Prostate Problems in Dogs

Question: Dear Doctor Mike I am a subscriber to your news letter and I would appreciate your help with a problem that I have with one of my dogs.

A year ago Skippy who is a 4 year old neutered cross breed, was diagnosed with ehrlichiosis. He was a stray that we rescued off the streets in Greece where we live. The illness appeared very rapidly. We woke up one morning to find that our dog had complete paralysis of his back legs. The paralysis effected the use of his bladder and my husband and I were having to insert a catheter into his penis 3 times a day in order to empty his bladder.

His treatment for the ehrlichiosis lasted for 3 months and he has been tested since and we have been told that he is now clear of the disease. He has regained the full use of one of his back legs and partial use of the other one, although the muscles in the bad leg have atrophied quite badly. The problem now is that he keeps getting a swollen prostate gland, which stops him being able to urinate. He will stand in the garden for ages stretching his legs in a bid to urinate and nothing happens. His bladder will then empty itself when he is lying down inside. He also seems to have loss of feeling in his bowels and occasionally he will soil his bed.

Do your have any suggestions as to what the problem could be. Each time we take him to the vets they put him on antibiotics for the swollen prostate, which seem to work, but I am worried that it could be a more serious problem as it keeps returning on a regular basis.

Looking forward to any help you might be able to give us.

Kind Regards Carole.

Answer: Carole-

I think that you are right to worry that there is an unresolved continuing problem leading to the recurrence of the prostate enlargement that Skippy experiences.

It is unusual for a neutered male dog to have benign prostate hypertrophy. This is the most common prostate problem but it almost always responds to castration and it does not occur in the great majority of neutered dogs. I think that this possibility can be discounted.

Prostatitis, infection of the prostate gland, can occur in neutered dogs, but is more common in intact dogs. The most worrisome cause of this problem, given Skippy's unknown early history, would be brucellosis (infection with Brucella canis bacteria). It would be very hard to clear an infection with this organism from the prostate gland. I think I would want to test for this disease early on because knowing it was present would indicate the need for long term antibiotic therapy and also because this disease is considered to be zoonotic (may be transmitted to humans), so proper precautions could be taken to prevent this spread. Brucellosis is associated with infection of the disks between spinal vertebrae (discospondylitis) and this will cause paralysis and antibiotic treatment would often result in improvement. It is entirely possible to have both brucellosis and ehrlichiosis. There are other possible bacterial infections, such as E. coli, Pseudomonas and Staph. If a culture of prostatic fluid can be obtained or an aspirate of a prostatic abscess can be cultured, it would help in the selection of antibiotics. Keep the prospect of brucellosis in mind when collecting samples. Infection of humans is rare but why take any chances? It is hard to culture brucellosis but both blood and prostate samples allow culture and there are blood tests for the condition, as well.

The other possible problems I can think of are prostatic cysts (also unusual in neutered dogs but perhaps if Skippy had the infection prior to castration this would account for that) and prostate cancer. Most dogs with prostate cancer are over 9 years of age but it is hard to completely rule it out. Prostatic cysts respond to antibiotics but then cause problems again when the antibiotics are withdrawn. Surgical drainage of the cysts is the best way to get a cure but it carries some risk of shock or rapidly spreading infections, so sometimes there is a bad outcome when surgery is attempted to drain prostatic cysts.

I would try to rule out brucellosis, since most veterinary practices have a lab they can send samples to for analysis. Brucellosis would require long term antibiotic therapy. Streptomycin is supposed to be a good way to start, then long term tetracycline use (which is the same antibiotic usually used for ehrlichiosis). Then, if that doesn't seem like a likely problem, the best bet is to find someone who can do ultrasound examination of the prostate and possibly obtain a sample for culture. After identifying the problem and the organism it may be possible to decide whether or not surgery or very long term antibiotic use seems like the best option.

Hope this helps.

Mike Richards, DVM 1/9/2001

Enlarged Prostate - abscess or cancer

Question: Dear Dr. Mike,

I have a 14 year old male Border Collie with an enlarged prostate (approximately 4 times its normal size). He was neutered at 9 years of age and is in remarkable health for his age.

Last Thursday he started having problems with urinating and defecating. Saturday morning I took him to my vet who immediately sent me on to the emergency clinic. My dog spent Saturday and Sunday at the e-clinic with a catheter in and with tests being run, x-rays were taken and antibiotic were administered. Monday morning he went back to my vet, still on the catheter. Urethra and bladder blockage, due to stones) have both been eliminated and the efforts are now is focused on the enlarged prostate. All tests (blood, urine, urethra scraping, etc.) have come back without a conclusive conclusion as to the reason for the swelling. It might be an abscess, it might be cancer, it might be an infection (although after several days of antibiotics a 2nd x-ray showed no change in the size of the prostate). At this point I am at a total loss. The two options I seem to be left with are euthanasia or an ultra sound and biopsy of the prostate to determine if it is indeed cancerous (approx. $400). Obviously if it is cancer the honorable thing to do (based on my dogs age) seems to be euthanasia. I have complete confidence in my Vet, but at the same time I recognize the limits of a general practice Doctor when it comes to oncology issues. I guess my questions would be: 1) Is prostate cancer common in older male dogs and if so is treatment even advisable at 14 years old? 2) Should I accept my doctor's current belief that it is cancer (none of the tests have been positive) and move forward with euthanasia without the biopsy? 3) Is it advisable or even humane to treat prostate cancer in a 14 year old dog 4) What is the most common form of doing a biopsy on the prostate. 5) If it is an abscess or infection that is resistant to antibiotics is surgery our only other option and is this even advisable on an otherwise healthy 14 year old dog?

All of my good intentions will only give him a few months or a year or two at most, but I don't want to look back and wonder if give up before it is time to do so. My dog is bright eyed and energetic for his age, but I get the impression that my vet feels that at this time euthanasia is the right thing to do, although to come right out and tell a loving pet owner that the time has come to put his friend and companion to rest has got to be the hardest part of his job.

Thank you for your time and your response.

Sincerely, Chuck

Answer: Chuck-

I think that if you just go on statistical probability, cancer is the most likely cause of a prostate enlargement of this size in a dog in your border collie's age range. Especially if there is no other sign of infection, like elevations in temperature or white blood cell count and no sign of bacteria, pus or blood in the urine. It is very hard to completely rule out the possibility of an abscess without a biopsy but cancer seems more likely with the medical history you have provided.

Treating for prostate cancer this severe usually requires some sort of radical surgery. The favored one, at the present time, seems to be removal of the prostate and anastamosis (joining) of the bladder and colon, so that urine is deposited into the colon and excreted from there with the stool. This is not likely to be curative for the cancer, as it is likely to have spread beyond the prostate but it does provide some additional time with reasonable quality of life. How much time varies depending on where else the tumor is.

There are a several things to think about as you try to decide what to do next.

If you accept the possibility that this is a cancer, X-rays of the chest would be a good idea. Tumors often spread to the chest and they are relatively easy to see on X-rays of the chest. If this is a prostate cancer and it has already spread, the prognosis would be poor with any treatment option. Carefully palpating the regional lymph nodes might also give some indication of whether a tumor has spread.

A biopsy is necessary, not just to decide if this is cancer or something else, but also to decide what type of cancer. This could be a prostatic adenocarcinoma or a transitional cell carcinoma or possibly another type of cancer. Knowing which one it is will enable your vets to make the best possible plan.

I think that surgeons would advise you that the quickest way to an answer and treatment is to do surgery and get biopsy samples along the way. I think that internal medicine specialists would lean towards an ultrasound guided biopsy. I think that the real difference is whether or not you are prepared, right at the moment of surgery, to move on to the next step. If you really would consider a major surgical procedure at this time, then just going for it might be the best option. Abscesses do sometimes require surgical drainage and tumors are probably best treated surgically, although chemotherapy to try to gain comfort is also a possibility.

You have to evaluate the whole patient. No matter what you do, you won't have a new or younger dog. You have a fourteen year old dog with all the same problems that were present before this one particular problem occurred. If he is in good enough shape, otherwise, to make it reasonable to expect a year or two more of life, then it is easier to contemplate a surgery that is quite extensive. If you know that there are other problems that are making your border collie's life less than pleasant, then contemplating a major surgery or prolonged chemotherapy isn't as easy. It sounds like you think he is in pretty good shape, which is helpful if you do go for treatment.

Quality of life is very hard to evaluate before attempting surgery or chemotherapy, because not all patients respond in the same way. Surgery would definitely fit in the "major" surgery category and at least a few weeks of recovery would have to be anticipated. Chemotherapy would be life long at this point, probably. Some dogs do really well with chemotherapy and others don't. I know of no good way to know who is going to have problems in advance. However, chemotherapy can be stopped at any time.

Lastly, cost has to be factored in. Surgery and chemotherapy are both expensive. If you can't afford at least two thousand dollars then it might not be a good idea to start down those paths. Either choice could cost more than that, as well. It is not easy to let money be a deciding factor but it has to be at times.

Most vets don't think that they should make a decision to euthanize a pet for a pet owner and often only discuss euthanasia as one of several options, even if they think it is the best option. It is just such a difficult topic since differences of opinion about when and even if to consider euthanasia vary widely among clients. I will tell people what I think only if they ask me point blank or if I really think a dog is suffering with little to no chance of recovery.

If this just makes you more confused, please feel free to write me again to ask for clarification.

Mike Richards, DVM 2/4/2000

Considering prostate surgery

Q: dr. mike:

a friend of mine has a dog with a large "mass" developing in the prostrate area. after monitoring its growth for some months, her vet has finally indicated that it should be removed. he also indicated that the prostrate area is a difficult area for surgery. how can my friend locate a veterinary surgeon who may specialize in this area? we live in the chicagoland area, but she would be willing to travel with the dog to get the best surgeon possible. in general, how does one locate veterinary specialists? and how does one judge their expertise? is there any type of national referral service? does any association compile statistics on treatments and success rates by doctor? i'd appreciate your response as soon as possible, as the "mass" is still growing. thanks.

A: J.

Sorry, but Hurricane Floyd interrupted our ability to respond to messages. We just got power back this evening.

I can not help much with your inquiry, beyond giving you the basic answers to some of your questions.

Most veterinary specialists require that a veterinarian refer cases to them, meaning that most of them will not take direct appointments from pet owners. This is good and bad -- good in that it assures that the specialist is necessary and conserves their time, bad in that some vets don't refer to specialists unless specifically asked to do so.

There are often referral centers with several specialists in major cities, so I suspect that Chicago probably has one. The other choice would be one of the veterinary schools in the area. The veterinary schools tend to be good sites for surgeries that require a lot of aftercare and I am under the impression that prostate surgery does require this.

There are several things to think about before considering prostate surgery, though. The first thing is to be sure that there are not metastases to the bone in the region or to other areas, if possible. Then consider that prostate surgery is not usually totally successful and that it almost always produces incontinence (which can sometimes be controlled with medications). There is some research on using laser or ultrasonic surgical techniques that seems promising but is mostly being done at human research centers (where they have equipment like that). Radiation therapy can be helpful and may give as good a prognosis as surgery. Piroxicam (Feldene Rx) is used to make dogs more comfortable and help prolong their lives in that manner, too. It is sometimes necessary to use medications to control other problems, such as high blood calcium levels, as well.

The best thing to do is to find a veterinary oncology specialist. There are usually good ones at most of the veterinary schools. Find out how successful they are in treating protate cancer and make sure you understand their concept of success --- is it OK if it is just prolonging life a few months, or do you want more from the definition?

I am certain that there is no one keeping track of success rates independently among veterinarians and there is no referral service I know of that isn't a "for-profit" venture -- which makes them much less useful since they are hardly objective.

Your friend's vet should have some idea who the good specialists are in the area. It would probably be best to take his or her referral first and then look for other means of locating a specialist if that doesn't work out.

Mike Richards, DVM 9/18/99

Prostatitis

Q: Have a one and a half year old male Yorkie with prostatitis according to a vet. What treatment would you recommend ? Would neutering be needed on a emergency basis?

A: Prostatitis is usually treated with antibiotics. It is generally from a bacterial infection of the prostate gland leading to inflammation. This causes pain when urinating and may cause lameness or stiffness in the rear legs. It can be a serious illness, sometimes leading to septicemia (blood borne infection). It is best to treat with an antibiotic that has been chosen based on a culture of the prostatic fluid but veterinarians often choose an antibiotic based on the likelihood it will work for prostate infection since culture and sensitivity takes a few days to get results from and adds to the expense of treating the condition. If the antibiotic doesn't seem to be working it is best to insist on a culture, though. Neutering probably doesn't help much with acute prostatitis but it may be helpful if chronic prostatitis is present and it definitely helps if there is benign hypertrophy of the prostate. The latter condition is more common as dogs get older and would be unusual in a young dog. In some instances prostate infections abcess. This is much more serious, does respond best to surgical drainage and is at least a pressing problem, if not an outright emergency. Castration is a good idea when treating prostatic abcesses but the abcess must still be treated properly as it will not go away with castration alone.

While I haven't seen much mention of it in the medical texts, I really think that prolonged exposure to females in heat, especially when mating does not occur, can lead to painful enlargement of the prostate that really isn't an infection. Just inflammation. This does seem to respond to castration or to limiting exposure to females in heat.

Good luck with all of this.

Mike Richards, DVM

Prostate enlargement

Question: I am a subscriber.

I have a 9 1/2 year old neutered (since 6 months of age) German Shorthaired Pointer. Several weeks ago we took him to the vet because he didn't seem like his old self - we had no clue has to what was wrong because he was not showing any particular symptom - he just did not seem right. The doctor ran a lot of tests (blood test, xrays, urinanalysis) and found he had bacteria in his urine. He put Buster on Baytril (3/4 of a pill twice a day) for 11 days. About thirteen days later we brought him back to the vet because he was dripping bloody urine out of his penis. The vet then put him on Baytril (1 pill twice a day) for 3 weeks. After two weeks we took him back in because he had started dripping bloody urine again. This time they did an ultrasound on him because they expected to find bladder stones - instead they found his prostate to be cystic or have a tumor (they're not sure). They (two vets) then found a very large prostate on palpation. We are now waiting to go to an Internist who can't see us until next week. We are continuing the Baytril. Our two regular vets indicated the internist might want to do a prostatic biopsy - should we have them go through with this procedure or just have them remove the prostate or the tumor/cyst? We just don't want to put Buster through any extra procedures if it's going to result in surgery anyway.

Thanks for any suggestions you can make.

Answer: Linda-

Prostate surgery is fairly high risk surgery so it is best to be certain that the surgery will be helpful prior to attempting it. Prostate enlargement can occur due to abscesses, benign prostate hypertrophy, prostatic cysts, peri-prostatic cysts (around but not in the prostate), prostatic adenocarcinoma ( cancer of the prostate itself) and transitional cell carcinoma (cancer of the urethral lining running through the prostate). The treatments for these conditions vary considerably.

Benign prostate hypertrophy is enlargement of the prostate that occurs with age. It is not cancer. It is very unusual in neutered dogs but pretty common in intact dogs. In your dog's case this diagnosis is not likely.

Prostatic cysts and abscesses are hard to tell apart. Ultrasound exam can helpful in differentiating these from prostate or transitional cell cancers, though.

There is no way that I know of to be sure which type of cancer is present, if cancer is present, without a biopsy. The prognosis and treatment of the cancers are somewhat different and it is best to identify which cancer is present in order to plan the appropriate treatment, so a biopsy is a good idea prior to surgery.

Prostatic adenocarcinomas are fairly malignant, so taking chest X-rays and X-rays of the spine and pelvis prior to surgery to rule out pre-existing metastatic cancer would be a good idea, too.

I know it adds an extra step, but biopsy prior to surgery is the best approach since it may help prevent an unnecessary surgical procedure.

Mike Richards, DVM 4/6/2000

Prostate problem and urination

Q: Dr. Mike: We took your advice and got a second opinion today. We gave the new vet all of the details, and he said he wanted to pass a catheter to make sure there were no stones. He also planned to take blood to compare to the previous blood test results. He took the dog to the back and within a few minutes he came out to us with a diagnosis and solution. He said that Wally's prostate was enlarged and releasing a gel type secretion that was making it difficult and almost impossible for Wally to urinate freely. He said that this inability to freely urinate caused Wally's bladder to become enormous. He said that the dripping urine was just overflow of the bladder. He used the catheter to empty Wally's bladder completely and the dog seemed quite relieved. The doctor's plan is to treat Wally with steroids which will make the prostate return to its normal size and will hopefully allow Wally to regain control of urination. The doctor warned that this may only be a temporary solution and that neutering would probably permanantly solve this problem. The doctor hospitalized Wally over the weekend so that he can empty his bladder as needed as we wait to see if the steroids will work. If not, we will go ahead and neuter him Monday. What are your thoughts of this diagnosis? Does is seem in order? Thanks again. We have really grown to value your opinion.

A: Your letters have pointed out one of the failings of providing this service online. If I was examining your dog, it would have occurred to me to suspect prostate disease. For some reason, I just assume pets are spayed or neutered and that is not a valid assumption!

Prostate problems could very well produce the symptoms you are seeing. My impression is that the enlargement of the prostate is responsible for the restriction in size of the urethra and that castration is the most sure method of resolving this problem as it almost always causes a shrinkage in the prostate size.

I appreciate your kind words but there is no substitute for a "hands on" examination in differentiating between the various urinary problems so please place more faith in what your vet is seeing than what I may say.

Mike Richards, DVM