Prostate

Picture of Prostate

The prostate is part of the male reproductive system. A walnut-sized gland located between the male bladder and the penis, the prostate sits just in front of the rectum. The urethra runs from the bladder to the penis, through the center of the prostate.​ It is the vessel through which urine passes after leaving the bladder, and the conduit in men for semen during sexual intercourse.

The prostate secretes fluid that nourishes and protects sperm after ejaculation. The milky fluid produced by the prostate – prostatic fluid – makes up around 30 percent of the total fluid ejaculated (the rest is sperm and fluid from the seminal vesicles).

The prostatic fluid protects sperm, helping them live longer and be more mobile. It contains a number of ingredients, including enzymes, zinc, and citric acid. One of the enzymes in a prostatic fluid is prostate-specific antigen (PSA). After ejaculation, PSA makes thickened semen runnier, helping sperm travel through it more easily, and increasing their likelihood of successfully fertilizing an egg.

During ejaculation, the prostate squeezes prostatic fluid into the urethra, and it is expelled with sperm as part of semen. This is a key part of male reproduction. Studying the components of prostatic fluid and how it protects sperm could provide new information that can be optimized for male birth control and contraception.

Production of fluid for semen:

One part of the semen is produced in the prostate. Together with sperm cells from the testicles, fluid from the seminal vesicle, and the secretions released by another pea-sized gland below the prostate (the bulbourethral gland), the prostate fluid makes up the semen.

 

Seminal Vesicles 

The seminal vesicles—sometimes called the seminal glands or vesicular glands—are part of the reproductive system in people assigned male at birth. They are small glands that produce the majority of the fluid that makes up semen, though they do not have a role in producing sperm. Sperm are produced in the testicles.
The seminal vesicles are paired ductal structures that include the prostate gland and the bulbourethral glands. They secrete fluid that will form part of the semen. This fluid contains proteins, enzymes, mucus, citric acid, inorganic phosphorus, potassium, prostaglandin, and nutrients such as fructose.
There is no way to increase the amount of fluid that the seminal vesicles can produce. The sperm in the seminal vesicles and prostate gland will multiply when you don’t ejaculate for a while. The more you don’t ejaculate, the more sperm you will have when you finally will. After ejaculation, it takes 2-3 days to completely refill the epididymis, depending on the individual. If you do not allow time for your sperm “stock” to refill, your test result will show a lower sperm count. On the other hand, waiting for too long has been associated with a lower amount of motile sperm cells.
It may be caused by several pathologies such as ejaculatory duct (ED) malformations, midline prostatic cysts, fibrosis due to prostatitis or seminal vesiculitis, seminal vesicle (SV) stones, or scarring after endoscopic manipulation (Kang et al., 2016; Wang et al., 2012). Treatment for an infection of the seminal vesicles is a course of antibiotics. In some cases, a pocket of pus, referred to as an abscess, may occur as a result of infection. In this case, the abscess may need to be drained.

EPIDIDYMIS AND VAS DEFERENS

Within the male reproductive system, the epididymis and the vas deferens make up the duct system of the male reproductive organs. These ducts are connected to the testicles. The epididymis is a set of two coiled tubes (one for each testicle) that connects the testicle directly to the vas deferens.

The epididymis has three parts. Near the top of the testicles is the head of the epididymis, which stores newly created sperm until they are ready to undergo maturation. Next is the body, a long, twisted tube where the sperm matures. This maturation takes approximately one week, as sperm travel through the tube. Last is the tail, which connects to the vas deferens. From here, the sperm is transported to the ejaculatory duct and out of the body.

The epididymis is a little-known but well-researched part of the male reproductive system. Sperm’s maturation in the epididymis is also a long, complicated process that can be interrupted to render sperm non-functional, and thus create a reversible contraceptive for men.

Urethra

The anatomy of the male urethraThe urethra is a tube that connects the bladder to the urinary opening for the removal of urine from the body of both females and males. It is the vessel through which urine passes after leaving the bladder, and the conduit in men for semen during sexual intercourse. The urethra is a dynamic fibromuscular tube that serves as the terminal region of both the male urinary and reproductive systems. The average male urethra is 20 cm long and begins within the bladder wall and ends in the distal glans of the penis.

Females use their urethra only for urinating, but males use their urethra for both urination and ejaculation. The urethral sphincters are two muscles used to control the exit of urine in the urinary bladder through the urethra, and allow for voluntary control over urination (e.g., muscles that allow a person to “hold” or release their urine, or pee).

In the human male, the urethra is around 7-8 inches long and opens at the end of the penis. This is the hole at the tip of the penis where both urine and semen are released from.

The urethra is divided into four parts in men, named after the location where they are found:

  • Pre-prostatic urethra – the portion of the urethra which passes almost vertically through the wall of the urinary bladder, before it enters the prostate gland
  • Prostatic urethra – the portion of the urethra that traverses the prostate
  • Membranous urethra – the intermediate part of the urethra that connects the prostatic urethra to the penile urethra
  • Spongy urethra (or penile urethra) – the portion of the urethra that traverses the penis

​It is important to note that the urethra is different from the ureter, which are muscular tubes that move urine from the kidneys to the urinary bladder. Though they sound similar, they are different.

Enlarged Prostate

Many men will experience an enlarged prostate in their lifetime. Learn about the symptoms of an enlarged prostate, what causes it, and how to treat an enlarged prostate here.By the time you reach the age of 60, you have a 50/50 chance of having an enlarged prostate. When you blow out 85 candles on the birthday cake, the likelihood increases to 90%.

 

 

You might be wondering, “If it’s so common, what’s the big deal about having benign prostatic hyperplasia (BPH)?”

To begin with, a healthy prostate is important in supporting sperm nourishment and transport. When a man ejaculates, the prostate produces the semen that propels the sperm. In a post-pubescent male, the prostate is about the size of a walnut and stays that way until age 40. For a still unknown reason, the prostate experiences a second growth spurt and can grow to the size of an apricot or even a lemon.

When you take into account that the prostate gland is located just below the bladder at the site where the urethra connects, you can start to see how this can become a serious issue. The enlarged prostate begins to interfere with the urethra, the tube inside the penis that carries urine and semen out of the body. The pressure can block the natural flow of urine (and semen) causing irritation. If left untreated, this condition can lead to symptoms such as increased urination, difficulty urinating, or more serious problems.

To check your prostate, your doctor or urologist will check your prostate gland by inserting a lubricated, gloved finger and feeling for any growth. Other tests may check your urine flow, and how much urine is left in your bladder after you go, as well as look for signs of an infection or prostate cancer.

ENLARGED PROSTATE SYMPTOMS AND CAUSES

There is not a consensus among physicians on exactly why the prostate begins to grow again, though it is widely speculated that an excess of certain hormones may be the catalyst. One study has shown a high correlation between DHT levels (dihydrotestosterone) in the blood and enlarged prostates. Conversely, men with low DHT levels do not experience enlarged prostates.

Estrogen has also been linked to prostate enlargement. As men age, less testosterone is found in the blood stream creating a larger proportion of estrogen. High levels of estrogen have been documented as a marker for this condition as well.

One important thing to note: just because you have a larger prostate does not necessarily mean you will suffer. As with real estate, it’s all about location, location, location. The position in relation to the urethra is more important than the actual size.

What must be remembered is if you recognize any of the enlarged prostate symptoms below, you need to ask for clinical testing to determine obstruction.

    • A weak or interrupted urinary stream
    • Sudden urgency to urinate
    • Frequent urination
    • Inability to completely empty the bladder during urination
    • Trouble initiating urine flow even when the bladder feels full

While these are most common, you may have an enlarged prostate and still not experience any of these. It’s safe to say that after the age of 40, you will want to keep a dialogue with your physician about your prostate health as well as receive full exams.

Important note: symptoms of bladder cancer, overactive bladder (OAB), and urinary retention may be similar to those associated with an enlarged prostate. It is important to have your primary care physician make a referral to a urologist if you fall into any of the following categories:

    • Young patients
    • Abnormal rectal exam, PSA, or urinalysis (see descriptions of these procedures below)
    • History of extensive urethral instrumentation or stricture
    • Poor response to medical therapy

DIAGNOSING AN ENLARGED PROSTATE

As with all incontinence conditions, a thorough diagnosis must be developed before action can be taken. You may have heard of some of these exams. And if you haven’t, now is a good time to familiarize yourself with them. Not only is knowledge power, but it also eliminates surprises.

      • Digital Rectal Exam. Due to the natural position of the prostate gland, an enlargement may be felt through the wall of the rectum. Your physician will insert a gloved finger into the rectum in order to assess the size and condition of the prostate gland.
      • Urinalysis. With a urine sample, the laboratory can test for infections or other problems. This is a simple way to rule out bladder infection and bladder cancer, which can cause similar symptoms.
      • Prostate Specific Antigen Test (PSA). Similar to a urinalysis, the PSA monitors the level of prostate-specific antigen in a patient’s blood. Through a routine blood draw, this test can be used to check for prostate cancer and an enlarged prostate. Additionally, a man’s PSA may actually be an indicator of whether or not he is at risk for continued prostate enlargement.
      • Urodynamic Tests. Urodynamics is a group of diagnostic tests done to evaluate the performance of the lower urinary tract. Measuring bladder pressure and urinary flow, these tests investigate problems such as urine control, urinary frequency or urgency, poor bladder emptying, and intermittent urination. A low flow and high pressure usually indicate an obstruction to the urinary outlet.
      • Cystoscopy. During cystoscopy, a small flexible fiberoptic camera is inserted into the urethra and bladder to evaluate the anatomy of the urethra, prostate, and bladder. To learn about screening for prostate cancer, check out the American Cancer Society’s updated guidelines on prostate cancer screening.

Because those with BPH can experience symptoms from mild to severe, the treatment options featured here are organized from least invasive to more intense.

TREATMENT OPTIONS FOR ENLARGED PROSTATE MANAGEMENT

Men experiencing minimal symptoms of BPH may choose to practice what is called active surveillance. This means simply monitoring your condition and continuing to meet with your physician regularly until changes warrant intervention.

NON-INVASIVE TREATMENT

SURGICAL TREATMENT FOR ENLARGED PROSTATE

MEDICATIONS FOR ENLARGED PROSTATE

There are two main classes of pharmaceuticals that work to alleviate enlarged prostate symptoms: alpha-blockers and alpha-reductase inhibitors

    • Alpha Blockers. Alpha-blockers relax the smooth muscle around the bladder neck and within the urethra.
    • Inhibitors. Inhibitors stop the conversion of the male hormone testosterone to DHT to reduce the prostate’s size, eliminating blockage.

Don’t be surprised if your physician prescribes a combination of the two medications, as they have been shown to work more effectively together than alone. The downside is that combination therapy may increase the likelihood of experiencing side effects from the medications. Be sure to work with your doctor to assess the benefits and costs (side effects) before starting on combination therapy.

Understand prostate cancer

Prostate cancer is most common in older men. In the US, about 1 out of 5 men will be diagnosed with prostate cancer.

A radical prostatectomy is a surgery to remove the prostate gland and seminal vesicles (and sometimes nearby lymph nodes) after a prostate cancer diagnosis. It is one treatment option for patients with localized prostate cancer. The major possible side effects of radical prostatectomy are urinary incontinence (being unable to control urine) and erectile dysfunction (impotence; problems getting or keeping erections). These side effects can also occur with other forms of prostate cancer treatment.

Prostate cancer starts when cells begin to grow out of control in the prostate gland. This cancer is one of the types of cancer that may spread slowly to other areas of the body. People with prostate cancer may not have symptoms or problems for years, or in their lifetime.

More than half of men diagnosed with prostate cancer are over 65 years old. African American men are significantly more likely to be diagnosed with prostate cancer than white men. However, nearly 90% of cases are found before cancer spreads from the prostate to other organs.

Stages of prostate cancer

The stage of the cancer is based on the results of the staging and diagnostic tests, including the prostate-specific antigen (PSA) test and the Grade Group.

PSA levels and Grade groups of prostate cancer

While the general guidelines recommend starting at age 55, you may need PSA screening between the ages of 40 and 54 if you: Have at least one first-degree relative (such as your father or brother) who has had prostate cancer. Have at least two extended family members who have had prostate cancer.

The PSA test measures the level of PSA in the blood. PSA is a substance made by the prostate that may be found in an increased amount in the blood of men who have prostate cancer.

The Grade Group depends on the Gleason score:

    • Grade Group 1 is a Gleason score of 6 or less.
    • Grade Group 2 or 3 is a Gleason score of 7.
    • Grade Group 4 is a Gleason score of 8.
    • Grade Group 5 is a Gleason score of 9 or 10.

Stage I (1) prostate cancer

In stage I, the cancer is found in the prostate only.

    • The cancer is not felt during a digital rectal exam and is found by needle biopsy (done for a high PSA level) or in a sample of tissue removed during surgery for other reasons (such as benign prostatic hyperplasia). The PSA level is lower than 10 and the Grade Group is 1.

Or stage I can be

    • The cancer is felt during a digital rectal exam and is found in one-half or less of one side of the prostate. The PSA level is lower than 10 and the Grade Group is 1.

Stage II (2) prostate cancer

In stage II, cancer is more advanced than in stage I, but has not spread outside the prostate. Stage II is divided into stages IIA, IIB, and IIC.

In stage IIA

    • The cancer is found in one-half or less of one side of the prostate. The PSA level is at least 10 but lower than 20 and the Grade Group is 1.

Or stage IIA can be

    • The cancer is found in more than one-half of one side of the prostate or in both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 1.

In stage IIB

    • The cancer is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 2.

In stage IIC

    • The cancer is found in one or both sides of the prostate. The PSA level is lower than 20 and the Grade Group is 3 or 4.

Stage III (3) prostate cancer

Stage III is divided into stages IIIA, IIIB, and IIIC.

In stage IIIA

    • The cancer is found in one or both sides of the prostate. The PSA level is at least 20 and the Grade Group is 1, 2, 3, or 4.

In stage IIIB

    • Cancer has spread from the prostate to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 1, 2, 3, or 4.

In stage IIIC

    • The cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. The PSA can be any level and the Grade Group is 5.

 

Stage IV (4) prostate cancer

Stage IV is divided into stages IVA and IVB.

In stage IVA

    • The cancer is found in one or both sides of the prostate and may have spread to the seminal vesicles or to nearby tissue or organs, such as the rectum, bladder, or pelvic wall. Cancer has spread to nearby lymph nodes. The PSA can be any level and the Grade Group is 1, 2, 3, 4, or 5.

In stage IVB

    • Cancer has spread to other parts of the body, such as the bones or distant lymph nodes. Prostate cancer often spreads to the bones.

Note: WEST LAFAYETTE, Ind. — For men older than about 60, an enlarged prostate means feeling the urge to make a pit stop way too often throughout the day.

But a new study shows that if these men also happen to have prostate cancer, the larger prostate actually impedes tumor growth.

The findings suggest that it might be a bad idea to downsize an enlarged prostate through surgery or drugs because doing so could lead to faster growth of prostate cancer. While the five-year survival rate for prostate cancer is generally very high, it is still one of the leading causes of death among men in the U.S., according to the Prostate Cancer Foundation.

Purdue UniversityPurdue University

 

Summary

The prostate is the male reproductive organ because it produces sperm; therefore, this organ must be examined, at least once a year. While the general guidelines recommend starting at age 55, you may need PSA screening between the ages of 40 and 54 if you: Have at least one first-degree relative (such as your father or brother) who has had prostate cancer. Have at least two extended family members who have had prostate cancer. Early detection of tumors, cysts, fibroids, and infection can prohibit prostate cancer.

References: malecontraceptive.org, MALECONTRACEPTIVE.ORG1, malecontraceptive.org2

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