Prostate Gland and Its Diseases
What is the prostate gland?
The prostate gland is unique to the male gender. Anatomically, it is located in the pelvis just below the urinary bladder, surrounding a portion of the urethra. Normally, it weighs approximately 18-20 gramsand is composed of both glandular and fibromuscular tissue. The prostate gland contributes approximately 0.5 ml of seminal fluid to each ejaculate. Fluid from the prostate is rich in citric acid, zinc, and proteins such as prostate specific antigen (i.e., PSA).
What is prostatitis?
Prostatitis is essentially an inflammatory condition of the prostate gland tissue. In certain situations, it is secondary to a bacterial infection. Rarely, this infection may result in a systemic febrile illness requiring acute hospitalization (i.e., acute bacterial prostatitis). More commonly, there is a history of less severe, recurrent urinary tract infections (i.e., chronic bacterial prostatitis). Additionally, prostate inflammation may occur in the absence of a bacterial infection (i.e., chronic nonbacterial prostatitis).
Findings associated with prostatitis may include fever; pain in the lower back, suprapubic region, pelvis, and genitals; painful or difficult urination; blood in the urine; elevated prostate specific antigen; and infertility.
Treatment for this disease entity is based upon clinical findings. An evaluation may include urine and prostate fluid analyses and cultures; biopsy of prostate tissue; endoscopic evaluation of the prostate and bladder; and urinary flow studies. Some therapies involve dietary changes, antibiotics, anti-inflammatory agents, and muscle relaxants.
Benign Prostate Hyperplasia (a.k.a. BPH)
BPH is a process characterized by increased cell growth within the prostate gland. The growth is concentrated within the area of the prostate that surrounds the urethra (i.e., periurethral zone). BPH initially develops after age 40 years and then continues to progress with increasing age.
With increasing severity of the disease process the flow of urine from the bladder is impaired, resulting in difficulty with urination. When this occurs, lower urinary tract symptoms (LUTS) result. LUTS is characterized by frequent urination, waking during the night to urinate, a weakened urine stream, and poor bladder emptying. When LUTS becomes severe, bladder stones may form, infections may occur, and bladder as well as kidney function may be permanently impaired.
An evaluation for BPH can include responding to questionnaires, physical examination, urinalysis, blood tests (i.e., prostate specific antigen, creatinine), urinary flow studies, endoscopic evaluation of the prostate gland, and possible prostate biopsy.
The treatment for BPH is based upon the symptoms and severity of the disease. Sometimes, only observation is necessary with future intervention needed if symptoms worsen. However, when symptoms are bothersome, medications may be prescribed (i.e., alpha-adrenergic blockers, 5 alpha-reductase inhibitors). When medications fail to work, surgical options are available. These range from minimally invasive transurethral procedures (i.e., prostate resection, microwave therapy, thermal therapy, laser ablation of prostate tissue) to traditional open surgery with direct removal of prostate gland tissue. Other treatments may inclue indwelling bladder catheterization or intermittent bladder catheterization by a patient or care-giver.
Prostate cancer is the most common cancer diagnosed and the second most common cause of cancer-related death in men in the United States. African-American men have the highest incidence of prosate cancer in the U.S. No clear causative factor has been establshed for prostate cancer. However, it is know that there is a familial predisposition for the disease and approximately 10% of prostate cancers are inherited. Additionally, high dietary fat consumption may be associated with an increased risk for prostate cancer, but this has not been definitively proven.
The need for prostate cancer screening has been a debated issue among experts in the medical community. However, many will agree that screening and subsequent treatment when indicated has resulted in a decrease in prostate cancer mortality. Current screening tests include a digital rectal examination and prostate specific antigen (PSA) blood test. The age at which screening should begin is individualized to the patient and is based, in part, upon one’s own family medical history, ethnic race, other risk factors, and a patient’s own wishes. Various organizations, including the American Urological Association, provide guidelines for prostate cancer screening.
Most prostate cancer is classified as adenocarcinoma and is found in the peripheral regions of the gland. Tissue sampling of the prostate gland is the current definitive means for diagnosing cancer.
Once prostate cancer is diagnosed, additional tests may be necessary to assess for the spread of the cancer. These tests may include a nuclear bone scan, CT scan, MRI study, or laparoscopic lymph node sampling.
After the extent of the cancer has been defined, a decision regarding treatment is necessary. In some situations, treatment may not be necessary and an observation or active surveillance protocol can be initiated.
If treatment is recommended, there are options. The recommended treatment is based upon the extent of the disease, the probability of curing the cancer, and individual patient factors. Curative treatments include surgery, radiation through multiple modalities, cryotherapy, and others. The main consequences of treatments are difficulty with urine control (i.e., leakage of urine) and difficulty maintaining erections for sexual intercourse (i.e., erectile dysfunction). Surgical treatments include open surgery and robotic surgery. Radiation treatment modalities can include external beam radiotherapy and interstitial radiotherapy (brachytherapy). Androgen suppression or hormonal therapy is usually reserved for special circumstances or later when the disease progresses or advances.