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Canine Prostatic Diseases

jeanne A. Barsanti, D.V.M., M.S.,*


and Delmar R. Pineo, D.V.M., Ph.D.t

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

A comple te history and physical examination are essential. On the


basis of this information, a list of most likely possibilities or "rule outs" can
be generated (Table 1) and appropriate diagnostic tests chosen. This section

*Diplomate, American College of Veterinary Internal Medicine; Associate Professor, Depart-


ment of Small Animal Medicine, University of Georgia College of Veterinary Medicine,
Athens, Georgia
tDiplomate, American College of Veterinary Internal Medicine; Professor, Department of
Physiology, University of Georgia College of Veterinary Medicine, Athens, Georgia

Veterinary Clinics of North America: Small Animal Practice-Vol. 16, No. 3, May 1986 587
588 }EANNE A. BARSANTI, AND DELMAR R. FINCO

Table 1. Clinical Signs Associated with Prostatic Diseases


NO SIGNS URETHRAL DISCHARGE
Hyperplasia Hyperplasia (blood)
Chronic bacterial infection Bacterial infection (pus with or without
Small cysts blood)
Small abscesses Cysts (serosanguineous or clear yellow)
Early carcinoma Abscesses (pus with or without blood)
Neoplasia (blood; possibly with
TENESMUS
inflammation)
Hyperplasia
Cyst
FEVER, DEPRESSION, PAIN, AND STIFF GAIT
Abscess
Acute bacterial infection
Neoplasia
Abscessation
DYSURIA/PARADOXICAL INCONTINENCE Neoplasia (adenocarcinoma)
Abscess
Cyst RECURRENT BACTERIAL CYSTITIS
Neoplasia Chronic bacterial prostatitis

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

*Eastman Kodak Co., Rochester, New York.


590 JEANNE A. BARSANTI, AND DELMAR R. FINCO

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

*Travenol Laboratories, Deerfield, Illinois.


CANINE PROSTATIC DISEASES 591
blind biopsy technique. Large prostatic cysts and acute septic inflammation,
as occur in acute bacterial prostatitis, are contraindications to blind biopsy
procedures. With these precautions, the only complication reported from
blind biopsy is mild hematuria, although, as with any biopsy procedure,
significant hemorrhage is possible. The dog should always be examined
closely for several hours after biopsy. Biopsy samples can be cultured for
bacteria as well as examined histologically.
We often advise prostatic biopsy if castration is recommended as
adjunctive therapy. A caudal abdominal incision with traction on the bladder
will usually allow visualization of the prostate for biopsy. An accurate
diagnosis can be made and surgical therapy instituted if nece.5sary.
Radiography
The size, location, and contour of the prostate gland can be evaluated
by caudal abdominal radiography. The prostate is often distinguishable on
lateral and dorsoventral survey radiographic views. In some cases, contrast
cystography may be necessary to delineate the position of the bladder in
order to locate the prostate. The normal gland is symmetric with a smooth
contour and is located near the cranial rim of the pelvic floor. As discussed,
the size varies with the age, body size, and breed of dog. However, a
normal-sized prostate does not displace the colon or the bladder from its
normal positions. A normal-sized prostate does not rule out diseases such
as infection, cystic change, early neoplasia, or mild hyperplasia.
Radiography is often of limited benefit in diagnosis of specific prostatic
diseases. In many cases, the prostate can be more accurately palpated on
physical examination than visualized on survey radiographs. Changes in
urethral size and the presence of reflux of contrast material into the prostate
on retrograde urethrography were initially thought to indicate specific
disease processes. However, more recent surveys have found variable
results with different diseases and in normal dogs.
The main benefits of radiography in prostatic disease are to define
prostatic size and shape when the gland cannot be definitely palpated and
to assess the effect of prostatic enlargement on the colon, bladder, urethra,
ureters, and kidneys. Excretory urography may be needed to evaluate the
presence of ureteral obstruction by a markedly enlarged prostate. Radio-
graphs are necessary to evaluate the thorax, vertebral bodies, and sublumbar
lymph nodes for the possibility of metastasis in cases of suspected prostatic
neoplasia.
Ultrasonography has the advantage of indicating prostatic consistency
as well as size and shape. This can help determine the presence of fluid-
filled cavities versus solid tissue masses. Ultrasound can also be used to
direct a prostatic aspirate or biopsy.

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 tends to develop multiple small cystic spaces, giving it a honey-


combed appearance. Because hyperplasia occurs in all older dogs, it often
occurs concomitantly with other prostatic diseases.
Clinical Signs. Prostatic hyperplasia can be present without clinical
signs. In other dogs, tenesmus may be present due to encroachment on
the pelvic canal owing to prostatic enlargement. We have noted an
intermittent hemorrhagic urethral discharge in dogs in which hyperplasia
was the only lesion on biopsy. Hyperplasia is not associated with any
systemic signs of illness. The affected dog is alert, active, and afebrile.
Diagnosis. On physical examination, the prostate should be nonpainful,
symmetrically enlarged, and have a normal consistency. Hematology and
urinalysis are normal. Abdominal radiographs may confirm prostatic enlarge-
ment with dorsal displacement of the colon and cranial displacement of the
bladder. If a urethral discharge is present, the discharge is hemorrhagic
but not purulent. Semen and postprostatic massage samples may be normal
or hemorrhagic. Definitive diagnosis is only possible by biopsy. A pre-
sumptive diagnosis can be made by history and physical examination with
support from hematology, urinalysis, and prostatic fluid analysis. We usually
do not recommend biopsy for confirmation of the diagnosis unless the
presenting complaint is a hemorrhagic urethral discharge; biopsy is then
recommended in order to differentiate hyperplasia from more serious
prostatic diseases that can also cause intermittent bleeding.
Treatment. Treatment is only required if related abnormal signs are
present. The most effective treatment is castration. The prostate gland will
begin to involute within days and a palpable decrease in prostatic size is
expected within 1 week. The prostate gland will continue to decrease in
size for 2 to 3 months after castration.
If castration is not feasible, low doses of estrogens can be used.
Diethylstilbestrol administered orally at 0.5 to 1.0 mg per day for 5 days
or estradiol cypionate at 0.1 mg per kg to a maximum total dosage of 2 mg
has been recommended. The potential side effects of the drugs must be
compared with their clinical benefit in each case before a decision is made
to administer the m. Severe bone marrow depression with resultant aplastic
anemia is possible, especially with overdosage or repeated administration.
Repeated administration or overdosage can also cause growth of the
fibromuscular stroma of the prostate, metaplasia of prostatic glandular
epithelium, and secretory stasis. These changes can result in further
prostatic enlargement and a predisposition to cyst formation, bacterial
infection, and abscessation.
An experimental drug that avoids the side effects of estrogens is the
antiandrogen flutamide . * When this drug was administered to research
dogs at 5 mg per kg per day given orally, prostatic size decreased with no
change in libido or sperm production. Unfortunately, the drug is not
currently available commercially.
Prostatic Cysts
Prostatic cysts vary in size, number, and location. Multiple, small cysts
may be present in a hyperplastic gland, giving it a honeycombed appearance

*Schering Corportation, Bloomfield, New Jersey.


CANINE PROSTATIC DISEASES 593
on a wedge biopsy. In other cases, a single cyst may become very large,
approaching the size of a distended bladder. Some large paraprostatic cysts
are remnants of the uterus masculinus rather than true prostatic cysts.
Clinical Signs. With large cysts, clinical signs such as dysuria and
tenesmus may be related to increased prostatic size. If a single paraprostatic
cyst becomes very large, abdominal distention may be seen. With small
intraprostatic cysts, there may be no abnormal signs or there may be a
urethral discharge if the cysts communicate with the urethra. The discharge
may be hemorrhagic or it may be a clear, light-yellow fluid. Dogs with
prostatic cysts have been misdiagnosed as having urinary incontinence
because the cyst fluid appears similar to urine on gross inspection.
Diagnosis. Findings on rectal palpation will vary with cyst size. With
a large cyst, a firm, cystic structure associated with the prostate gland may
be palpated in the caudal abdomen or in the perineal area. With smaller
intraprostatic cysts, the prostate gland may vary from mildly enlarged to
markedly and asymmetrically enlarged. Fluctuant areas may or may not be
palpable.
Hematology is normal. Urinalysis is usually normal. Mild hematuria
may be present if hemorrhage occurs into the cyst and the cyst communi-
cates with the urethra. If a urethral discharge is present, it should be
examined cytologically to differentiate a urethral discharge from urine; a
"urinalysis" can be performed on both and compared in regard to pH,
specific gravity, and dipstick analysis. Prostatic fluid collected by ejaculation
or prostatic massage should be examined. Prostatic cyst fluid is usually
yellow to serosanguineous with only low numbers of white blood cells.
Whether cyst fluid will be obtained by ejaculation or prostatic massage
depends on whether the cyst communicates with the urethra.
With large paraprostatic cysts, two "bladders" may be evident on
survey radiography. A cystogram may be necessary to determine which
structure is the bladder. With small cysts that communicate with the
urethra, retrograde urethrography may indicate reflux of contrast agent into
the prostate gland.
Treatment. The recommended therapy for large prostatic cysts is
drainage, surgical removal if possible, or marsupialization. Castration is
recommended as adjunctive therapy. One potential complication of mar-
supialization is chronic infection. The recommended therapy for small
intraprostatic cysts is castration.
Acute Bacterial Prostatitis
Acute bacterial prostatitis affects sexually mature male dogs. Infection
usually results from ascent of bacteria up the urethra. E . coli is the most
frequent causative organism, but infection with other gram-negative and
gram-positive organisms is also possible. Infection may also reach the
prostate gland via blood, extension of infection from the bladder and
urethra, and perhaps from the rest of the reproductive tract via semen.
Clinical Signs. Clinical signs include signs of systemic illness such as
anorexia, depression, and fever. Vomiting may occur owing to an associated
localized peritonitis. Caudal abdominal pain, which can be localized to the
594 JEANNE 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

usual daily dose administered each evening. Supplementation with folic


acid will help prevent a folic acid deficiency with long-term use of
trimethoprim/sulfonamide,
Castration has been recommended as adjunctive therapy to reduce the
quantity of prostatic tissue. It alone will not eliminate infected prostatic
tissue. It might be best to control infection first, if possible, because
prostatic blood flow (and thus antibiotic delivery) might decrease after
castration.
Prostatectomy will eliminate infected prostatic tissue and can be used
in cases that are refractory to antibiotic therapy. If castration is done a few
weeks prior to prostatectomy, the reduction in prostatic size may make the
surgery easier. However, this surgery is never easy. Severe hemorrhage is
possible. The urethra must be meticulously sutured to prevent leakage of
urine. The presence of infection can lead to septic shock immediately after
surgery. Urinary incontinence is also a frequent sequela to prostatectomy.
Prostatic Abscessation
Prostatic abscessation is a severe form of chronic bacterial prostatitis
in which pockets of septic, purulent exudate develop within the parenchyma
of the prostate gland.
Clinical Signs. The dog may be presented for varying signs related to
either prostatic enlargement or infection. Prostatic abscesses vary in size
and number. If the abscess or abscesses become very large, the dog may
be presented with tenesmus from incursion on the colon or rectum or
dysuria from incursion on the urethra. Incursion on the urethra can lead
to partial urethral obstruction causing a chronically distended bladder,
eventual detrusor dysfunction, and overflow urinary incontinence.
Clinical signs related to infection include a constant or intermittent
urethral discharge that may be hemorrhagic or purulent. If the abscess
ruptures on the outer surface of the prostate, a localized peritonitis results,
with fever, pain, and possibly vomiting. Icterus due to hepatopathy asso-
ciated with sepsis may also be present.
Diagnosis. On palpation, the prostate gland may or may not be
enlarged, depending on the size and location of the abscess pockets.
Occasionally, a fluctuant area may be palpated. The inability to palpate
such an area does not rule out abscessation, because the abscess may be
deeper within the gland or have a firm fibrous capsule. Pain on palpation
is more often related to a localized peritonitis than to the abscess itself.
Absence of pain does not rule out abscessation. The prostate gland is often
asymmetric and may feel of varying consistency (a cobblestone contour with
firmer and softer areas).
The white blood cell count may be normal or a neutrophilic leukocytosis
may be present. A neutrophilic leukocytosis is common with a localized
peritonitis secondary to prostatic abscessation. A UTI is often present.
Prostatic fluid collected by ejaculation or postprostatic massage is usually
purulent and septic and may also be hemorrhagic. Refer to the section on
diagnostic techniques for discussion of the difficulty of accurately assessing
the results of prostatic massage when UTI is present. Quantitative culture
of urine and prostatic fluid should show significant numbers of the same
CANINE PROSTATIC DISEASES 597
organisms. Either aerobic or anaerobic bacteria may be involved in prostatic
abscesses. Liver enzyme concentrations in serum may be elevated and liver
function, such as BSP retention, may be abnormal.
Prostatic enlargement, which can be asymmetric, may be evident on
survey radiographs. Reflux into the prostate gland may be noted on
retrograde urethrography if the abscess communicates with the urethra.
Presumptive diagnosis is based on history, physical examination, he-
matology, urinalysis, prostatic fluid cytology, and culture. The diagnosis
should be confirmed by aspiration or exploratory celiotomy because the
current treatment of choice is surgical. At surgery, the abscess contents
should be collected for aerobic and anaerobic culture and a tissue section
should be obtained for histopathology.
Treatment. Surgical drainage is the current treatment of choice. There
are many methods to accomplish this, including needle aspiration, tube or
Penrose drains, or marsupialization. Alternatively, the entire prostate may
be removed. Complications are common with all methods. Drainage
through the abdomen often results in oliguria and shock immediately after
surgery, probably from the release of bacteria and their toxins. Intensive
care is often required for several days after surgery. If placed over the
prostate, drains may sever the urethra, leading to a urine fistula . Ascending
infection with antibiotic-resistant bacteria is possible. Marsupialization
leaves a chronic draining stoma in many dogs. If the stoma closes too early,
the abscess may reform. Prostatectomy is difficult if the prostate is markedly
enlarged and may result in urinary incontinence.
Polyuria and polydipsia, similar to that expected with nephrogenic
diabetes insipidus, have been noted in a few dogs after surgical treatment
for prostatic abscessation. The polyuria, polydipsia, and pre-operative
evidence of hepatic dysfunction have resolved within 1 month of initiating
treatment.
Castration is often recommended as adjunctive therapy to reduce the
amount of prostatic tissue available for reabscessation. This would not be
necessary if prostatectomy was performed unless castration was done prior
to prostatectomy in an effort to reduce prostatic size.
Regardless of which surgical therapy is elected, the dog must receive
antibiotics. If the dog is systemically ill, intravenous antimicrobials should
be used initially. Based on prostatic penetration, chloramphenicol or
trimethroprim are the drugs of choice . However, choice should be based
on the causative organism, its antibiotic sensitivity, and the degree of
sepsis. After stabilization of clinical signs, the dog should be managed with
antibiotics in the same way as a dog with chronic bacterial prostatitis.
W e have managed two dogs with antibiotic therapy alone when the
owners refused surgery. These dogs did well as far as attitude and activity.
Urinary tract infection and signs of systemic illness were controlled.
However, in each case the abscess remained and signs of illness recurred
whenever antibiotics were withdrawn, so continuous antibiotic therapy was
required.
If prostatic enlargement has resulted in partial urethral obstruction,
bladder and urethral function should be carefully assessed. Prolonged
bladder distention may have resulted in bladder atony so that the dog may
598 JEANNE A. BARSANTI, AND DELMAR R. FINCO

have overflow incontinence. An indwelling urinary catheter will be neces-


sary to let the detrusor tight junctions reform. If the bladder wall has been
chronically distended and infected, it may be irreversibly damaged.
Prostatic abscesses are often difficult and expensive to treat. The client
should be made aware of these difficulties, so that a quick cure is not
expected.
Prostatic Neoplasia
The most common prostatic neoplasm in the dog as well as in man is
adenocarcinoma. Transitional cell carcinoma may also involve the prostate,
but this section will focus on prostatic adenocarcinoma. This neoplasm is
always malignant and tends to metastasize to sublumbar lymph nodes and
the lumbar vertebral bodies as well as to the lungs.
Clinical Signs. Prostatic adenocarcinoma arises in old dogs. The clinical
signs, such as tenesmus and dysuria, are often related to increased prostatic
size. Rear-limb weakness or stiffness and pain in the hind quarters are
common signs and were present in 40 per cent of affected dogs in one
survey. The pain may be related to necrosis and inflammation as the tumor
outgrows its blood supply or may be due to lumbar vertebral metastasis.
Chronic weight loss may also be present. If prostate glands are carefully
palpated routinely in older male dogs, a firm neoplastic nodule may be
palpated prior to marked prostatic enlargement and prior to clinical signs.
Diagnosis. On prostatic palpation, one or more firm nodules may be
detected in early cases. In the majority of cases presented with clinical
signs, the prostate gland will be markedly enlarged and asymmetric with
increased firmness. It may be painful on palpation and is often nonmovable.
The finding of a large prostate in a previously castrated male is highly
suggestive of neoplasia. The sublumbar lymph nodes should be palpated
rectally and may be enlarged.
A neutrophilic leukocytosis may be present depending on the degree
of necrosis and inflammation associated with tumor growth. If the tumor
has grown in such a manner as to obstruct both ureters, hydronephrosis
and azotemia may result from such slowly developing obstruction. Urinalysis
may show hematuria and pyuria due to prostatic necrosis and inflammation
secondary to tumor growth. Infection may also be present. Prostatic fluid
may vary from hemorrhagic to purulent, possibly with secondary infection.
The prostatic fluid should also be examined for neoplastic cells, but falsely
negative results are common.
Asymmetric prostatic enlargement may be evident on survey abdominal
radiography. The lumbar vertebral bodies should always be carefully
examined for areas of lysis, which are suggestive of metastasis. The degree
of enlargement of the subluinbar lymph nodes should also be determined.
Thoracic radiographs are indicated to check for pulmonary metastasis.
A presumptive diagnosis is based on history, physical examination,
hematology, urinalysis, cytology of prostatic fluid, and radiography. Unless
metastatic disease is evident radiographically, the diagnosis should always
be confirmed by aspiration or biopsy because the prognosis is poor.
Treatment. Prostatectomy is the treatment of choice. The owner must
be willing to accept the probable postsurgical development of urinary
CANINE PROSTATIC DISEASES 599
incontinence and the probability that metastasis has occurred even if it is
not yet clinically or radiographically evident. In advanced cases with
metastatic disease, euthanasia is often the most humane course because of
lack of effective therapy. Palliative therapy includes castration, estrogen
administration, and various chemotherapy regimens designed for humans.
Veterinary experience with these treatments is extremely limited. Castra-
tion in two dogs in our hospital did not halt or slow tumor growth.

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Department of Small Animal Medicine


College of Ve terinary Medicine
University of Georgia
Athens, Georgia 30602