Sunday, July 12, 2009

Your Prostate Gland

The prostate is an exocrine gland of the male reproductive system. Its main function is to store and secrete a clear fluid that constitutes up to one-third of the volume of semen.

  • A healthy prostate is slightly larger than a walnut.
  • It is situated in front of the rectum, just below the bladder where urine is stored, and surrounds the tube (urethra) that carries urine from the body.
  • The gland functions as part of the male reproductive system by producing the white fluid that contains semen.
  • The prostate also contains smooth muscle that helps expel semen during ejaculation; thus, prostate problems can lead to impotence.

The prostate gland has four distinct glandular regions:

1. The Peripheral Zone (PZ) - The sub-capsular portion of the posterior aspect of the prostate gland which surrounds the distal urethra and comprises up to 70% of the normal prostate gland in young men. It is from this portion of the gland that more than 70% of prostatic cancers originate.

2. The Central Zone (CZ) - This zone constitutes approximately 25% of the normal prostate gland and surrounds the ejaculatory ducts. Central zone tumors account for more than 25% of all prostate cancers.

3. The Transition Zone (TZ) - This zone is responsible for 5% of the prostate volume and very rarely is associated with carcinoma. The transition zone surrounds the proximal urethra and is the region of the prostate gland which grows throughout your lifetime. It is involved in benign prostatic enlargement.

4. The Anterior Fibro-muscular zone - This zone accounts for approximately 5% of the prostatic weight, is usually devoid of glandular components, and composed only, as its name suggests, of muscle and fibrous tissue.

Prostate Disorders
Three types of disorders can occur in the prostate gland: inflammation or infection (prostatitis), enlargement (benign prostatic hyperplasia - BPH), and cancer.

Normal Inflamed Enlarged

1) Prostatitis is a clinical term used to describe a wide spectrum of disorders ranging from bacterial infection to chronic pain syndromes. It is not contagious (generally not spread through sexual contact):

  • Acute Bacterial Prostatitis is the least common but easiest to diagnose and treat. It is caused by bacteria and comes suddenly with chills and fever, pain in the lower back and genital area, and burning or painful urination. Additional indications are excessive white blood cells and bacteria in the urine.
  • Chronic (Nonbacterial) Prostatitis (chronic pelvic pain syndrome) is the most common, but least understood, form of prostatitis. Found in men of any age from the late teens on, the symptoms go away and then return without warning, and may be inflammatory or non-inflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism, but do contain the kinds of cells the body usually produces to fight infection. In the non-inflammatory form, no evidence of inflammation, including infection-fighting cells, is present.
  • Asymptomatic Inflammatory Prostatitis is the diagnosis when there are no symptoms, but the patient has infection-fighting cells in the semen. It is often found when a doctor is looking for causes of infertility or is testing for prostate cancer.

2) BPH, or benign prostatic hyperplasia, is the second common problem that can occur in the prostate. "Benign" means "not cancerous" and "hyperplasia" means "too much growth." As men age, the prostate gland slowly enlarges. The gland tends to expand in an area that doesn't expand with it, causing pressure on the urethra, which can lead to urinary problems. The urge to urinate frequently, a weak urine flow, breaks in urine stream, and dribbling are all symptoms of an enlarged prostate. At its worst, BPH can lead to a weak bladder, bladder or kidney infections, complete blockage in the flow of urine, and kidney failure.

Since the prostate has propensity to grow once manhood is reached, BPH is the most common prostate problem for men older than 50. The American Urological Association assesses that by age 60, more than half of American men will have BPH. By age 70, almost all men have some prostate enlargement. By age 85, about 90 percent of men have BPH but only 30 percent will exhibit symptoms!

3) Prostate Cancer is one of the most common cancers in American men. There are no warning signs of symptoms of early prostate cancer. Once a malignant tumor causes the prostate gland to swell significantly, or once cancer spreads beyond the prostate, the following symptoms may be present:

  • A frequent need to urinate, especially at night
  • Difficulty starting or stopping the urinary stream
  • A weak or interrupted urinary stream
  • A painful or burning sensation during urination or ejaculation
  • Blood in urine or semen

Symptoms of advanced prostate cancer include:

  • Dull, incessant deep pain or stiffness in the pelvis, lower back, ribs or upper thighs; arthritic pain in the bones of those areas
  • Loss of weight and appetite
  • Fatigue
  • Nausea
  • Vomiting

There are 4 stages of Prostate Cancer:

  • T1 - Tumor is microscopic and confined to prostate but is undetectable by a digital rectal exam (DRE) or by ultrasound. Usually discovered by PSA tests or biopsies.
  • T2 - Tumor is confined to prostate and can be detected by DRE or ultrasound.
  • T3 / T4 - In stage T3, the cancer has spread to tissue adjacent to the prostate or to the seminal vesicles. In stage T4, tumors have spread to organs near the prostate, such as the bladder.
  • N+ / M+ - Cancer has spread to pelvic lymph nodes (N+) or to lymph nodes, organs, or bones distant from the prostate (M+).
Prostate cancer is the most common cancer, other than skin cancers, in American men. It is the second leading cause of cancer death in American men, behind only lung cancer, and accounts for 9% of cancer-related deaths in men. The American Cancer Society estimates that during 2009, about 192,000 new cases of prostate cancer will be diagnosed in the United States. 30% of prostate cancers occur in men under age 65. About 1 man in 6 will be diagnosed with prostate cancer during his lifetime, but only 1 man in 35 will die of it. More than 2 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.

Prostate Disorder Symptoms
Different prostate problems sometimes have similar symptoms. For example, one man with prostatitis and another with BPH may both have a frequent, urgent need to urinate. A man with BPH may have trouble beginning a stream of urine; another may have to urinate frequently at night. Or, a man in the early stages of prostate cancer may have no symptoms at all.

Common symptoms of prostate disorders are:

  • Sensation of not emptying your bladder completely after you have finished urinating.
  • Frequent urination (consistently in intervals of less than 2 hours and / or multiple times during the night).
  • Interrupted urination (you have to stop and start several times during urination).
  • Difficulty in postponing urination.
  • Weak or limited urinary stream.
  • Pushing and straining required to begin urination.
  • A burning pain during urination.
  • Pain in lower back, in the area between the testicles and anus, in the lower belly or upper thighs, or above the pubic area. Pain may be worse during bowel movement.
  • Reduced ability to gain and hold erections, weak ejaculation, and dissatisfaction with sexual performance.
  • Some pain during or after ejaculation.
  • Pain in the tip of your penis.
  • Fever and chills.
  • Loss of appetite.

One prostate problem does not lead to another. For example, having prostatitis or an enlarged prostate does not increase the chance for prostate cancer. It is true that some men with prostate cancer also have BPH, but the two conditions are not automatically linked. Most men with BPH do not develop prostate cancer. But because the early symptoms for both conditions could be the same, a doctor would need to evaluate them. It is also possible to have more than one condition at a time. This confusing array of potential scenarios makes a case for all men, especially after age 45, to have a thorough medical exam that includes the PSA test and DRE every year.

Diagnostic Tests
The PSA blood test determines whether you have cancer of the prostate. The test measures how much of a protein essential to human reproduction, PSA (prostate-specific antigen), is in your blood. PSA turns your gelatinous pre-semen into a liquid, thus supporting ejaculation. If your PSA is below 4, most doctors agree that you needn't be tested again for a year. During annual tests, remember that it is normal for your reading to go up by a few tenths of a point every year. In general, only a drastic increase in PSA (an increase of at least 0.75 points or 20 percent) is considered a reason to worry. This test is recommended on an annual basis for all men over 50 (and for men above 45 if there is a family history of prostate problems).

A digital rectal examination (DRE) is a quick and safe screening technique in which a doctor inserts a gloved, lubricated finger into the rectum to feel the size and shape of the prostate. The prostate should feel soft, smooth, and even. The doctor checks for lumps or hard, irregular areas of the prostate that may indicate the presence of prostate cancer. The entire prostate cannot be felt during a DRE, but most of it can be examined, including the area where most prostate cancers are found.

Western Medicine
Western medicine relies on aggressive and costly prescription drugs and prohibitively-expensive surgery to deal with problems related to prostate and reproductive disorders. These methods generally address only the symptoms of prostate disorder and not the underlying causes. As soon as you stop using the drugs, the problem returns! And these prescription drugs often result in unwanted and even dangerous side effects.

While prostatitis caused by infection can be treated with antibiotics, there are no drugs for treating chronic pelvic pain syndrome. Its symptoms are treated with anti-inflammatory drugs and analgesics.

FDA-approved drugs only relieve the symptoms of BPH - they do not cure it. The 5 alpha-reductase inhibitors, Proscar (Finasteride) and Avodart (Dutasteride), work by blocking an enzyme that acts on the male hormone, testosterone, to boost organ growth. When the enzyme is blocked, growth slows down and the gland may shrink. This treatment may not produce a positive effect until after six to 12 months of treatment. It also works best for advanced cases of prostate enlargement.

Alpha-adrenergic receptor blockers, which work by blocking adrenergic nerve receptors in the lower urinary tract, basically help relax the smooth muscle of the prostate and bladder neck to relieve pressure and to improve urine flow. These drugs, which do not shrink the size of the prostate, include: Cardura (Doxazosin), Flomax (Tamsulosin), Hytrin (Terazosin), and Uroxatral (Alfuzosin). For many men, these alpha-blockers can improve urine flow and can reduce symptoms within days. But since the underlying cause is not addressed, symptoms will return once you stop using the drugs.

The combined side effects of Alpha-Blockers and 5-Alpha Reductase Inhibitors include breast tenderness and enlargement, decreased sex drive, difficulty getting an erection, dizziness, fainting, headache, heart failure, increased ejaculatory dysfunction, lightheadedness, nasal congestion, retrograde ejaculation (ejaculation back into the bladder), sudden drop in blood pressure, tiredness, and upper respiratory tract infection.

Surgical options include Transurethral Needle Ablation (TUNA), Transurethral Vaporization (TUVP), Laser Surgery, Transurethral Resection (TURP), Transurethral Incision (TUIP), and Open Prostatectomy. All of these procedures often require patients to wear a catheter for 3 to 4 days after surgery and carry some risk of incontinence, impotence, infection, and complications.

An alternative treatment that has become popular is saw palmetto which is used by millions of men in the United States to treat BPH. Saw palmetto, however, was recently found to have no effect in reducing the frequent urge to urinate or other annoying symptoms of an enlarged prostate. Published in the Feb. 9, 2006, New England Journal of Medicine, a yearlong study found that the plant extract was no more effective than inactive pills (placebos) in easing symptoms of BPH.

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