INTRODUCTION

The prostate gland is one of the medical topics not regularly discussed by both sexes , about 40% males probably feign ignorance or may not even have an idea of what a prostate is until they are probably 50-60 years age. The other 50% of male with a majority of female folks and may go through their life without a hint of what a prostate is. Only about 1-10% of people know what a prostate is.

Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.1

Picture By Henry Vandyke Carter - Henry Gray - wiki Public Domain )
Worry not because at the end of this article, after reading this, you shall be added to the educated 10 %. I am going to give you the same education I gave to my last patient who claimed ignorance about the prostate.

WHAT IS A PROSTATE GLAND?

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A prostate is a small guava-like shaped organ weighing about 18-22gm. It is normally located at the base of the male folks’ urinary bladder. (A reservoir that keeps urine until we feel pressed and able use the loo).

Anatomically, it sits in front of the rectum (close to the anus) and is separated from the rectum by a kind of covering called fascia Denonvillier. ( It doesn’t actually have a covering of its own). Its peculiar anatomical position makes it easily felt during a digital rectal examination (DRE). Oh yes, the only way a doctor can know if your prostate needs ‘fixing’ is to stick his/her hand inside the anus to check lol.

WHAT IS THE FUNCTION OF THE PROSTATE GLAND?
Basically, the prostate gland contributes a good proportion of seminal fluids which mixes with the sperm from the testicles to form an ejaculate.
The gland is also noted to contract during ejaculation with an inbuilt mechanism to prevent backward flow of semen into the bladder. (Remember the anatomy I tried to explain earlier?)

HOW DOES A SICK PROSTATE MAKE YOU FEEL?
Because of its anatomical location (close to the bladder), a sick prostate would make you have urinary symptoms, it will disrupt the storage/reservoir function of the bladder and also the normal flow of urine. In medicine, we chose to call these Lower Urinary Tract Symptoms ( LUTS).
The symptoms could be better understood if they are classified into the two categories.

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STORAGE DYSFUNCTION.

Imagine a 10,000mls reservoir that has recently gotten broken, it would always be leaking and would never reach the full capacity, thus would need a constant refill of water to reach the brim. The symptoms seen in storage dysfunction include

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• frequency - there would be increase bathroom sessions.

• Urgency simply means a sudden urge to urinate when one can no longer hold urine for a long.

• Urge Incontinence.

• Dysuria- The urinating process would be very painful.

OBSTRUCTIVE SYMPTOMS.
This could be likened to a newly blocked tap that was previously flowing well. These symptoms are
• Poor Stream- When urinating, the urine would have a poor projectile.

• Terminal Dribbling – This is the presence of streaks of urine after completing the act.

• Hesitancy- This is when there is a challenge in initiating the urine act and maintaining it.

• Sense of Incomplete emptying of the bladder – After urinating, one may have the feeling of not completing the whole process.
Remember the patient I talked about earlier, he had some of the LUTS symptoms hence the need for the education, it was good he noticed them early, some people may not take the warnings seriously and may end up with a urinary retention or even a bladder outlet obstruction. This could be simply seen as an abdominal swelling. ( imagine a pregnant male in labor pains..hehehe)

WHAT TYPE OF DISORDERS CAN A PROSTATE GLAND HAVE?

The prostate can be affected in three different ways.
• (1) Prostatitis – This occurs when the prostate is attacked by a bacteria or other micro-organism that could cause inflammation (let’s call this an internal prostate war!) Klebsiella, E-Coli, Proteus e.t.c. are notable bacteria who are have been implicated in the prostate wars!

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These soldiers usually find their way to the prostate via the bloodstream, but they can also be contracted as a sexually transmitted infection.

A person with prostatitis would have the LUTS syndrome, with an addition of other symptoms like waist pain, painful ejaculation, bloody sperm, fever, chills etc. some of these symptoms can subside with antibiotics but when the symptoms persist for more than 3 months, it may be an indication for a gentle prostate massage and a further check-up.

• (2) Benign Prostate Hypertrophy- The prostate can increase in size when this happens, it can also cause the LUTS syndrome. Enlargement of the prostate is part of the normal aging process seen in men. About 50% of men aged 50 and above would have an enlarged prostate in their lifetime, surprisingly, the % can go to 80% in men aged 80 and above.
Dihydrotestosterone production (DHT) a by-product of testosterone is noted to be responsible for the increase in the size of the prostate.

•(3) Carcinoma of the prostate

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This is the worst case scenario of the prostate- cancer Of the prostate is the most commonly diagnosed cancer in men over 40 years of age worldwide. As a male, the lifetime risk of developing the disease is about 30%, there is also a 3 % risk of dying from cancer.
Not much is known about the causes of cancer of the prostate, but notable risk factors such as aging, race, family history, hormone, diet (consumption of unsaturated fat or red meat), occupational and environmental causes could contribute.

The symptoms of cancer could also mimic the LUTS, it can be silent, but a rising prostate-specific antigen (PSA) level is a pointer.

(4) BLADDER OUTLET OBSTRUCTION

This is the blockage of the base of the bladder and reduction in the flow of urine via the urethra.scarring, bladder stones and enlarged prostate can cause bladder outlet obstruction.

COMPLICATIONS OF BLADDER OUTLET OBSTRUCTION.

A person with the bladder obstruction would definitely have

• Urine retention which might eventually lead to stone formations in the bladder known as calculi.

• When these stones are formed, it would lead to further blockages in other important channels in the urinary system .hydronephrosis, hydroureters, hydrocalcycosis are all possibilities that could result if a blockage occurs.

• Renal failure is the worst case scenario of the bladder outlet obstruction.

WHEN TO CHECK YOUR PROSTATE

You don’t have to wait up to 50years to go for a check-up, a routine check-up should be done when any of the LUTS symptoms are noticed or if there is a history of prostate cancer in any 1st degree relative of yours as a male.

Picture By National Cancer Institute - wiki Public Domain

During the check-up, the doctor would carry out a digital rectal examination or an ultrasound and would make a further decision if a biopsy should be done. An absolute indication for biopsy is a PSA level >10ng/ml.

A biopsy is a surgery to get small pieces of the prostate to look at under a microscope. If the biopsy shows there are cancer cells, then your doctor will discuss treatment options.2

The normal range for PSA is between 0-4ng/ml so this could be a valuable index for monitoring disease progression and treatment.

CONCLUSION

The treatment modalities depend on the state of the prostate gland; it also depends on the stage of the disease. Active surveillance forms part of the treatment, others are
• Surgery
• Radiotherapy
• Hormonal therapy
• Cryo-ablation.

Prostate education should be made known to all the male folks in order for them to know when to seek help and get better medical attention.

FUTHER READINGS.

• https://www.webmd.com/urinary-incontinence-oab/picture-of-the-prostate

• https://www.sciencedirect.com/science/article/pii/S0022534717611959

• https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html

• https://www.cdc.gov/cancer/prostate/prostate-cancer-health-tip-sheet.htm

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