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Prostate Overview
The prostate gland, although the size of a walnut or a plum, holds significant importance in both male urinary system and reproductive system. The prostate lies in front of the rectum and below the bladder. This roughly conical or heart shaped gland is wider at the top and narrower at the bottom. A healthy prostate weighs about 30 grams. Prostate may tend to grow as men age (especially over the age of 40) and changes in the prostate size have been associated with urinary problems in men. The prostate gland plays
The prostate gland is typically divided into five lobes or zones, namely:
- Peripheral zone: This is the largest part of the prostate and surrounds the urethra. It is where most prostate cancers originate.
- Central zone: This part of the prostate surrounds the ejaculatory ducts and is located near the transition zone.
- Transition zone: The transition zone of the prostate encircles the urethra near the bladder. The transition zone is largely responsible for the prostate’s enlargement as men age. In some cases, this can lead to benign prostatic hyperplasia (BPH).
- Anterior Fibromuscular stroma: This part lies at the front of the prostate and contains mostly fibrous tissue.
- Posterior fibromuscular stroma: This part also consists of fibrous tissues but it lies at the back of the prostate.
What does the prostate do?
The prostate performs several crucial functions that influence male urinary and reproductive health. Some of the functions include:
- Producing seminal fluid:The prostate gland secretes a whitish gray fluid that makes up a significant portion (about 30%) of semen, aiding in the nourishment and transport of sperm during ejaculation. The part of the seminal fluid produced by the prostate contains various components, including:
- Enzymes such as Zinc and Citric acid which help to break down and liquefy the semen, making it easier for sperm to move and fertilize an egg. These enzymes also lubricate the urethra making it easier for urine or the ejaculate to move out of our body through the urethra.
- Fructose which provides energy for the sperm.
- Prostate-specific antigen (PSA): While not directly involved in reproduction, PSA levels are monitored for potential prostate problems such as prostate cancer.
- Supporting sperm viability:The fluid produced by the prostate gland helps protect and sustain sperm cells to increase the probability of the sperm successfully fertilizing an egg.
- Facilitating Ejaculation:During ejaculation, the prostate contracts, expelling prostatic fluid into the urethra. This fluid mixes with sperm and seminal vesicle fluid to form semen, which is then expelled from the body. This contraction also closes the opening between the bladder and urethra, preventing simultaneous urination and ejaculation under normal anatomical circumstances.
- Muscle Control During Urination:The prostate surrounds the urethra. Urethra is the narrow tube which helps transport urine from the bladder out of our body. The prostate muscles relax and contract to control the flow of urine, allowing for bladder emptying and preventing leakage.
- Hormone regulation:The prostate gland is sensitive to hormones such as testosterone and dihydrotestosterone (DHT). DHT influences the functioning and development of the prostate. These hormones help regulate prostate health and function throughout a man's life.
Prostate Disorders and Issues
Common issues with the prostate gland include:
Prostatitis:Prostatitis occurs when the prostate gland is inflammed. It is known to cause pelvic pain and discomfort, along with urinary symptoms like frequent or painful urination.
Benign Prostatic Hyperplasia (BPH): It is caused by theenlargement of the prostate gland. Urinary symptoms such as frequent urination, increased urge to urinate and a weak urine stream are common in men with BPH. Men over the age of 50 years are typically at a higher risk of developing Benign prostatic hyperplasia or BPH.
Prostate Cancer:Malignant cell growth in the prostate gland can lead to prostate cancer. Unfortunately, early stages of prostate cancer may not have tell-tale signs or present clear symptoms. However, as the disease progresses, signs and symptoms such as urinary difficulties, hematuria and erectile dysfunction may manifest.
Prostate Cysts:Cysts or fluid filled sacs that can form in the prostate gland. They are often asymptomatic but may cause pain or discomfort if they become large or infected.
Ejaculatory Disorders:Prostate issues or dysfunction can be linked to conditions such as premature ejaculation or retrograde ejaculation, where ejaculation occurs into the bladder instead of outward through the penis.
Prostate Stones and Prostate abscess are other common prostate disorders.
Symptoms of prostate problems
Symptoms of prostate issues can vary depending on the specific condition but common signs of prostate problems include:
- Frequent urination, especially at night (nocturia)
- Difficulty starting or maintaining urination
- Weak or interrupted urine flow
- Pain, burning sensation or discomfort during urination or ejaculation
- Blood in the urine or semen (dysuria)
- Erectile dysfunction
- Severe abdominal discomfort
- Pelvic pain or pressure
- Incontinence or leakage of urine
- Discomfort in the penis, testicles, or perineum, which is the region between the testicles and the rectum.
- Feeling a sudden and strong urge to urinate.
- Leakage or dribbling of urine during or after urination
If you experience one or more of the aforementioned prostate symptoms, please consult a urologist right away.
Common Tests Related to Prostate
Several medical tests are commonly used to assess the health of the prostate gland. Here are some common types of prostate tests:
Digital Rectal Examination or DRE:During a digital rectal exam, a urologist or physician evaluates your prostate gland for irregularities in size, texture or shape by inserting a gloved finger into the rectum. Abnormalities such as lumps or enlargement may indicate prostate issues such as prostate cancer.
Prostate-Specific Antigen (PSA) Test:This blood test measures the level of PSA, a protein produced by the prostate gland. Elevated PSA levels can indicate prostate enlargement, inflammation, infection or cancer. However, PSA levels could also be elevated due to other factors so further testing may be needed to confirm the exact cause.
Prostate Ultrasound:Prostate ultrasound, also known as transrectal ultrasound or TRUS, utilizes sound waves to generate images of the prostate gland, aiding in the evaluation of its size, and internal structure. It is often used alongside other prostate tests such as biopsies to diagnose prostate conditions.
Prostate Biopsy:During a prostate biopsy, small samples of prostate tissue are collected using a needle. The needle is usually inserted through the rectum with the guidance of ultrasound imaging. The sample tissues acquired through biopsies are sent for further microscopic analysis to screen for cancer or other irregularities.
Prostate MRI:Magnetic resonance imaging (MRI) scans can provide detailed images of the prostate gland, helping to detect abnormalities such as tumors. MRI may be used in conjunction with other tests to screen for prostate cancer or to guide biopsies.
PCA3 or Prostate Cancer Antigen 3:This molecular test is used to assess the risk of prostate cancer in men who have had a negative biopsy previously or are suspected of having prostate cancer based on other factors, such as elevated PSA levels or abnormal digital rectal examination (DRE) findings.
Bone Scan:A bone scan is typically performed in patients who have recently been diagnosed with prostate cancer to determine if the cancer has spread (metastasized) to the bones. Prostate cancer commonly metastasizes to the bones, particularly the pelvis, spine, ribs, and long bones of the arms and legs. Detecting bone metastases is crucial for accurate staging of the cancer and treatment planning.
Positron Emission Tomography Computed Tomography (PET-CT):PET CT scans are becoming more prevalent in the diagnosis, staging and treatment of prostate cancer. PET CT involves the injection of a radioactive tracer, typically fluorodeoxyglucose (FDG) or more commonly for prostate cancer, prostate-specific membrane antigen (PSMA) radiotracers such as 68Ga-PSMA-11 or 18F-DCFPyL. PSMA is a protein highly expressed on the surface of prostate cancer cells, allowing for highly specific detection of prostate cancer lesions.
Uroflowmetry:This test measures the rate and pattern of urine flow during urination. It can help evaluate urinary symptoms related to prostate enlargement (BPH) and assess the effectiveness of treatment.
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Frequently Asked Questions
1. What factors increase the risk of developing prostate problems?
Ans - Risk factors for prostate issues include (but aren’t limited to):
- age: increases with age (especially after the age of 50)
- Dietary choices: High-fat diet and consuming a lot of red meat diet could potentially increase the risk of developing prostate issues
- Physical inactivity and obesity: May slightly increase risk of prostate cancer.
- Family history of prostate problems in the immediate blood relatives increases the risk of developing prostate issues.
- Certain genetic mutations can elevate the risk of developing prostate issues. For example, BRCA1/2 is associated with the increased risk of developing prostate cancer.
- Men of a certain ethnicity or race (eg: african american men) could be at an increased risk of developing prostate related issues.
2. How often should men have regular check-ups for prostate health?
Ans - Generally, regular check-ups for prostate health including prostate-specific antigen (PSA) tests are recommended for men over the age of 45 and even earlier for those at higher risk or with symptoms. Please consult your urologist to determine a screening schedule based on individual risk factors and your health.
3. What is the Prostate gland and what does it do?
Ans - Positioned beneath the bladder in men, the prostate gland is a small walnut sized organ responsible for synthesizing seminal fluid, crucial for nourishing and conveying sperm during ejaculation. The prostate gland encircles the urethra which facilitates the passage of urine and semen out of the body.
4. What is the role of genetics in Prostate health?
Ans - Genetics play a significant role in prostate health. Certain genetic mutations and abnormalities such as BRCA1/2 are known to increase the risk of prostate cancer and other prostate issues. Family history of prostate issues such as benign prostatic hyperplasia (BPH) or Prostate cancer can also increase an individual's potential risk of developing these issues. Men with a known family history of prostate issues should consult a doctor for personalized advice regarding prostate health and screening.