In Greek the word “prostates” means “to stand before”. Anatomist Heropilus named it as such because the prostate stood before the testes, as he saw it. Now we know that it is a part of the male reproductive system.
The prostate is a small gland made up of about fifty smaller glands. At birth it is about the size of a pea and by the age of fifty years to the size of a walnut. It is surrounded by a fibrous capsule which does not allow it to grow to the exterior. Inward growth continues and constricts the urethra. Fortunately this is a slow process and manifests itself in later life. 50 % of men in their 60s are affected by this condition. However, 90% of men in their 70s and 80s are affected by benign hypertrophy of the prostate.
It is supplied by a branch of the internal iliac artery and venous return is by the iliac vein. The prostate gland contains many bundles of smooth muscles, about 50 small glands, each about the size of a pea in early childhood. In adulthood it becomes the size of a walnut. The prostate is a part of the male reproductive system and is located inferior to the bladder; it surrounds the initial part of the urethra and the ejaculatory duct.
The Location of the Prostate gland
The main function of the prostate gland is the production of a milky fluid which is said to energize the sperm and provide a medium for the sperm to swim, upon ejaculation. During ejaculation of semen, this milky fluid is discharged into the urethra. Sperm cells are equipped with the flagellum which allows them to swim, hopefully to the ova.
Frequency of Common Conditions of the Prostate gland.
One quarter of men over the age of 55 years are likely to have prostatic conditions.
Half of all men over the age of 70 are likely to have similar conditions.
It is recommended that every man aged 50 or more has his prostate examined each year.
For men with positive history annual check ups should begin at the age of 40 years.
Men who have their testes removed before puberty do not develop hypertrophy of the prostate. It is for this reason that BHP is said to be male sex hormone related.
Dihydrotestosterone (DHT) is testosterone derivative found in the prostate. Animals which lose the ability to produce DHT as they age do not develop BHP. However, these studies could not be replicated in human subjects. Older men continued to accumulate DHT in the prostate and it continued to develop BHP.
Prostatitis (Inflammation of the prostate) is the term used to describe inflammation of the prostate. It is sometimes caused by bacterial infections. In most cases prostatitis is due to idiopathic causes. Idiopathic prostatitis is difficult to manage because the pathophysiology is not clearly understood. However, when prostates is due to bacterial agents it can be managed easily because the antibiotics concentrate in the prostate gland.
Prevalence of Prostate cancer - Australia
Cancers of the prostate gland affect one out of eighteen Australian men. It is more common in the over 65 age group. The cause of prostate cancer is still unknown. However, around three thousand 3,000 men in Victoria are diagnosed each year to be suffering from ca of the prostate gland. Old age and a positive family history are definite contributing factors. The growth of Ca of the prostate is hormone related. Hence men with Ca of the prostate are often prescribed a female sex hormone called stilboestrol.
In the early stages of malignancy cancerous cells are located within the prostate gland. Hence early diagnosis is essential to cure and management. However, as the malignant cells proliferate the vascular and lymphatic systems, treatment and management become more difficult. Cure becomes impossible.
In the terminal stages death is usually due to metastasis which results in erosion of blood vessels, bones and muscles.
Pathophysiology of Prostate enlargement: Benign Prostatic Hyperplasia (BPH) is non-malignant hypertrophy of the prostate gland. It becomes more common as men get older. The urethral obstruction is a result of the squeezing action of the enlarged gland. Eventually the urethra fails to open when the bladder contracts for urination. The reasons for the enlargement are not clearly understood but a positive family history and
Signs and Symptoms of an Enlarged Prostrate:
- Inability to initiate stream.
- Going to the toilet at frequent intervals but voiding only small amounts each time.
- Acute retention of urine is seen. This may cause pain due to bladder distension.
- Hematuria may be present. The internal bleeding is due to excessive distension and damage of blood vessels.
- Inflammation of the urinary bladder is called cystitis. It is due to distension, irritation and low grade infections.
- Temporary relief is often obtained by inserting a foley catheter into the bladder. This should be done by a qualified practitioner using an aseptic technique.
- Chronic and ongoing retention is less common but may result in unsafe distension of the bladder which is often painless.
- Chronic retention can cause damage to the ureters, pelvis and kidney tissue.
- Damaged kidneys produce hypertension by increasing the production of angiotensin - a powerful vasoconstrictor.
