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The Prostate Cancer Treatment Book
By Peter D. Grimm, John C. Blasko, John E. Sylvester
The McGraw-Hill Companies, Inc.Copyright © 2004Peter D. Grimm, John C. Blasko, and John E. Sylvester
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What Good Is a Prostate, Anyway?
Ian M. Thompson, M.D.; J. Brantley Thrasher, M.D.; Mark A. Moyad, M.D., M.P.H.; John E. Sylvester, M.D.
Most people rarely—if ever—think about the prostate gland. They understand it's a male organ in the pelvic area, situated somewhere between the navel and testicles. They may be vaguely aware that it serves some purpose related to creating offspring. And they know that measuring the prostate specific antigen (PSA) level is an important annual blood test for many men. But the gland is tucked deep inside and it rarely causes trouble, so there's little incentive to take the time to learn about it.
But when the words prostate cancer are uttered, suddenly the prostate leaps to the forefront of consciousness and the race is on to gather as much information as possible, in as little time as possible.
So, that's where we begin. Chapter 1 helps you clear this first hurdle in conquering prostate cancer by explaining what the prostate gland is, what it does, and what can go wrong with it.
What is the prostate and what function does it serve?
The prostate is a conglomeration of tiny glands, ducts, and muscle tissue encased by fibrous tissue. It produces fluid that contains hormones and proteins to keep sperm alive after ejaculation as the sperm searches for an egg to fertilize.
The average size of a prostate is about 30 to 40 grams, about the size of a small lime or walnut. Its texture is firm. About one-third of the prostate is composed of muscular tissue, with the rest being glandular tissue.
As a man ages, his prostate often gets bigger, sometimes doubling or tripling in size. Although there is a lot of discussion about prostate enlargement in aging men and the uncomfortable symptoms that this can cause, it's important to remember that not all men experience prostate enlargement, and cancer is not responsible for this enlargement.
The prostate's zones include the transition, the central, the anterior, and the peripheral (see Figure 1.1).
The transition zone is the most interior part of the prostate; it immediately surrounds the urethra (the slender tube that carries urine away from the bladder and out of the body through the tip of the penis). The transition zone can begin to grow after age 40, with this noncancerous enlargement possibly leading to urinary difficulties.
The central zone is up near the bladder and is the seat of about one-third of the glands that make and secrete prostatic fluid. The central zone, similar to the transition zone, is generally the part of the prostate that grows after a man turns 40. Prostate cancer is unusual in the central zone and if it does develop, it tends to be a slower growing type of cancer.
The anterior zone (anterior means "front") is mostly muscle tissue. The peripheral zone is at the back of the gland and is the portion closest to the rectum. It contains most of the secretion-producing glands and is where prostate cancer usually develops.
Are there "right" and "left" glands, or are there "right" and "left" sides of one gland?
Physicians describe a right side and a left side, but in reality there is only a subtle demarcation between the two sides. Think of a plum. It's one fruit, but the small groove down the middle leaves the impression of two halves. That's similar to the prostate gland.
Where is the prostate, and what other important organs are near it?
If you measured how far the prostate is situated inside the pelvic area, it's about two inches from the perineum, which is the region of exterior skin and internal muscle between the anus and the scrotum. The gland sits just below the bladder and in front of the rectum (see Figure 1.2). Off the base of the prostate and behind the bladder are the two seminal vesicles, which produce most of the fluid that makes up the ejaculate.
What are the apex and the base of the prostate?
The base of the prostate is the wider part of the gland that nestles up to the bladder. The apex is the more pointed end of the gland that faces down toward the perineum.
How does the prostate work?
Just before ejaculation, sperm from the testicles is transported into the urethra by a long tube called the vas deferens. This sperm combines with fluid both from the seminal vesicles and the prostate, creating semen. The prostate and adjacent muscular contractions then propel the semen out of the urethra through the tip of the penis for ejaculation.
BPH and Prostatis
What is benign prostatic hyperplasia (BPH) and what causes it?
Benign prostatic hyperplasia is the medical term for noncancerous enlargement of the prostate. At about age 40, the transition and/or central portion of the prostate can begin to grow. As one or both of these areas enlarge, the growth can compress the part of the urethra that runs through the prostate (see Figure 1.3).
The prostate is sensitive to the normal male hormones (androgens) inside a man's body. The primary androgen, of course, is testosterone, and it's testosterone that seems to be partially responsible for BPH in older men.
What are the symptoms of BPH?
Depending on how the prostatic tissue grows, it may cause different symptoms in different men. However, the usual symptoms are more frequent urination, especially in the middle of the night. Also, the bladder may not feel completely empty, or there may be a need to push or strain because of a slow urinary stream. Another possible symptom is urgency (meaning a strong desire to urinate). Urgency occurs when the bladder gets the signal that it's full. If this is a very strong signal and a man cannot relieve himself quickly, it's possible to leak urine.
Is treatment of BPH always necessary?
No, not always. In fact, many men with BPH aren't bothered by symptoms at all. It could be that the onset of symptoms is so gradual or the symptoms are so minor that they don't adversely impact quality of life. For instance, a man may have to get up just once or twice a night and urinate only a bit more frequently during the day.
When symptoms progress to a point of interfering with usual daily activities—such as a man being unable to take a long car trip because he has to use a restroom frequently or he gets out of bed several times at night—then he'll probably seek treatment.
Can drugs treat BPH?
Yes. The three classes of medications most frequently used to treat BPH are alpha-blockers, 5-alpha-reductase inhibitors, and herbal supplements.
Alpha-blockers. These medications relax the smooth muscle tissue at the neck of the bladder and in the prostate, to let patients urinate more freely. These medications are very effective in improving symptoms, usually within days to weeks. Alpha-blockers are generally safe but sometimes can make patients dizzy or weak. Some alpha-blockers may also cause a slight decrease in blood pressure. A few patients can't take alpha-blockers because the drugs leave them feeling fatigued and drained.
5-alpha-reductase inhibitors. Finasteride (Proscar) and dutasteride (Avodart) are approved in the United States to treat BPH. These drugs block the conversion of testosterone into the more potent dihydrotestosterone. Used over three to six months, 5-alpha-reductase inhibitors shrink the prostate. In large clinical trials, the men who took these medication
Excerpted from The Prostate Cancer Treatment Book by Peter D. Grimm. Copyright © 2004 by Peter D. Grimm, John C. Blasko, and John E. Sylvester. Excerpted by permission of The McGraw-Hill Companies, Inc..
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