Prostate

The prostate is a gland of the male reproductive system surrounding the urethra, the tube that carries urine out from the urinary bladder.
 
A young man’s prostate is about the size of a walnut. It slowly grows larger with age.The function of the prostate is to produce and store a milky white fluid that becomes part of semen, the fluid that carries sperm out during ejaculation.
 
The prostatic fluid mainly consists of sugars, proteins and other chemicals which help the sperm to survive inside the female’s body.
 
In females, the paraurethral gland, now called the female prostate gland is considered homologous to the male prostate.

The gland is also located around the urethra in females and expels fluid like the male prostate during orgasm.

Common Prostate Disorders

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) occurs in older men, this is enlargement of the prostate to the point where urination becomes difficult.
Symptoms include needing to go to the toilet 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 generally with medication, but under certain circumstances surgery that removes the prostate is needed.
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. The procedure is done under general anesthesia and usually takes 30 to 60 minutes.

Prostatitis

This is the inflammation of the prostate gland, characterized by painful and frequent urination, lower back pain, generalized body aches and pains and sometimes fever.
 
There are many types and categories of this disease but for the purpose of simplicity, we can generally divide them into 2 groups; infective prostatitis and non-infective prostatitis.

Infective Prostatitis

This is usually caused by bacterial infection of the prostate gland. It is diagnosed by laboratory analysis of urine and sometimes the semen. The treatment involves general anti-inflammatory medicines and certain antibiotics.

Non-infective Prostatitis

This occurs due to various causes and is usually diagnosed after ruling out the infection. Treatment usually involves a variety of modalities such as certain medicines, physiotherapy, light-therapy and sometimes even surgery.
 
A common type of non-infective prostatitis is congestive prostatitis. This is commonly characterized by semen like discharge when the person sits in a squatting position, such as while urinating, and sometimes lower back pain. This is usually seen in sexually active men especially those who experience frequent ejaculations (such as those who frequently masturbate).
 
In these individuals, the prostate starts functioning faster than normal, hence producing more semen. When the person somehow decreases the frequency of ejaculation, the prostate becomes congested with semen and then, when the person sits in a the squatting position, his lower abdominal structures such as the bladder put pressure on the prostate, squeezing it and hence what is observed is discharge of semen like drops.
 
This condition settles down on its own after a few months. Sitting in a warm bathtub for 10-15 minutes daily will also reduce prostatic inflammation and provide some relief. However, if the condition persists, consultation with a urologist is recommended.

Prostate Cancer

Prostate cancer is one of the most common cancers affecting older men and a significant cause of death for elderly men. Prostate cancer develops primarily in men over fifty. The cancer responds best to treatment when detected early.
 
The cancer of prostate is, in most cases, slow-growing and symptom-free. It however, may cause pain, difficulty in urinating, problems during sexual intercourse, or erectile dysfunction. Other symptoms can potentially develop during later stages of the disease.
 
The prostate regularly secretes a chemical in blood called Prostate Specific Antigen (PSA). Its blood levels increase considerably in the case of cancer and this increment, together with case history and physical examination of the patient helps in making the diagnosis.
 
Later a biopsy (laboratory analysis of a small chunk of prostate tissue) is needed to confirm the diagnosis, and determine the severity of the disease and respective mode of treatment.

Prognosis

The prognosis (chance of recovery) and treatment options from prostate cancer depend on the following:

• The stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other places in the body).
• The patient’s age and health.
• Whether the cancer has just been diagnosed or recurred.
  Prognosis also depends on the level of PSA.

Spread of Prostate Cancer in the body (Metastasis)

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
• After prostate cancer has been diagnosed, tests are done to find out if cancer cells have spread within the prostate or to other parts of the body. These tests include the following:

Radionuclide bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Seminal vesicle biopsy: The removal of fluid from the seminal vesicles (glands that produce semen) using a needle. A pathologist views the fluid under a microscope to look for cancer cells.
The information achieved from the above tests, plus the results of tissue biopsy and blood levels of PSA, help in determining the stage of the disease which in turn determines the prognosis and treatment options.

Treatment

Four types of standard treatment are used

Watchful waiting

Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This is usually used in older men with other medical problems and early- stage disease.

Surgery

Patients in good health are usually offered surgery as treatment for prostate cancer. The following types of surgery are used:

• Pelvic lymphadenectomy: A surgical procedure to remove the lymph nodes in the pelvis. A pathologist views the tissue under a microscope to look for cancer cells. If the lymph nodes contain cancer, the doctor will not remove the prostate and may recommend another treatment.
• Radical prostatectomy: A surgical procedure to remove the prostate, surrounding tissue, and seminal vesicles (other neighboring structures along the male reproductive tract)
• Transurethral resection of the prostate (TURP): A surgical procedure to remove tissue from the prostate using a resectoscope (a thin, lighted tube with a cutting tool) inserted through the urethra. This procedure is sometimes done to relieve symptoms caused by a tumour before other cancer treatment is given. Transurethral resection of the prostate may also be done in men who cannot have a radical prostatectomy because of age or illness.
   
  Impotence and leakage of urine from the bladder or stool from the rectum may occur in men treated with surgery. In some cases, doctors can use a technique known as nerve-sparing surgery. This type of surgery may save the nerves that control erection. However, men with large tumours, or tumours that are very close to the nerves may not be able to have this surgery.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy.

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.
• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
  There is an increased risk of bladder cancer and/or rectal cancer in men treated with radiation therapy.
  Impotence and urinary problems may occur in men treated with radiation therapy.

Hormone Therapy

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. In prostate cancer, male sex hormones can cause prostate cancer to grow. Drugs, surgery, or other hormones are used to reduce the production of male hormones or block them from working.
 
Hot flashes (A sudden, temporary onset of body warmth, flushing, and sweating), impaired sexual function, loss of desire for sex, and weakened bones may occur in men treated with hormone therapy. Other side effects include diarrhea, nausea, and pruritis (itching).

Follow-up tests

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Where to Seek Treatment

In Pakistan, all tertiary care hospitals have a Urology department that deals with cases of prostate problems. A Urologist is a surgeon and will further involve other specialists such as an Oncologist (cancer specialist) to treat prostate cancer.