The prostate is an exocrine gland of the male reproductive system in most mammals and some invertebrates. It differs considerably among species anatomically, chemically, and physiologically. Anatomically, the prostate can be subdivided in two ways: by zone or by lobe.
It does not have a capsule ; rather an integral fibromuscular band surrounds it.
The prostate also contains some smooth muscles that also help expel semen during ejaculation. The function of the prostate is to secrete a fluid which contributes to the volume of the semen. The prostatic fluid is expelled in the first part of ejaculate, together with most of the sperm. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid, those in prostatic fluid have better motilitylonger survival, and better protection of genetic material.Three charges are at the corners of an equilateral triangle determine
Disorders of the prostate include enlargementinflammationinfection, and cancer. The prostate is a gland of the male reproductive system. In adults, it is about the size of a walnut. Within it sits the urethra coming from the bladder which is called the prostatic urethra and which merges with the two ejaculatory ducts. A study stated that prostate volume among patients with negative biopsy is related significantly with weight and height body mass indexso it is necessary to control for weight.
A surrounding fibrous layer is sometimes referred to as the prostatic capsule or prostatic fascia and a surrounding fibromuscular band is integral. The prostate can be subdivided in two ways, either by zone or by lobe. The "lobe" classification is more often used in anatomy. The prostate is incompletely divided into five lobes:. The prostate has been described as consisting of three or four zones.
The veins of the prostate form a network — the prostatic venous plexusprimarily around its front and outer surface.
The lymphatic drainage of the prostate depends on the positioning of the area. Vessels surrounding the vas deferens, some of the vessels in the seminal vesicle, and a vessel from the posterior surface of the prostate drain into the external iliac lymph nodes.
Some named lymph glands of the pelvis. The tissue of the prostate consists of glands and stroma. The stroma of the prostate is made up of fibrous tissue and smooth muscle.
Over time, thickened secretions called corpora amylacea accumulate in the gland. Three histological types of cells are present in the prostate gland: glandular cells, myoepithelial cells, and subepithelial interstitial cells. The prostatic part of the urethra develops from the middle, pelvic, part of the urogenital sinusof endodermal origin. Condensation of mesenchymeurethraand Wolffian ducts gives rise to the adult prostate gland, a composite organ made up of several tightly fused glandular and non-glandular components.
To function properly, the prostate needs male hormones androgenswhich are responsible for male sex characteristics. The main male hormone is testosteronewhich is produced mainly by the testicles. It is dihydrotestosterone DHTa metabolite of testosterone, that predominantly regulates the prostate. The prostate gland enlarges over time, until the fourth decade of life.
During male seminal emission, sperm is transmitted from the vas deferens into the male urethra via the ejaculatory ducts, which lie within the prostate gland. Stimulation sends nerve signals via the internal pudendal nerves to the upper lumbar spine; the nerve signals causing contraction act via the hypogastric nerves. It is possible for some men to achieve orgasm solely through stimulation of the prostate gland, such as prostate massage or anal intercourse. Prostatitis is inflammation of the prostate gland.The prostate makes a significant contribution to the production and ejaculation of semen during sexual intercourse.
Prostate cancer is a common disorder of the prostate that often necessitates the surgical removal of the prostate. Evidence suggests that some men are at genetically higher risk of developing prostate cancer than others.
The prostate is a small muscular gland located inferior to the urinary bladder in the pelvic body cavity. It is shaped like a rounded cone or a funnel with its base pointed superiorly toward the urinary bladder. The prostate surrounds the urethra as it exits the bladder and merges with the ductus deferens at the ejaculatory duct.
The prostate contains two main types of tissue: exocrine glandular tissue and fibromuscular tissue. The prostate produces a secretion that makes up a large portion of semen volume.
The prostatic secretions are a milky white mixture of simple sugars such as fructose and glucoseenzymes, and alkaline chemicals.
The sugars secreted by the prostate function as nutrition for sperm as they pass into the female body to fertilize ova. Enzymes work to break down proteins in semen after ejaculation to free sperm cells from the viscous semen. The alkaline chemicals in prostatic secretions neutralize acidic vaginal secretions to promote the survival of sperm in the female body. The prostate contains the ejaculatory duct that releases sperm during ejaculation.
The ejaculatory duct opens to allow semen to pass from the ductus deferens into the urethra and eventually out of the body. During orgasm, smooth muscle tissue in the prostate contracts in order to push semen through the urethra. Under normal conditions, urine in the urethra passes through the prostate with no complications whatsoever. An enlarged prostate can lead to difficulty urinating or eventually even an inability to urinate.
There are many treatments for an enlarged prostate including medications, lifestyle changes, and prostatectomy, the surgical removal of the prostate. By: Tim Barclay, PhD. Last Updated: Feb 24, Now please check your email to confirm your subscription.
There was an error submitting your subscription. Please try again. Email Address.The prostate bed is a structure in the male pelvis situated just beneath the bladder where the prostate gland rests. The term is most often used in the context of a surgical procedure known as a radical prostatectomy in which the prostate gland is removed in men diagnosed with prostate cancer.
Due to its adjacent position, the prostate bed is especially vulnerable to the spread of cancer. Because of this, the prostate bed also known as the prostatic fossa is often the focus of secondary cancer treatment. Surgery is commonly used to cure prostate cancer if it hasn't spread metastasized beyond the prostate gland itself. The radical prostatectomy is the main type of surgery performed. It involves the removal of the entire prostate gland and surrounding tissue, including the seminal vesicles the organs which secrete fluids that make up semen.
Nearby lymph nodes may also be removed. The choice of surgery depends largely on the treatment goals. A retropubic prostatectomy is more commonly used if doctors believe that the cancer has spread to the lymph nodes. A laparoscopic prostatectomy is far less invasive but required a skilled surgeon and may not be offered in all clinics.
Of the three, the perineal prostatectomy is less commonly used because it is more likely to cause nerve damage resulting in erection problems. The prostate bed is a key area of focus in men undergoing a prostatectomy. It is where cancerous cells are most often found after the gland has been removed. It is also the site where cancer commonly recurs in persons previously treated for a malignancy. For these reasons, adjuvant secondary radiation therapy may be used to ensure that all cancer cells have been eradicated.
Meanwhile, any suggestion of recurrence will typically include an investigation of the prostate bed and surrounding tissues. After a radical prostatectomy has been performed, the doctor will want to regularly monitor your condition with a blood test called a prostate-specific antigen PSA assay.
The PSA is used to detect inflammation of the prostate gland. After the gland has been removed, the PSA should drop to an undetectable level within a month or so. However, if the PSA begins to rise, your doctor may suggest a procedure called external beam radiation therapy. This delivers targeted radiation directly to the prostate bed and surrounding tissue. It is sometimes performed in conjunction with hormone therapy to improve cure rates.
Adjuvant radiation therapy may be also be recommended in men considered to be at higher risk of recurrence. The procedure is performed soon after the prostatectomy to better ensure all traces of cancer are killed. For men who experience a recurrence in the area of the prostate bed, but with no metastasissalvage radiation therapy may be prescribed. The goal of salvage therapy is to control rather than cure the cancer and to prevent it from metastasizing beyond the immediate area.
It is not appropriate for metastatic disease. Side effects from radiation therapy can vary s based on how localized or extensively distributed the cancer is. Be sure to discuss with your doctor what you can reasonably expect before deciding on a course of radiation therapy. Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide!
Prostate Cancer. In a radical prostatectomy, the prostate gland can be accessed in a number of different ways:.It runs almost vertically through the prostate from its base to its apex, lying nearer its anterior than its posterior surface; the form of the canal is spindle-shaped, being wider in the middle than at either extremity, and narrowest below, where it joins the membranous portion.
A transverse section of the canal as it lies in the prostate is horse-shoe-shaped, with the convexity directed forward. From Wikipedia, the free encyclopedia. Prostatic urethra The male urethra laid open on its anterior upper surface.
Prostatic part labeled at upper right. Male reproductive system. Seminal vesicles excretory duct Prostate Urethral crest Seminal colliculus Prostatic utricle Ejaculatory duct Prostatic sinus Prostatic ducts Bulbourethral glands. Anatomy portal. Authority control TA98 : A Categories : Wikipedia articles incorporating text from the 20th edition of Gray's Anatomy Prostate Male urethra Genitourinary system stubs.
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Anatomical terminology [ edit on Wikidata ]. TA98 : A This article related to the genitourinary system is a stub. You can help Wikipedia by expanding it.The male urethra is a fibromuscular tube that drains urine from the bladder. It has a longer, more complicated, course than the female urethra and is also more prone to pathology.
The male urethra measures, on average, cm in length. It commences at the internal urethral orifice in the trigone of the bladder and opens in the navicular fossa of the glans penis at the external urethral meatus, which is the narrowest part of the urethra. The male urethra can be divided into anterior and posterior portions. The anterior urethra is composed of the penile and bulbar urethra to the level of the urogenital diaphragm.
The posterior urethra is composed of the membranous and prostatic urethra. The anterior urethra is lined by pseudostratified columnar epithelium.
The very distal portion at approximately the level of the fossa navicularis is lined by squamous epithelium. The division into anterior and posterior urethras is important in terms of pathology and in imaging the urethra: the anterior urethra being visualized by performing a retrograde ascending urethrogram and the posterior urethra with an antegrade descending or micturating urethrogram.
Anatomy: Abdominopelvic. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait. Unable to process the form. Check for errors and try again. Thank you for updating your details. Log In. Sign Up. Log in Sign up. Articles Cases Courses Quiz. About Blog Go ad-free.Data was presented describing radiographic failure patterns after surgery. Target volumes used in previous trials were reviewed.
Below the superior border of the pubic symphysis, the anterior border extends to the posterior aspect of the pubis and posteriorly to the rectum where it may be concave at the level of the VUA. At this level the lateral border extends to the levator ani. Above the pubic symphysis the anterior border should encompass the posterior cm of the bladder wall and posteriorly it is bounded by the mesorectal fascia. At this level the lateral border is the sacrorectogenitopubic fascia.
Seminal vesicle remnants, if present, should be included in the CTV if there is pathologic evidence of their involvement. Radiation therapy is being used with increasing frequency in the management of patients following radical prostatectomy for localized prostate cancer. Three prospective randomized clinical trials demonstrate a significant clinical advantage to the use of adjuvant radiation therapy to the surgical bed of patients who have extraprostatic tumor extension, seminal vesicle invasion, or positive surgical margins.
Furthermore, there is substantial evidence that radiation therapy to the prostate fossa is an effective salvage therapy in men who have developed biochemical evidence of treatment failure following radical prostatectomy. Radiation therapy to the prostatic fossa can be associated with urinary and bowel morbidity. Furthermore, the long term results of adjuvant and especially salvage radiation therapy demonstrate a substantial proportion of men recur despite treatment.
Prostatic fossa calculus
The prospective randomized clinical trials of adjuvant radiation therapy and most retrospective series of salvage radiation therapy have utilized non-conformal radiation therapy methods. This may contribute to morbidity because of unnecessary normal tissue irradiation and to less than optimum tumor control due failure to accurately target areas harboring subclinical disease. This normal tissue radiation limits the radiation dose prescription to the target volume thereby reducing the potential effectiveness of radiation therapy.
As in men receiving primary radiation therapy for cancer of the prostate, there is strong rationale to utilize modern 3-D conformal or intensity-modulated radiation therapy techniques for patients following surgery.
There is data that suggests that patients treated with conformal radiation therapy techniques in the definitive setting tolerate treatment better and this opens the possibility for radiation dose escalation. Until recently there has been little investigation into what constitutes the appropriate clinical target volume CTVthe tissue volume at risk of subclinical microscopic and macroscopic tumor growth for the prostatic fossa following radical prostatectomy.
Because the Radiation Therapy Oncology Group RTOG and other cooperative groups are interested in evaluating post-prostatectomy radiation therapy in clinical trials it is important to define the CTV for this special clinical situation.
The objectives of this current study are to evaluate the agreement amongst genitourinary GU radiation oncologists and to develop an RTOG consensus for the CTV following radical prostatectomy. This research was reviewed and approved by the Washington University Human Research Protection Office and all collaborators completed training in both human research and patient privacy at their respective institutions.
Treatment planning computed tomography CT scans from two men with prostate cancer who had undergone prior radical prostatectomy were utilized for this study. The CT data sets were acquired with patients in the supine position. The men had empty rectums and partially full bladders at the time of treatment planning CT scanning. Non-contrast CT scans were obtained from the top of the iliac crest through the perineum in 3-millimeter slices.C program to add days to date
Each case had a slightly different clinical scenario emphasizing either a positive margin at the apex or invasion of the seminal vesicles. Clinical synopses of each case were provided to a panel of participating physicians and these are summarized in Table 1.
Each participating physician was asked to use their institutional treatment planning system to define a CTV for each clinical case. Contours from each investigator were then imported into the Computerized Environment for Radiation Research CERRan open source Matlab-based radiation therapy planning analysis tool. Several algorithms were utilized to measure the level of agreement between physicians.
The commonly used apparent volume overlap was calculated using the following formula:. Where p i is the agreement probability by which a voxel is selected by the experts.
Squamous cell carcinoma of the prostate: long-term survival after combined chemo-radiation
A volume — agreement cumulative histogram could be generated based on Eq.Benign Focal Prostate Lesions Etiology Benign focal lesions of the prostate include benign prostatic hyperplasia BPH see Chapter 72congenital cysts, acquired cysts, prostatitis acute bacterial, chronic bacterial, chronic pelvic pain syndrome [inflammatory and noninflammatory], and asymptomatic prostatitisprostatic abscess, and prostatic calcification.
The National Institutes of Health classification of prostatitis syndromes provides a useful conceptual framework. Categories I and II reflect acute and chronic bacterial prostatitis, respectively. Category IV refers to asymptomatic inflammatory prostatitis, usually diagnosed incidentally.
The presentation of benign prostate disease varies according to the particular pathologic process. For example, acquired prostate cysts and calcification are typically asymptomatic, whereas prostatitis ranges from incidentally detected asymptomatic conditions to symptomatic cases.
Any part of the prostate gland can be involved by prostatitis, abscess, or calcification. Acquired cysts are located in a paramedian distribution. In prostatitis, there is an increased number of inflammatory cells. Cysts and calcifications are benign processes. Benign findings such as cysts and calcifications are typically incidental, usually found on routine investigation for other conditions; most benign processes such as BPH and prostatitis require little investigation.
TRUS can provide high-resolution images of the prostate and real-time guidance for intervention such as biopsy, aspiration, and drainage, without the use of radiation. Magnetic resonance imaging MRI accurately delineates the internal prostatic anatomy but is not routinely used for the investigation of benign prostate lesions owing to its high cost and relatively limited availability. Relative to these modalities, radiography and computed tomography CT have limited roles in the evaluation of most prostate processes.
Antibiotics are the mainstay of treatment for prostatitis. Other treatments, including both pharmacologic and nonpharmacologic approaches, have been assessed as potential treatments for chronic prostatitis and pelvic pain syndromes. Prostatic abscess drainage is the only indication for surgical intervention in benign prostatic disease. Acute bacterial prostatitis is most commonly caused by aerobic gram-negative rods, in particular Escherichia coli and Pseudomonas species.Top 6 Natural Ways To Treat An Enlarged Prostate
Bacteria may ascend to the prostate by reflux of infected urine into the prostatic duct, by lymphatic or hematogenous dissemination, or during interventions such as prostatic biopsy. Emphysematous prostatitis occurs secondary to infection with gas-forming organisms; while rare, it is associated with high mortality. Acute bacterial prostatitis usually manifests as an acute illness with fever, chills, lower back and perineal pain, urinary frequency and urgency, and dysuria.
Rectal palpation usually reveals an enlarged, exquisitely tender prostate gland. The diagnosis of acute bacterial prostatitis is based primarily on clinical findings, in association with positive results of urinalysis and urine culture. The prostate may be focally or diffusely involved. In acute infection, the prostate enlarges secondary to infection and inflammation.
An increased number of inflammatory cells is seen in prostate biopsy specimens. When indicated, ultrasonography and MRI are favored for their high soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation. However, imaging modalities may be limited in the differentiation of prostatitis from BPH and prostate cancer. Prostatic tenderness associated with acute prostatitis may preclude TRUS.
In acute prostatitis, the gland may appear normal or focally or diffusely enlarged.
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