The prostate is an exocrine gland of the male reproductive system, and exists directly under the bladder, in front of the rectum. An exocrine gland is one whose secretions end up outside the body e.g. prostate gland and sweat glands. It is approximately the size of a walnut.
The urethra - a tube that goes from the bladder to the end of the penis and carries urine and semen out of the body - goes through the prostate.
There are thousands of tiny glands in the prostate - they all produce a fluid that forms part of the semen. This fluid also protects and nourishes the sperm. When a male has an orgasm the seminal-vesicles secrete a milky liquid in which the semen travels. The liquid is produced in the prostate gland, while the sperm is kept and produced in the testicles. When a male climaxes (has an orgasm) contractions force the prostate to secrete this fluid into the urethra and leave the body through the penis.
In the vast majority of cases, the prostate cancer starts in the gland cells - this is called adenocarcinoma. In this article, prostate cancer refers just to adenocarcinoma.
Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer - it is only when an autopsy is done that doctors know it was there. Several studies have indicated that perhaps about 80% of all men in their eighties had prostate cancer when they died, but nobody knew, not even the doctor.
Experts say that prostate cancer starts with tiny alterations in the shape and size of the prostate gland cells - Prostatic intraepithelial neoplasia (PIN). According to Medilexicon`s medical dictionary, Prostatic intraepithelial neoplasia means "dysplastic changes involving glands and ducts of the prostate that may be a precursor of adenocarcinoma; low grade (PIN 1), mild dysplasia with cell crowding, variation in nuclear size and shape, and irregular cell spacing; high grade (PIN 2 and 3), moderate to severe dysplasia with cell crowding, nucleomegaly and nucleolomegaly, and irregular cell spacing."
Classification of prostate cancer
It is important to know the stage of the cancer, or how far it has spread. Knowing the cancer stage helps the doctor define prognosis - it also helps when selecting which therapies to use. The most common system today for determining this is the TNM (Tumor/Nodes/Metastases). This involves defining the size of the tumor, how many lymph nodes are involved, and whether there are any other metastases.
When defining with the TNM system, it is crucial to distinguish between cancers that are still restricted just to the prostate, and those that have spread elsewhere. Clinical T1 and T2 cancers are found only in the prostate, and nowhere else, while T3 and T4 have spread outside the prostate.
There are many ways to find out whether the cancer has spread. Computer tomography will check for spread inside the pelvis, bone scans will decide whether the cancer has spread to the bones, and endorectal coil magnetic resonance imaging will evaluate the prostatic capsule and the seminal vesicles.
symptoms of prostate cancer
During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:
- The patient urinates more often
- The patient gets up at night more often to urinate
- He may find it hard to start urinating
- He may find it hard to keep urinating once he has started
- There may be blood in the urine
- Urination might be painful
- Ejaculation may be painful (less common)
- Achieving or maintaining an erection may be difficult (less common)