What is the primary function of the male reproductive system?
to produce sperm cells and deliver them into the female reproductive tract.
What are the primary organs of the male system? and what are formed there? the 2 testes in which the sperm cells are formed.
What are the other 2 groups of accessory organs internal and external reproductive organs
Describe the testes ovoid structures suspended within the cavity of the scrotum by a spermatic cord
What are the seminiferous tubules? each testis is filled with about 1000 threadlike coiled seminiferous tubules, the sperm cell factories. They are lined with specialized tissue called germinal epithelium which function to produce a million male sex cells daily
What is also known as the sperm cell factories? seminiferous tubules
What are other specialized cells called and where are they located, and what do they secrete and produce? they are called interstitial cells or cells of Leydig, located in the spaces between the seminiferous tubules and function in the production and secretion of male sex hormones.
In young males what are the sperm cells called they are called spermatogonia and are undifferentiated
When and what caused undifferentiated spermatogenic cells to change? Hormones during early adolescence
What do spermatogenic cells do to become primary spermatogonia? they begin to undergo mitosis and some of them enlarge
How many chromosomes do secondary spermatocytes contain? 23
What happens to secondary spermatocytes do soon after they are formed? they each divide again and the result is four spermatids with 23 chromosomes each
How do spermatids become transformed into mature sperm cells? by a process of differentiation which is called spermatogenesis
What is the epidiymis? a coiled tube which lies on the outer surface of each testis
Where do sperm complete there maturation and are stored? in the epididymis
From the seminiferous tubules sperm passes through what? into the ? sperm pass through a network of small tubules into a large tube, the epididymis
Where does the epididymis empty into? a straight tube, the vas deferens or sperm duct
From the scrotum where does the vas deferens pass as part of the spermatic cord. the inguinal canal
Which way does the vas deferens loop after entering the pelvic cavity? they loop over the side and then down the posterior surface of the urinary bladder
What happens to the vas deferens when it nears termination? it becomes dilated into a portion called the ampulla
What does the vas deferens unite with just outside of the prostate gland? it becomes slender and unite with the duct of a seminal vesicle
What is the seminal vesicle? it is a saclike structure near the base of the bladder.
What does the seminal vesicle secrete? It secretes a slightly alkaline fuid which is thought to regulate the pH of he tubular contents and also greatly increase the volume of the fluid that is discharged from the vas deferens
What forms the ejaculatory duct and where does it pass through? The fusion of the ducts of the vas deferens and seminal vesicle and passes the substances of the two through the prostate gland.
Describe the prostate gland? chestnut shaped structure that surrounds the beginning of the urethra (urogenital diaphragm), just below the urinary bladder.
How many lobes compose the prostate gland and what does it secrete? composed of 5 lobes (posterior lobe is what is felt upon rectal exam) and secretes a milky fluid with an alkaline pH which helps neutralize the acidic sperm.
What enhances the motility of sperm cells and why? the milky fluid with alkaline pH from the prostate, because they remain immobile in the acidic contents of the epididymis.
What does the prostatic help do? helps neutralize the acidic secretions of the vagina and help sustain sperm cells that enter the female reproductive tract.
What are the small glands which lie below the prostate? Bulboruethral glands or Cowper's glands
What do the bulboruethral glands or Cowper's glands secrete and it's function. secrete a mucous like fluid which is released in response to sexual stimulation and helps lubricate the penis
Seminal fluid (semen) is slightly _____ __ with the average number present in the fluid is about ______ per __. semen is slightly alkaline pH with 120 million per ml
Sperm cells are _____ and account for ___ of the semen volume. so tiny and account for less than 1% of semen volume.
Semen (seminal fluid) is conveyed by the _____ and consists of (4) conveyed by the urethra and consists of sperm cells and secretions from seminal vesicles, prostate glands, and bulbourethral glands.
What are the male external reproductive organs? scrotum and penis
What encloses the testes? scrotum
Where dose the urethra pass? the penis
Prostatic cancer is the most common cancers for what age? men over 50 and rarely seen in younger age groups
65 is the peak age of incidence for which male cancer. and is higher is which race. prostate cancer and is higher in blacks than whites
Prostate cancer developes in American black men at ____ age and also seems to present in a more ____ stage. Because of this what is the mortality of blacks then whites? at a young age in a more advanced stage. mortality in blacks is twice that then whites
What is prostate cancer seem to be linked to? And who has a higher frequency of it? linked to hormones and is higher in people who had a venereal disease and familial connection.
What is prostate cancer found concurrently with? benign prostatic hyperplasia (BPH)
Prostate cancer is almost exclusively what histology? adenocarcinoma
Where does prostate cancer generally rise? and where does BPH generally arise prostate cancer arises on the periphery of the prostate.
BPH usually originates from the central portion of the gland.
prostate sarcomas are ____ rare
How are tumors of the prostate classified? By the Gleason score. The pathologist evaluates the predominant degree of differentiation of the primary and secondary tumor and gives each a number 1-5.
As per the Gleason score, which score is less aggressive? Low scores are less aggressive than higher scores
What is the appearance of adenocarcinomas of the prostate. range from well differentiated to undifferentiated neoplasms
Majority of prostatic cancers have more than ____ histologic pattern
What is the best way to detect early potentially curable carcinoma of the prostate. digital rectal examination
Where does prostate cancer usually originate. in the posterior lobe which is easily reached by the index finger.
Normal BPH feels similar to _____, while prostate cancer feels like _____ BPH- tip of nose
Prostate Ca- one's knuckle
Which other way may be of value in screening for prostate ca? transrectal ultrasound
50% of asymptomatic prostate ca are found by digital exam
How do most symptomatic prostate patients present? with local symptoms- urinary outflow blockage or unexplained cystitis
When does diagnosis of prostate ca occur? when prostatic tissue is removed to relieve bladder outlet obstruction for what was thought to be BPH
What are late presenting symptoms of prostate ca? -bone pain
-uremia (toxic condition; retention of nitrogen in blood)
What is the preferred method of obtaining histologic diagnosis for prostate ca? transrectal or perineal needle biopsy
What may be used for moderately advanced lesions producing obstructive symptoms (prostate)? transurethral resection of the prostate (TURP)
Only __% of patients undergoing TURP for BPH have a malignancy 10%
What is very suggestive of metastatic disease of prostate? an elevated serum prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) levels appear to be proportional to prostatic volume
Normal level of prostate ca are? due to the age of the patient
How do you rule out bone mets from prostate ca? What is recommended for detection of pelvic lymphadenopathy. -bone scans rule out bone mets
-pelvic CTs detect pelvic lymphadenopathy
Approx __% of localized prostatic cancers are ____ at time of dx. 85%
What is present in almost all cases of prostate ca? perineural invasion
Extension to the capsule occurs early in prostate ca, but usually not before invasion of the prostate has caused obstructive symptoms
What has a profound influence on survival in prostate ca? perforation of the capsule and/or extention into the seminal vesicles
What else gets involved late in prostate ca? bladder, rectal, and extention to pelvic wall
What does lymph node invasion in prostate ca depend on? the size of the tumor and the degree of differentiation
What is the most frequent sites of regional node mets in prostate ca? 1-obturator
3-hypogastric lymph nodes
in that order
Is regional lymphatic mets common from cancer of prostate? yes
In terms of blood borne disease the veins draining the prostate form a well defined plexus around the base of the gland
The plexus around the base of the gland has connections to the _____, which is believed responsible for high incidence of mets to _____ (prostate)-. vertebral system
Mets of prostate ca go to -liver
-and sometimes preferentially to the bones of the pelvis and spine
What are the 5 treatment options for prostate ca? 1- observation for pts w/ stage 1A
2- radical prostatectomy (limited to healthy males w/ early stage and no mets)
3-interstitial (iodine or gold) therapy + ext XRT
4- external XRT
5- hormonal manipulation
Radical prostatectomy is effective in treating what? what occurs and what percent of pts are eligible for this procedure? treating disease confined to the capsule (T1 and T2), the prostate gland, seminal vesicles and a cuff of bladder neck are removed. Approx 5-10% are eligible
What occurs in almost all pts w/ radical prostatectomy? What new procedure is helping this? What are other complications? Impotence.
newer nerve sparing procedure
other complications- blood loss and fistula formation between the bladder and rectum
What is the major issue of radiotherapy for prostate ca? the incorporation of pelvic and para-aortic lymph nodes
When utilizing XRT to treat prostate ca what energy is used? dose to tumor? dose to nodes? high energy units above 10 mV
tumor- 75-80 Gy
nodes- 45-50 Gy
What are XRT portal arrangements for prostate ca? 4 field box or IMRT followed by boost to the tumor itself
What is interstitial treatment for prostate ca? -if only treatment and is early stage- Iodine 125
-xtra cap extent- Palladium 103
=as an initial boost to the tumor
How is interstitial tx done for prostate ca? What are the doses? This procedure is done under anethesia and the seeds may be implanted by Mick gun.
Dose 125-145 Gy followed by 40-50 Gy of XRT to gland itself and primary echelon of nodes
After irradiation for prostate ca regression rates are ____ and ___ may be required for clinical evidence of tumor to disappear. slow
-tumors have long cell cycle time and takes several divisions before lysis occurs
What are side effects of irradiation of prostate -similar to pelvic irradiation
-impotence in up to 35%- XRT and 15%- interstitial
What happens with palliative RT of prostate ca? What doses? Because pts with mets may survive many months or years, a relatively high dose should be used to avoid retreatment.
Doses 40-50 Gy in 3-4 wks
What is hormonal tx of prostate ca reserved for? demonstration of symptomatic local reccurrence or distant mets
Describe hormonal tx for prostate ca. it centers around orchiectomy or the administration of estrogens. Both will remove 90-95% of circulating testosterone. Current medicines are Zoladex and Lupron.
What is the prognosis of prostate ca? 10 yr survival involving radical surgery for small tumors was 60%.
Which cancer is rare accounting for only about 1% of male malignancies? testis cancer
Why is testis cancer important? because it is commonly found in pts between 20-34 and potential of productive yrs of life lost.
Testicular cancer is now one of the most ____ of the solid cancers in adults curable
What are the commonest form of cancer in men between 15-44 testis cancer, leukemia, and lymphoma
Who are testis tumor rarely found in? American blacks, Africa, Asia, and New Zealand
What is the etiology of testis cancer? -more frequent in identical twins
-higher in undescended testis
What is the incidence of undecended testicles? 1 in 80 inguinal testes and 1 in 20 abdominal testes
What have been suspected with testes cancer? -gonadal dysgenesis
-interference w/ blood supply
What is the histology of testicular cancers? 95%- germ cell
5%- non-germ cells
Of germ cell testicular tumors the most common kinds are? seminomas 35-50% of all germ cell tumors
What is the peak age of incidence for seminomas of testicular ca? 40 yrs -most testes cancers occur at relatively young ages; the most common testicular cancer in elderly men is lymphoma
Which makes up 1-3% of all germ cell tumors of testes? Choriocarcinoma- which has the worst prognosis
What are other types of testicular cancers? -embryonal carcinomas
-yolk sac tumors
How does testicular cancer present? as a painless scrotal mass ranging 1- over 10 cm in diameter.
90% of testicular masses are brought to doctors attention by the patient making self exams
What are signs of testicular ca? -feeling of heaviness
-pain due to hemorrhage w/in tumor
Approx 96% of solid tumors of testis are ___. malignant
Pts w/ testicular tumors should exam for mets- -mass of epigastrium
-enlarged spclv node (Virchow's node) palpable
Gynecomastia (testes tumor) may be present if it produces HCG (human chorionic gonatropin) or estrogens
Testicular ca has 2 biochemical markers HCG and AFP (alpha-fetoprotein)
The 2 biochemical markers (testes) serves as guides for staging
-choice of therapy
To stage germ cell what method? stage pure seminoma? abd pelvic CT- germ cel
To bx testes inguinal exploration followed by orchiectomy
How do testicular neoplasms spread? orderly to lymphatics and adj tissues
Where do advanced and ingnored testicular neoplasms disseminate to? lungs, liver, and brain
blood borne mets from seminoma of testes is lung
Where do majority of testis lymph terminate? in lumbar lymph nodes between T11 and L4
What testis tumors are radiosensitive? lyphomas and tumors from germinal epithelium
Nongerminal cell of testis require what tx? they are radioresistent and require surgery
How do you surgically dx testicular tumors? orichectomy
as well as bilateral retroperitoneal lymph node dissection
Tx for nonseminomatous testes tumors Surgery w/ chemo
RT for seminomas (testes) is tx of choic if -no disease above diaphragm
-no lymph mets
-no elevated serum markers
If retroperitoneal disease of testes RT if disease is less than 5 cm
Where is RT of testes given? zone of nodal drainage- the lumbar periaortic area and in ipsilateral groin region
What is the RT tx for testes? AP/PA fields to 2000-2500 cGy in 2-3 wks
What dose can induce permanant sterility in men? max dose of 200 cGy in one fx
Complication of testes RT is decreased sperm
Chemo is tx of choice for (testes) -nonseminomas
-stage 3 and 4
-when RT fails
Stage I and II pure seminoma (testes) cure rate is? What tx process? close to 100% cure
tx- radical orchiectomy followed by RT
Stage I and IIA nonseminomatous germ cell cure rate is (testes)? 95%
In the US penis cancers is? Non-circumcized and bad hygiene %? US- less than 1%
non-circumcized/ bad hygeine -10-12%
What is the histology of penile ca? squamous
What give most protection against developement of penile ca? neonatal circumcision
How does penile ca present? penile growth, ulcer, or foul smell
-inguinal adenopathy or ulceration
What symptoms of penile ca? painless w/ erosion w/ attendant bleeding w/o pain
About __% of pt will delay med attention for more than one year (penis) 50%
After bx confirms dx cancer, penile ca is evaluated with regard to size, location, and if lesion is fixed
w/ attention should be given to penile base and scrotom to check for extention
How does penile cancer spread? direct extention and lymphatics- tx prevents future spread
Where does lymphatics of penis drain? into superficial inguinal nodes
then external iliac nodes
then periaortic nodes
What is primary tx of penis ca? surgery and XRT
What is the goal of surgery of penis? remove lesions w/ adequate margins to guard against local failure
Small tumors of penis can be managed with ____ alone. circumcision
Penectomy w/ urethrostomy is for malignant lesions of proximal shaft
RT is used for tx of (penis)
-small primary carcinomas
-lymph node mets
-avoid the cosmetic and functional deficits left by surgery and devastating psychological effects on patients
RT for penis techniques and doses
electrons- superficial lesion
mV- infiltrating tumors over .5 cm thick
65-70 Gy in 5-7 wks
-interstitial implants with Radium 226, cesium, or iridium 60 Gy -6 days