TAKING care of three children, running a family home and working in practice is challenging in its own right, so finding the time to complete essential and compulsory CPD adds yet another stress. With this in mind, I am grateful to anyone who comes up with a solution to make my life and, no doubt, many other working parents’ lives, just a little bit easier. With the introduction of webinars, I believe we have finally got a solution that gives quality, informative, practical CPD which can be slotted in when time and other commitments allow. The online lectures at www.thewebinarvet.com can be viewed live over the web or can be viewed at a later stage and, best of all, they can be accessed from the comfort of home. In this webinar on canine prostatic disease, sponsored by Virbac Animal Health, Dr Henry L’Eplattenier started by refreshing our memories on the prostate’s anatomy and function, and followed with the seven recognised diseases of the prostate:
- BPH
- Prostatic cysts
- Prostatitis
- Prostatic abscess
- Squamous metaplasia
- Paraprostatic cysts
- Prostate carcinoma
BPH is the most commonly recognised disease of the prostate and is present in almost all entire males older than five years – although not all show clinical signs. This figure has made me consider that BPH should be checked for when examining entire older males (for any reason) and of the importance of rectal examination. Blood tests are also now available to aid diagnosis and this will be discussed at a later stage of the report. The signs of a bloody discharge, straining to defaecate and stranguria are all familiar clinical signs associated with BPH. On rectal examination the prostate generally feels symmetrically enlarged and is non-painful. In Dr L’Eplattenier’s opinion, BPH does not exist in neutered males so if castrated dogs are showing signs of prostate enlargement, neoplasia of the prostate should be considered. BPH can develop into prostatitis, usually by an ascending infection. Additional clinical signs include depression, fever, and a stiff gait associated with a painful prostate. For this reason, prostate disease should be considered in all the aged, stiff dogs that may be diagnosed rightly or wrongly with osteoarthritis. If prostatitis is left untreated, an abscess can develop which is a relative emergency due to the risk of perforation and peritonitis. The signs of shock, sepsis and endotoxaemia associated with an ultrasound demonstrating a fluid-filled cyst within the abdomen is considered enough evidence to make a diagnosis. Prostatic neoplasia is a not a
common disease but is seen mostly in castrated males. However, because neoplasia is relatively rare, it is not recommended as a reason to advise owners to avoid castration.
Diagnosis of prostate disease
Diagnosis is, of course, based on history, physical examination and clinical signs. As regards prostate palpation, it is important to remember that if the prostate is enlarged, it can slip cranially and consequently can be difficult to palpate per rectum. It is therefore important to push the prostate caudally with the opposite hand. Ultrasound, x-rays, urinalysis and FNAs can all prove useful when it comes to making a specific diagnosis. Canine prostate specific esterase (CPSE) is a relatively new blood test available to help diagnose BPH. It is present in semen and levels in serum have been shown to rise in dogs suffering from BPH. A recent study has shown the test to be 97.1% sensitive and 92.7% specific. This blood test is now available from a number of labs in the UK to screen, diagnose and monitor dogs with BPH.
Medical management
Until relatively recently, progestagens were the drugs of choice. These included drugs such as delmadinone acetate (Tardak, Pfizer). However, side effects are a consideration, especially if using Tardak repeatedly, including diabetes mellitus, mammary tumours and reduced libido. Androgen receptor blockers are now available in the form of osaterone acetate (Ypozane, Virbac) and this has become the medical treatment of choice for BPH. It is a seven-day oral treatment which has a clinical effect for five to six months. It should be used with caution in dogs with liver disease or hypoadrenocorticism. It is safe to use Ypozane and antibiotics concurrently if required. Antibiotics are used where there is evidence of infection – the choice of antibiotics should be made based on the bacteria present but we must also consider how the antibiotic will be distributed. The best antibiotics for penetrating the prostate are the fluoroquinolones (e.g. enrofloxacin) and trimethoprim-sulfa. The antibiotic course will often have to be extended for 4-6 weeks and in the event of an abscess, the appropriate antibiotic should be given IV for the first 48-72 hours.
NSAIDs and cancer
The COX-2 enzyme has been found to be expressed in various types of cancer and there may be a place for the use of COX-2 inhibitors in their treatment. Preliminary results suggest that
NSAIDs such as piroxicam may be useful in the treatment of prostate cancer although there needs to be more studies.
Surgical treatment
Castration is the treatment of choice for BPH and other hormonal dependant conditions such as squamous metaplasia which is caused by oestrogens such as those produced in sertoli cell tumours. It has been demonstrated, however, that castration does not help in the treatment of prostate carcinomas. Dr L’Eplattenier finished the session by discussing and showing images of the surgical techniques for omentalisaton in the treatment of cysts and abscesses and partial prostatectomies for the treatment of prostate carcinoma. The prostate webinar proved to be a really useful update and reminder on diagnosing and treating prostatic disease and it is certainly something I will consider more when older male dogs walk through the clinic door for a general health check. Best of all, I didn’t even have to leave home to attend this CPD and could fit it in around my hectic schedule. With more and more time constraints for vets within the profession, webinars are bound to play an increasingly greater role in allowing vets to update their knowledge whilst keeping that ever important work-life balance.
- This webinar, Diseases of the Prostate, can be viewed again free at any time at www.thewebinarvet.com/virbacwe…thanks to the sponsorship of Virbac.
