosis. Chronic infection by itself
causes no increase in prostatic size. The prostate gland may vary in
symmetry and consistency owing to deposition of fibrous tissue secondary
to chronic inflammation. The areas of infection may be focal, multifocal, or
diffuse.
The white blood cell count may be normal to increased. Urinalysis
often shows evidence of infection with pyuria, hematuria, and bacteriuria.
Prostatic fluid collected by ejaculation or after prostatic massage is inflam-
matory, and quantitative bacterial cultures should be positive for significant
CANINE PROSTATIC DISEASES 595
numbers of one species of bacteria. As discussed under diagnostic tech-
niques, results of prostatic massage are difficult to interpret in the presence
of UTI. In order to utilize this technique, UTI must first be controlled.
Presumptive diagnosis is by history, physical examination, hematology,
urinalysis, prostatic fluid cytology, and quantitative culture. In most cases,
if these techniques are carefully done and correctly assessed, a presumptive
diagnosis is sufficient. Definitive diagnosis is by prostatic tissue culture and
histopathology.
Treatment. Chronic bacterial prostatitis is very difficult to treat effec-
tively because the blood-prostatic fluid barrier is intact. The blood-prostatic
fluid barrier is based partly on the pH difference between the blood,
prostatic interstitium, and prostatic fluid, partly on the characteristics of
the prostatic acinar epithelium, and partly on the protein-binding charac-
teristics of antibiotics.
The pH of blood and prostatic interstitium is 7.4. The pH of normal
prostatic fluid is less than 7 .4. The pH of prostatic fluid in dogs with
prostatic infection is also usually acidic. When infected prostatic fluid is
acidic, basic antibiotics such as erythromycin, oleandromycin, and trimeth-
oprim will cross the barrier more effectively than other antibiotics. Distri-
bution of chloramphenicol is not affected by pH differences because it is
nonionizable.
Lipid solubility is also an important factor in determining drug move-
ment across prostatic epithelium. Drugs with low lipid solubility cannot
cross into the prostatic acini. Many of these drugs are the acidic antibiotics
such as penicillin, ampicillin, and cephalosporins. Others include the
aminoglycosides. Chloramphenicol, the macrolide antibiotics, trimetho-
prim, and the sulfonamides are examples of lipid soluble drugs that can
potentially enter prostatic fluid.
Protein binding in plasma determines the amount of drug that enters
prostatic fluid. The more protein-bound the drug, the less drug is available
to cross the prostatic epithelium. This factor is probably less important than
lipid solubility or pKa, for biologic systems rarely reach equilibrium.
Examples of drugs with significant protein binding are clindamycin and
chloramphenicol.
Current recommendations depend on whether a gram-positive or
gram-negative organism is the infective agent. If the causative organism is
gram-positive, erythromycin, clindamycin, chloramphenicol, or trimetho-
prim/sulfonamide can be chosen based on sensitivity testing. If the causative
organism is gram-negative, chloramphenicol or trimethoprim/sulfonamide
is best. Carbenicillin may be effective in cases with bacterial resistance to
less expensive antimicrobials.
Antibiotics should be continued for at least 4 to 6 weeks. Urine and
prostatic fluid should be recultured at 3 to 4 days and again 1 month after
discontinuing antibiotics to be sure the infection has been eliminated and
not merely suppressed. The prognosis for cure is only fair. The long-term
cure rate in men with chronic bacterial prostatitis is approximately 30 per
cent. If the prostatic infection cannot be eliminated, antibiotics must be
used continuously to prevent recurrent urinary tract infections. Trimetho-
prim/sulfonamide is most useful for this and is often effective at half the
596 JEANNE A. BARSANTI, AND DELMAR R. FINCO
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