Prostate
Encyclopedia
The prostate is a compound tubuloalveolar exocrine gland
of the male reproductive system
in most mammal
s.
In 2002, female paraurethral glands, or Skene's gland
s, were officially renamed the female prostate by the Federative International Committee on Anatomical Terminology.
The prostate differs considerably among species anatomically
, chemically, and physiologically
.
along with spermatozoa
and seminal vesicle
fluid. The alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The alkalinization of semen is primarily accomplished through secretion from the seminal vesicles. The prostatic fluid is expelled in the first ejaculate fractions, together with most of the spermatozoa. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid, those expelled in prostatic fluid have better motility
, longer survival and better protection of the genetic material (DNA).
The prostate also contains some smooth muscles that help expel semen during ejaculation
.
.
In human prostatic secretions, the protein content is less than 1% and includes proteolytic enzymes, prostatic acid phosphatase
, and prostate-specific antigen. The secretions also contain zinc
with a concentration 500–1,000 times the concentration in blood.
s), which are responsible for male sex
characteristics.
The main male hormone is testosterone
, which is produced mainly by the testicle
s. Some male hormones are produced in small amounts by the adrenal gland
s. However, it is dihydrotestosterone
that regulates the prostate.
(endodermal origin). Endodermal outgrowths arise from the prostatic part of the urethra and grow into the surrounding mesenchyme
. The glandular epithelium of the prostate differentiates from these endodermal cells, and the associated mesenchyme differentiates into the dense stroma
and the smooth muscle of the prostate. The prostate glands represent the modified wall of the proximal portion of the male urethra and arises by the 9th week of embryonic life in the development of the reproductive system
. Condensation of mesenchyme
, urethra
and Wolffian duct
s gives rise to the adult prostate gland, a composite organ made up of several glandular and non-glandular components tightly fused.
, also known as the paraurethral gland, found in females, is homologous
to the prostate gland in males. However, anatomically, the uterus
is in the same position as the prostate gland. In 2002 the Skene's gland was officially renamed the prostate by the Federative International Committee on Anatomical Terminology.
The female prostate, like the male prostate, secretes PSA
and levels of this antigen rise in the presence of carcinoma of the gland. The gland also expels fluid, like the male prostate, during orgasm
.
prostate is classically said to be slightly larger than a walnut
. In actuality, it is approximately the size of a kiwifruit
. The mean weight of the "normal" prostate in adult males is about 11 grams, usually ranging between 7 and 16 grams. It surrounds the urethra
just below the urinary bladder
and can be felt during a rectal exam. It is the only exocrine organ located in the midline in humans and similar animals.
The secretory epithelium is mainly pseudostratified, comprising tall columnar cells and basal cells which are supported by a fibroelastic stroma containing randomly orientated smooth muscle bundles. The epithelium is highly variable and areas of low cuboidal or squamous epithelium are also present, with transitional epithelium in the distal regions of the longer ducts.
Within the prostate, the urethra coming from the bladder is called the prostatic urethra
and merges with the two ejaculatory duct
s.
The prostate does not have a capsule, rather an integral fibromuscular band surrounds it. It is sheathed in the muscles of the pelvic floor, which contract during the ejaculatory process.
The prostate can be divided in two ways: by zone, or by lobe.
. The idea of "zones" was first proposed by McNeal in 1968. McNeal found that the relatively homogeneous cut surface of an adult prostate in no way resembled "lobes" and thus led to the description of "zones."
The prostate gland has four distinct glandular regions, two of which arise from different segments of the prostatic urethra:
The "lobe" classification is more often used in anatomy.
is inflammation
of the prostate gland. There are primarily four different forms of prostatitis, each with different causes and outcomes. Two relatively uncommon forms, acute prostatitis and chronic bacterial prostatitis, are treated with antibiotic
s (category I and II, respectively). Chronic non-bacterial prostatitis or male chronic pelvic pain syndrome (category III), which comprises about 95% of prostatitis diagnoses, is treated by a large variety of modalities including alpha blockers, phytotherapy
, physical therapy
, psychotherapy
, antihistamine
s, anxiolytic
s, nerve modulators, surgery
, and more. More recently, a combination of trigger point
and psychological therapy has proved effective for category III prostatitis as well. Category IV prostatitis, relatively uncommon in the general population, is a type of leukocytosis
.
(BPH) occurs in older men; the prostate often enlarges to the point where urination becomes difficult. Symptoms include needing to urinate
often (frequency) or taking a while to get started (hesitancy). If the prostate grows too large, it may constrict the urethra and impede the flow of urine, making urination difficult and painful and, in extreme cases, completely impossible.
BPH can be treated with medication, a minimally invasive procedure
or, in extreme cases, surgery that removes the prostate. Minimally invasive procedures include transurethral needle ablation of the prostate
(TUNA) and transurethral microwave thermotherapy
(TUMT). These outpatient procedures may be followed by the insertion of a temporary prostatic stent
, to allow normal voluntary urination, without exacerbating irritative symptoms.
The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. TURP results in the removal of mostly transitional zone tissue in a patient with BPH. Older men often have corpora amylacea (amyloid
), dense accumulations of calcified proteinaceous material, in the ducts of their prostates. The corpora amylacea may obstruct the lumens of the prostatic ducts, and may underlie some cases of BPH.
Urinary frequency due to bladder spasm, common in older men, may be confused with prostatic hyperplasia.
Statistical observations
suggest that a diet low in fat and red meat
and high in protein
and vegetables, as well as regular alcohol consumption
, could protect against BPH.
is one of the most common cancer
s affecting older men in developed countries and a significant cause of death
for elderly men (estimated by some specialists at 3%). Despite this, the American Cancer Society's position regarding early detection is "Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment. Starting at age 50, (45 if African American or brother or father suffered from condition before age 65) talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you."
If checks are performed, they can be in the form of a physical rectal exam, measurement of prostate specific antigen
(PSA) level in the blood, or checking for the presence of the protein Engrailed-2
(EN2) in the urine.
Co-researchers Hardev Pandha and Richard Morgan published their findings regarding checking for EN2
in urine in the 1 March 2011 issue of the journal Clinical Cancer Research
. A laboratory test currently identifies EN2 in urine, and a home test kit is envisioned similar to a home pregnancy test strip. According to Morgan, "We are preparing several large studies in the UK and in the US and although the EN2 test is not yet available, several companies have expressed interest in taking it forward."
, sperm is transmitted from the ductus deferens into the male urethra via the ejaculatory ducts, which lie within the prostate gland.
It is possible for men to achieve orgasm solely through stimulation of the prostate gland, such as prostate massage or receptive anal intercourse
.
and an increased risk of prostate cancer. Reported studies of 48,000 and 29,000 men who had vasectomies showed 66 percent and 56 percent higher rates of prostate cancer, respectively. The risk increased with age and the number of years since the vasectomy was performed.
However, in March of the same year, the National Institute of Child Health and Human Development held a conference cosponsored by the National Cancer Institute and others to review the available data and information on the link between prostate cancer and vasectomies. It was determined that an association between the two was very weak at best, and even if having a vasectomy increased one's risk, the risk was relatively small.
In 1997, the NCI held a conference with the prostate cancer Progressive Review Group (a committee of scientists, medical personnel, and others). Their final report, published in 1998 stated that evidence that vasectomies help to develop prostate cancer was weak at best.
. Stents can be temporary or permanent. They are inserted into the urethra. This is mostly done on an outpatient basis under local or spinal anesthesia and takes about 30 minutes.
Glossary
Exocrine gland
Exocrine glands are a type of ductal glands that secrete their products into ducts that lead directly into the external environment...
of the male reproductive system
Reproductive system
The reproductive system or genital system is a system of organs within an organism which work together for the purpose of reproduction. Many non-living substances such as fluids, hormones, and pheromones are also important accessories to the reproductive system. Unlike most organ systems, the sexes...
in most mammal
Mammal
Mammals are members of a class of air-breathing vertebrate animals characterised by the possession of endothermy, hair, three middle ear bones, and mammary glands functional in mothers with young...
s.
In 2002, female paraurethral glands, or Skene's gland
Skene's gland
In human anatomy , the Skene's glands are glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening and may be near or a part of the G-Spot...
s, were officially renamed the female prostate by the Federative International Committee on Anatomical Terminology.
The prostate differs considerably among species anatomically
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
, chemically, and physiologically
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
.
Function
The function of the prostate is to secrete a slightly alkaline fluid, milky or white in appearance, that usually constitutes 20–30% of the volume of the semenSemen
Semen is an organic fluid, also known as seminal fluid, that may contain spermatozoa. It is secreted by the gonads and other sexual organs of male or hermaphroditic animals and can fertilize female ova...
along with spermatozoa
Spermatozoon
A spermatozoon is a motile sperm cell, or moving form of the haploid cell that is the male gamete. A spermatozoon joins an ovum to form a zygote...
and seminal vesicle
Seminal vesicle
The seminal vesicles or vesicular glands are a pair of simple tubular glands posteroinferior to the urinary bladder of male mammals...
fluid. The alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The alkalinization of semen is primarily accomplished through secretion from the seminal vesicles. The prostatic fluid is expelled in the first ejaculate fractions, together with most of the spermatozoa. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid, those expelled in prostatic fluid have better motility
Motility
Motility is a biological term which refers to the ability to move spontaneously and actively, consuming energy in the process. Most animals are motile but the term applies to single-celled and simple multicellular organisms, as well as to some mechanisms of fluid flow in multicellular organs, in...
, longer survival and better protection of the genetic material (DNA).
The prostate also contains some smooth muscles that help expel semen during ejaculation
Ejaculation
Ejaculation is the ejecting of semen from the male reproductory tract, and is usually accompanied by orgasm. It is usually the final stage and natural objective of male sexual stimulation, and an essential component of natural conception. In rare cases ejaculation occurs because of prostatic disease...
.
Secretions
Prostatic secretions vary among species. They are generally composed of simple sugars and are often slightly alkalineBase (chemistry)
For the term in genetics, see base A base in chemistry is a substance that can accept hydrogen ions or more generally, donate electron pairs. A soluble base is referred to as an alkali if it contains and releases hydroxide ions quantitatively...
.
In human prostatic secretions, the protein content is less than 1% and includes proteolytic enzymes, prostatic acid phosphatase
Prostatic acid phosphatase
Prostatic acid phosphatase , also prostatic specific acid phosphatase , is an enzyme produced by the prostate. It may be found in increased amounts in men who have prostate cancer or other diseases....
, and prostate-specific antigen. The secretions also contain zinc
Zinc
Zinc , or spelter , is a metallic chemical element; it has the symbol Zn and atomic number 30. It is the first element in group 12 of the periodic table. Zinc is, in some respects, chemically similar to magnesium, because its ion is of similar size and its only common oxidation state is +2...
with a concentration 500–1,000 times the concentration in blood.
Regulation
To work properly, the prostate needs male hormones (androgenAndrogen
Androgen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors...
s), which are responsible for male sex
Sex
In biology, sex is a process of combining and mixing genetic traits, often resulting in the specialization of organisms into a male or female variety . Sexual reproduction involves combining specialized cells to form offspring that inherit traits from both parents...
characteristics.
The main male hormone is testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
, which is produced mainly by the testicle
Testicle
The testicle is the male gonad in animals. Like the ovaries to which they are homologous, testes are components of both the reproductive system and the endocrine system...
s. Some male hormones are produced in small amounts by the adrenal gland
Adrenal gland
In mammals, the adrenal glands are endocrine glands that sit atop the kidneys; in humans, the right suprarenal gland is triangular shaped, while the left suprarenal gland is semilunar shaped...
s. However, it is dihydrotestosterone
Dihydrotestosterone
Dihydrotestosterone is an androgen or male sex hormone. The enzyme 5α-reductase synthesises DHT in the prostate, testes, hair follicles, and adrenal glands...
that regulates the prostate.
Development
The prostatic part of the urethra develops from the pelvic (middle) part of the urogenital sinusUrogenital sinus
The definitive urogenital sinus is a part of the human body only present in the development of the urinary and reproductive organs...
(endodermal origin). Endodermal outgrowths arise from the prostatic part of the urethra and grow into the surrounding mesenchyme
Mesenchyme
Mesenchyme, or mesenchymal connective tissue, is a type of undifferentiated loose connective tissue that is derived mostly from mesoderm, although some are derived from other germ layers; e.g. some mesenchyme is derived from neural crest cells and thus originates from the ectoderm...
. The glandular epithelium of the prostate differentiates from these endodermal cells, and the associated mesenchyme differentiates into the dense stroma
Stroma (animal tissue)
In animal tissue, stroma refers to the connective, supportive framework of a biological cell, tissue, or organ.The stroma in animal tissue is contrasted with the parenchyma.Examples include:* Stroma of iris...
and the smooth muscle of the prostate. The prostate glands represent the modified wall of the proximal portion of the male urethra and arises by the 9th week of embryonic life in the development of the reproductive system
Development of the reproductive system
The development of the reproductive system is a part of prenatal development, and concerns the sex organs. It is a part of the stages of sexual differentiation...
. Condensation of mesenchyme
Mesenchyme
Mesenchyme, or mesenchymal connective tissue, is a type of undifferentiated loose connective tissue that is derived mostly from mesoderm, although some are derived from other germ layers; e.g. some mesenchyme is derived from neural crest cells and thus originates from the ectoderm...
, urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
and Wolffian duct
Wolffian duct
The mesonephric duct is a paired organ found in mammals including humans during embryogenesis....
s gives rise to the adult prostate gland, a composite organ made up of several glandular and non-glandular components tightly fused.
Female prostate gland
The Skene's glandSkene's gland
In human anatomy , the Skene's glands are glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening and may be near or a part of the G-Spot...
, also known as the paraurethral gland, found in females, is homologous
Homology (biology)
Homology forms the basis of organization for comparative biology. In 1843, Richard Owen defined homology as "the same organ in different animals under every variety of form and function". Organs as different as a bat's wing, a seal's flipper, a cat's paw and a human hand have a common underlying...
to the prostate gland in males. However, anatomically, the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
is in the same position as the prostate gland. In 2002 the Skene's gland was officially renamed the prostate by the Federative International Committee on Anatomical Terminology.
The female prostate, like the male prostate, secretes PSA
Prostate specific antigen
Prostate-specific antigen also known as gamma-seminoprotein or kallikrein-3 is a glycoprotein that in humans is encoded by the KLK3 gene. KLK3 is a member of the kallikrein-related peptidase family that are secreted by the epithelial cells of the prostate gland...
and levels of this antigen rise in the presence of carcinoma of the gland. The gland also expels fluid, like the male prostate, during orgasm
Orgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
.
Structure
A healthy humanHuman
Humans are the only living species in the Homo genus...
prostate is classically said to be slightly larger than a walnut
Walnut
Juglans is a plant genus of the family Juglandaceae, the seeds of which are known as walnuts. They are deciduous trees, 10–40 meters tall , with pinnate leaves 200–900 millimetres long , with 5–25 leaflets; the shoots have chambered pith, a character shared with the wingnuts , but not the hickories...
. In actuality, it is approximately the size of a kiwifruit
Kiwifruit
The kiwifruit, often shortened to kiwi in many parts of the world, is the edible berry of a cultivar group of the woody vine Actinidia deliciosa and hybrids between this and other species in the genus Actinidia....
. The mean weight of the "normal" prostate in adult males is about 11 grams, usually ranging between 7 and 16 grams. It surrounds the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
just below the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
and can be felt during a rectal exam. It is the only exocrine organ located in the midline in humans and similar animals.
The secretory epithelium is mainly pseudostratified, comprising tall columnar cells and basal cells which are supported by a fibroelastic stroma containing randomly orientated smooth muscle bundles. The epithelium is highly variable and areas of low cuboidal or squamous epithelium are also present, with transitional epithelium in the distal regions of the longer ducts.
Within the prostate, the urethra coming from the bladder is called the prostatic urethra
Prostatic urethra
The prostatic urethra, the widest and most dilatable part of the urethra canal, is about 3 cm. long.It runs almost vertically through the prostate from its base to its apex, lying nearer its anterior than its posterior surface; the form of the canal is spindle-shaped, being wider in the middle...
and merges with the two ejaculatory duct
Ejaculatory duct
-Anatomy:The ejaculatory ducts are paired structures in male anatomy. Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle. They pass through the prostate, and open into the urethra at the Colliculus seminalis...
s.
The prostate does not have a capsule, rather an integral fibromuscular band surrounds it. It is sheathed in the muscles of the pelvic floor, which contract during the ejaculatory process.
The prostate can be divided in two ways: by zone, or by lobe.
Zones
The "zone" classification is more often used in pathologyPathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
. The idea of "zones" was first proposed by McNeal in 1968. McNeal found that the relatively homogeneous cut surface of an adult prostate in no way resembled "lobes" and thus led to the description of "zones."
The prostate gland has four distinct glandular regions, two of which arise from different segments of the prostatic urethra:
| Name | Fraction of gland | Description >- | Peripheral zone (PZ) |
Up to 70% in young men | urethra Urethra In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine... . It is from this portion of the gland that ~70–80% of prostatic cancers originate. >- | Central zone (CZ) |
Approximately 25% normally | >- | 5% at puberty | >- | Approximately 5% | This zone is usually devoid of glandular components, and composed only, as its name suggests, of muscle Muscle Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to... and fibrous tissue. |
Lobes
| Anterior lobe (or isthmus) | >- | >- | >- | roughly corresponds to part of central zone |
Prostatitis
ProstatitisProstatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
is inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
of the prostate gland. There are primarily four different forms of prostatitis, each with different causes and outcomes. Two relatively uncommon forms, acute prostatitis and chronic bacterial prostatitis, are treated with antibiotic
Antibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s (category I and II, respectively). Chronic non-bacterial prostatitis or male chronic pelvic pain syndrome (category III), which comprises about 95% of prostatitis diagnoses, is treated by a large variety of modalities including alpha blockers, phytotherapy
Phytotherapy
Phytotherapy is the study of the use of extracts from natural origin as medicines or health-promoting agents.Traditional phytotherapy is often used as synonym for herbalism and regarded as "alternative medicine" by much of Western medicine, although effects of many substances found in plants have...
, physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
, psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, antihistamine
Antihistamine
An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
s, anxiolytic
Anxiolytic
An anxiolytic is a drug used for the treatment of anxiety, and its related psychological and physical symptoms...
s, nerve modulators, surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, and more. More recently, a combination of trigger point
Trigger point
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...
and psychological therapy has proved effective for category III prostatitis as well. Category IV prostatitis, relatively uncommon in the general population, is a type of leukocytosis
Leukocytosis
Leukocytosis is a raised white blood cell count above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection, and is observed in certain parasitic infections...
.
Benign prostatic hyperplasia
Benign prostatic hyperplasiaBenign prostatic hyperplasia
Benign prostatic hyperplasia also known as benign prostatic hypertrophy , benign enlargement of the prostate , and adenofibromyomatous hyperplasia, refers to the increase in size of the prostate....
(BPH) occurs in older men; the prostate often enlarges to the point where urination becomes difficult. Symptoms include needing to urinate
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
often (frequency) or taking a while to get started (hesitancy). If the prostate grows too large, it may constrict the urethra and impede the flow of urine, making urination difficult and painful and, in extreme cases, completely impossible.
BPH can be treated with medication, a minimally invasive procedure
Minimally invasive procedure
There are three main categories which describe the invasiveness of surgical procedures. These are: non-invasive procedures, minimally invasive procedures, and invasive procedures ....
or, in extreme cases, surgery that removes the prostate. Minimally invasive procedures include transurethral needle ablation of the prostate
Transurethral needle ablation of the prostate
Transurethral needle ablation is a technique that uses low energy radio frequency energy delivered through two needles to ablate excess prostate tissue. It can be done with a local anesthetic on an outpatient basis...
(TUNA) and transurethral microwave thermotherapy
Transurethral microwave thermotherapy
Transurethral microwave thermotherapy is one of a number of effective and safe procedures used in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia . TUMT provides a one-time efficacious treatment of LUTS due to BPH...
(TUMT). These outpatient procedures may be followed by the insertion of a temporary prostatic stent
Prostatic stent
A prostatic stent is a stent used to keep open the male urethra and allow the passing of urine in cases of prostatic obstruction and lower urinary tract symptoms . Prostatic obstruction is a common condition with a variety of etiologies...
, to allow normal voluntary urination, without exacerbating irritative symptoms.
The surgery most often used in such cases is called transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. TURP results in the removal of mostly transitional zone tissue in a patient with BPH. Older men often have corpora amylacea (amyloid
Amyloid
Amyloids are insoluble fibrous protein aggregates sharing specific structural traits. Abnormal accumulation of amyloid in organs may lead to amyloidosis, and may play a role in various neurodegenerative diseases.-Definition:...
), dense accumulations of calcified proteinaceous material, in the ducts of their prostates. The corpora amylacea may obstruct the lumens of the prostatic ducts, and may underlie some cases of BPH.
Urinary frequency due to bladder spasm, common in older men, may be confused with prostatic hyperplasia.
Statistical observations
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
suggest that a diet low in fat and red meat
Red meat
Red meat in traditional culinary terminology is meat which is red when raw and not white when cooked. In the nutritional sciences, red meat includes all mammal meat. Red meat includes the meat of most adult mammals and some fowl ....
and high in protein
Protein
Proteins are biochemical compounds consisting of one or more polypeptides typically folded into a globular or fibrous form, facilitating a biological function. A polypeptide is a single linear polymer chain of amino acids bonded together by peptide bonds between the carboxyl and amino groups of...
and vegetables, as well as regular alcohol consumption
Alcohol consumption
Alcohol consumption may refer to:* Alcohol consumption by youth in the United States* Alcoholic beverage* Legal drinking age* List of countries by alcohol consumption* Long-term effects of alcohol* Short-term effects of alcohol...
, could protect against BPH.
Prostate cancer
Prostate cancerProstate cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. Most prostate cancers are slow growing; however, there are cases of aggressive prostate cancers. The cancer cells may metastasize from the prostate to other parts of the body, particularly...
is one of the most common cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
s affecting older men in developed countries and a significant cause of death
Death
Death is the permanent termination of the biological functions that sustain a living organism. Phenomena which commonly bring about death include old age, predation, malnutrition, disease, and accidents or trauma resulting in terminal injury....
for elderly men (estimated by some specialists at 3%). Despite this, the American Cancer Society's position regarding early detection is "Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. The American Cancer Society believes that men should not be tested without learning about what we know and don’t know about the risks and possible benefits of testing and treatment. Starting at age 50, (45 if African American or brother or father suffered from condition before age 65) talk to your doctor about the pros and cons of testing so you can decide if testing is the right choice for you."
If checks are performed, they can be in the form of a physical rectal exam, measurement of prostate specific antigen
Prostate specific antigen
Prostate-specific antigen also known as gamma-seminoprotein or kallikrein-3 is a glycoprotein that in humans is encoded by the KLK3 gene. KLK3 is a member of the kallikrein-related peptidase family that are secreted by the epithelial cells of the prostate gland...
(PSA) level in the blood, or checking for the presence of the protein Engrailed-2
EN2 (gene)
Homeobox protein engrailed-2 is a protein that in humans is encoded by the EN2 gene.-In cancer diagnosis:A promising method of diagnosing prostate cancer is to detect EN2 in urine...
(EN2) in the urine.
Co-researchers Hardev Pandha and Richard Morgan published their findings regarding checking for EN2
EN2 (gene)
Homeobox protein engrailed-2 is a protein that in humans is encoded by the EN2 gene.-In cancer diagnosis:A promising method of diagnosing prostate cancer is to detect EN2 in urine...
in urine in the 1 March 2011 issue of the journal Clinical Cancer Research
Clinical Cancer Research
Clinical Cancer Research is a peer-reviewed medical journal on clinical oncology published by the American Association for Cancer Research.-History of the journal:...
. A laboratory test currently identifies EN2 in urine, and a home test kit is envisioned similar to a home pregnancy test strip. According to Morgan, "We are preparing several large studies in the UK and in the US and although the EN2 test is not yet available, several companies have expressed interest in taking it forward."
Male sexual response
During male orgasmOrgasm
Orgasm is the peak of the plateau phase of the sexual response cycle, characterized by an intense sensation of pleasure...
, sperm is transmitted from the ductus deferens into the male urethra via the ejaculatory ducts, which lie within the prostate gland.
It is possible for men to achieve orgasm solely through stimulation of the prostate gland, such as prostate massage or receptive anal intercourse
Anal sex
Anal sex is the sex act in which the penis is inserted into the anus of a sexual partner. The term can also include other sexual acts involving the anus, including pegging, anilingus , fingering, and object insertion.Common misconception describes anal sex as practiced almost exclusively by gay men...
.
Vasectomy and risk of prostate cancer
In 1993, the Journal of the American Medical Association revealed a connection between vasectomyVasectomy
Vasectomy is a surgical procedure for male sterilization and/or permanent birth control. During the procedure, the vasa deferentia of a man are severed, and then tied/sealed in a manner such to prevent sperm from entering into the seminal stream...
and an increased risk of prostate cancer. Reported studies of 48,000 and 29,000 men who had vasectomies showed 66 percent and 56 percent higher rates of prostate cancer, respectively. The risk increased with age and the number of years since the vasectomy was performed.
However, in March of the same year, the National Institute of Child Health and Human Development held a conference cosponsored by the National Cancer Institute and others to review the available data and information on the link between prostate cancer and vasectomies. It was determined that an association between the two was very weak at best, and even if having a vasectomy increased one's risk, the risk was relatively small.
In 1997, the NCI held a conference with the prostate cancer Progressive Review Group (a committee of scientists, medical personnel, and others). Their final report, published in 1998 stated that evidence that vasectomies help to develop prostate cancer was weak at best.
Unclogging a prostate
A surgeon can unclog a blocked prostate by inserting an artificial 'tube' called a stentStent
In the technical vocabulary of medicine, a stent is an artificial 'tube' inserted into a natural passage/conduit in the body to prevent, or counteract, a disease-induced, localized flow constriction. The term may also refer to a tube used to temporarily hold such a natural conduit open to allow...
. Stents can be temporary or permanent. They are inserted into the urethra. This is mostly done on an outpatient basis under local or spinal anesthesia and takes about 30 minutes.
Additional images
See also
- Skene's glandSkene's glandIn human anatomy , the Skene's glands are glands located on the anterior wall of the vagina, around the lower end of the urethra. They drain into the urethra and near the urethral opening and may be near or a part of the G-Spot...
- Prostate massageProstate massageProstate massage is the massage or stimulation of the male prostate gland for sexual stimulation or medical purposes.The prostate takes part in the sexual response cycle, and is essential for ejaculation...
- Corpora amylaceaCorpora amylaceaCorpora amylacea, also known as prostatic concretions, are small hyaline masses of unknown significance found in the prostate gland, neuroglia, and pulmonary alveoli. They are derived from degenerate cells or thickened secretions and occur more frequently with advancing age...
Glossary