The Prostate What is the Prostate The prostate is a gland consisting of fibrous, muscular and glandular tissue surrounding the urethra below the urinary bladder. Its function is t0 secrete prostatic fluid as a medium for semen, helping it to reach the female reproductive tract. Within the prostate, the urethra is joined by two ejaculatory ducts. During sexual activity, the prostate acts as a valve between the urinary and reproductive tracts, This enables semen to ejaculate without mixing with urine. Prostatic fluid is delivered by the contraction of muscles around gland tissue. Nerve and hormonal influences control the secretory and muscular functions of the prostate. Ureteral orifice Urhary bladder Bladder wall Seminal vesicles Intemal rethral sphincter Pubic slmphysis krtemal uethral sphincter Ejaculatory ducts Prostatic capsule Prostatovesiculd jmction Anterior rectal wall Prostate glmd Prostatic uretfua Deep dorsal vein of the penis Prostatic utricle Exterul urelhral sphincter Bu Glands of the Prostate lbourethral glmd Membrmou wetfua The prostate is mainly filled with secretory glands. These glands are made of many ducts with grape-shaped saccule ends or "acini". Secretory cells lining the ducts are stimulated by hormones to expel prostatic fluid. During sexual activity muscle contracts and secretes prostatic fluid. The basal cell, Sefttory tlnd with gapeshaped adN end. Zones of the Prostate also found lining the ducts of the prostate, may be responsible for most types of prostatic hyperplasia as a result of uncontrolled prostatic tissue growth. Secretory cells are tlre most nmerou in ihe gland md lorm the imer lining. The bmal cell is located below the Eiacdatory duct lining swface md my fEdion to rebuild A - Central zone B - Fibromuscular zone C - Trmsitional zone D - Peripheral zone E - Periurethral glmd region prostatic tissue aJter inlection or other dmage Fibromselar sfuma Ductal Proshtic Anterior View with Exposed Prostatic Urethra lmen fluid tigone U.eth.a in bladdsn..k Opdts Benign Prostatic Hyperplasia (BPH) of uretud gidd Orfrce of eia.datory duct Benign Prostatic Hyperplasia (BPH), is the most common type of tumour in mature men. lt is a benign growth, which means it may enlarge but will not spread to other locations in the body. The tumour can cause discomfort and may grow to completely close the bladder neck, preventing urination. This condition occurs because MehbEnoDs Dre$16 digital rectal exam is useful in detecting early signs of prostatic enlargement. A the tumour usually grows in the transitional zone and periurethral gland region located ai the prostate base near the bladder neck. Prostate Gancer Prostate carcinoma is the most common malignant tumour Early BPH: Narrowing of the prostatic urethra causing difficulty in starting, maintaining and stopping urination. Prostatitis is an uncomfoftable condition in which the prostate becomes inflamed and swollen due to an infection. Prostatitis can make urinating painful. in men. Unlike BPH, prostate cancer not only enlarges but also metastasizes (spreads) to other parts of the body. This disease is complicated by the simple transfer of cancer cells directly to other parts of the body through a local plexus of veins. 2011 Wolters Kluwer Health. Printed in South Africa under license by Smartworks (Pty) Ltd. html lmages and text copyright @ 2011 Wolters Kluwer Health I Lippincott Williams & Wilkins @ http ://wwwwolterskluwerpharma.com/index. 11 'oo "", u\u',"-Z'-rZ \, u.^ l. ^"^ ^.^ Incomplele emplying ^^ a,q \ \ 0 2 3 A 5 2. Frequency Over the post month, how oflen hove you hod io urinote ogoin less thon 2 hours offer you finished urinoting? 0 2 3 4 5 3. lnlermittency Over the post month, how often hove you found thot you've stopped ond storted ogoin severol times when you urinoted? 0 2 3 4 5 4. Urgency 0 2 3 4 5 5. Weqk slreqm Over the post month, how often hove you hod o weok urinory streom? 0 2 3 A 5 5. Stroining Over the post monih, how often hove you hod to push ond stroin to begin urinotion? 0 2 3 4 5 7. Nocturiq Over the post month, how mony times did you most typicolly get up to urinote from the time you went io bed ot night until the time you get up in the morning? 0 I 2 3 4 5 None Time Over the post month. how often hove you hod o sensotion of not emptying your blodder completely ofter you finished urinoting? Over fhe post monlh, how often hove you found it difficult to postpone urinotion? Times Times Trmes Times Lr- uor, Lo", ""A _o \ Quolily ol life due to urinory symptoms 0 ,\ q6^ o.4'L I _9 ^ "% 's'9 o,,n -O 2 3 "Q,o. a- '14 -q 4 5 6 lf you were to spend the rest of your life with your urinory condition the woy it now, how would you feel obout thot? Quolity ot tife Assessment index . is eol = f-*---l The lnternotionol Prostoie Symptom Score (l-PsS) is sn importont ospect Totor r-pss* scole l--l of fhe initiol evoluotion jn poiients'suspected lss with BPH. American lJrclogical Association (ALIA)Symptom Score lodex, fhese symptom scorcs ore identicol and eonslsi of seyen g uestjons relating to the severity of sympioms. os well as o seperale queslion abaut the boihersomeness ofthe symptoms. fhe maximum possible score is ii: scores O - 8 ore grenerally regarded os mild. q - lq as moderale; end 2B ot obove os severe. l/je I-PSS. ond AUA scores Zrre used lo mecsure SWptomseverityon1Yandarenoladiogno5tiCtesftodelerminewhefhelsymptc)msarcdUetoBPH.