Prostate

The prostate is an exocrine gland of the male reproductive system. In adults, it is about the size of a walnut, and has an average weight of about , usually ranging between . The prostate is located in the pelvis. It sits below the urinary bladder and surrounds the urethra. The part of the urethra passing through it is called the prostatic urethra, which joins with the two ejaculatory ducts. Zones are more typically able to be seen on histology, or in medical imaging, such as ultrasound or MRI. Blood and lymphatic vessels The prostate receives blood through the inferior vesical artery, internal pudendal artery, and middle rectal arteries. These vessels enter the prostate on its outer surface where it meets the bladder, and travel forward to the apex of the prostate. Basal cells surround the luminal epithelial cells in benign glands. The glands are formed as many follicles, which drain into canals and subsequently 12–20 main ducts. These in turn drain into the urethra as it passes through the prostate. Over time, thickened secretions called corpora amylacea accumulate in the gland. About 150 of these genes are more specifically expressed in the prostate, with about 20 genes being highly prostate specific. The corresponding specific proteins are expressed in the glandular and secretory cells of the prostatic gland and have functions that are important for the characteristics of semen, including prostate-specific proteins, such as the prostate specific antigen (PSA), and the prostatic acid phosphatase. Development In the developing embryo, at the hind end lies an inpouching called the cloaca. This, over the fourth to the seventh week, divides into a urogenital sinus and the beginnings of the anal canal, with a wall forming between these two inpouchings called the urorectal septum. The urogenital sinus divides into three parts, with the middle part forming the urethra; the upper part is largest and becomes the urinary bladder, and the lower part then changes depending on the biological sex of the embryo. Around the end of the third month of embryonic life, outgrowths arise from the prostatic part of the urethra and grow into the surrounding mesenchyme. Condensation of mesenchyme, urethra, and 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 (androgens), which are responsible for male sex characteristics. The main male hormone is testosterone, which is produced mainly by the testicles. It is dihydrotestosterone (DHT), a metabolite of testosterone, that predominantly regulates the prostate. The prostate gland enlarges over time, until the fourth decade of life. ==Function==

In ejaculation The prostate secretes fluid, which becomes part of the semen. Its secretion forms up to 30% of the semen. Semen is the fluid emitted (ejaculated) through the male urethra during the sexual response. The secretions of the prostate include proteolytic enzymes, prostatic acid phosphatase, fibrinolysin, zinc, and prostate-specific antigen. and is known to be the primary source of most metals found in semen, which are released during ejaculation. In urination The prostate's changes of shape, which facilitate the mechanical switch between urination and ejaculation, are mainly driven by the two longitudinal muscle systems running along the prostatic urethra. These are the urethral dilator (musculus dilatator urethrae) on the urethra's front side, which contracts during urination and thereby shortens and tilts the prostate in its vertical dimension thus widening the prostatic section of the urethral tube, and the muscle switching the urethra into the ejaculatory state (musculus ejaculatorius) on its backside. In stimulation It is possible for some men to achieve orgasm solely through stimulation of the prostate gland, such as via prostate massage or anal intercourse. This has led to the area of the rectal wall adjacent to the prostate to be popularly referred to as the "male G-spot". ==Clinical significance==

Inflammation showing inflamed prostate (H&E stain) with large amount of darker cells (leukocytes); area without inflammation seen on the left Prostatitis is inflammation of the prostate gland. It can be caused by infection with bacteria, or other noninfective causes. Inflammation of the prostate can cause painful urination or ejaculation, groin pain, difficulty passing urine, or constitutional symptoms such as fever or tiredness. When inflamed, the prostate becomes enlarged and is tender when touched during digital rectal examination. The bacteria responsible for the infection may be detected by a urine culture. Acute prostatitis and chronic bacterial prostatitis are treated with antibiotics. Chronic non-bacterial prostatitis, or male chronic pelvic pain syndrome is treated by a large variety of modalities including the medications alpha blockers, non-steroidal anti-inflammatories and amitriptyline, antihistamines, and other anxiolytics. psychotherapy, nerve modulators, and surgery. More recently, a combination of trigger point and psychological therapy has proved effective for category III prostatitis as well. Prostate enlargement An enlarged prostate is called prostatomegaly, with benign prostatic hyperplasia (BPH) being the most common cause. BPH refers to an enlargement of the prostate due to an increase in the number of cells that make up the prostate () from a cause that is not a malignancy. It is very common in older men. It is often diagnosed when the prostate has enlarged to the point where urination becomes difficult. Symptoms include needing to urinate often (urinary frequency) or taking a while to get started (urinary hesitancy). If the prostate grows too large, it may constrict the urethra and impede the flow of urine, making urination painful and difficult, or in extreme cases completely impossible, causing urinary retention. Over time, chronic retention may cause the bladder to become larger and cause a backflow of urine into the kidneys (hydronephrosis). BPH can be treated with medication, a minimally invasive procedure or, in extreme cases, surgery that removes the prostate. In general, treatment often begins with an alpha-1 adrenergic receptor antagonist medication such as tamsulosin, which reduces the tone of the smooth muscle found in the urethra that passes through the prostate, making it easier for urine to pass through. For people with persistent symptoms, procedures may be considered. The surgery most often used in such cases is transurethral resection of the prostate, in which an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. Minimally invasive procedures include transurethral needle ablation of the prostate and transurethral microwave thermotherapy. These outpatient procedures may be followed by the insertion of a temporary stent, to allow normal voluntary urination, without exacerbating irritative symptoms. Cancer Prostate cancer is one of the most common cancers affecting older men in the UK, US, Northern Europe and Australia, and a significant cause of death for elderly men worldwide. Often, a person does not have symptoms; when they do occur, symptoms may include urinary frequency, urgency, hesitation and other symptoms associated with BPH. Uncommonly, such cancers may cause weight loss, retention of urine, or symptoms such as back pain due to lesions that have spread outside of the prostate. A digital rectal examination and the measurement of a prostate-specific antigen (PSA) level are usually the first investigations done to check for prostate cancer. PSA values are difficult to interpret, because a high value might be present in a person without cancer, and a low value can be present in someone with cancer. The next form of testing is often the taking of a prostate biopsy to assess for tumour activity and invasiveness. Because of the significant risk of overdiagnosis with widespread screening in the general population, prostate cancer screening is controversial. If a tumour is confirmed, medical imaging such as an MRI or bone scan may be done to check for the presence of tumour in other parts of the body. Prostate cancer that is only present in the prostate is often treated with either surgical removal of the prostate or with radiotherapy or by the insertion of small radioactive particles of iodine-125 or palladium-103, called brachytherapy. Cancer that has spread to other parts of the body is usually treated also with hormone therapy, to deprive a tumour of sex hormones (androgens) that stimulate proliferation. This is often done through the use of GnRH analogues or agents (such as bicalutamide) that block the receptors that androgens act on; occasionally, surgical removal of the testes may be done instead. Cancer that does not respond to hormonal treatment, or that progresses after treatment, might be treated with chemotherapy such as docetaxel. Radiotherapy may also be used to help with pain associated with bony lesions. Sometimes, the decision may be made not to treat prostate cancer. If a cancer is small and localised, the decision may be made to monitor for cancer activity at intervals ("active surveillance") and defer treatment. If a person, because of frailty or other medical conditions or reasons, has a life expectancy less than ten years, then the impacts of treatment may outweigh any perceived benefits. Surgery Surgery to remove the prostate is called prostatectomy, and is usually done as a treatment for cancer limited to the prostate, or for prostatic enlargement. When it is done, it may be done as open surgery or as laparoscopic (keyhole) surgery. Usually the procedure for cancer is a radical prostatectomy, which means that the seminal vesicles are removed and the vasa deferentia are also tied off. ==History==

The prostate was first formally identified by Venetian anatomist Niccolò Massa in Anatomiae libri introductorius (Introduction to Anatomy) in 1536 and illustrated by Flemish anatomist Andreas Vesalius in Tabulae anatomicae sex (six anatomical tables) in 1538. The first time a word similar to prostate was used to describe the gland is credited to André du Laurens in 1600, who described it as a term already in use by anatomists at the time. A monograph, "Practical observations on the treatment of the diseases of the prostate gland" by Everard Home in 1811, was important in the history of the prostate by describing and naming anatomical parts of the prostate, including the median lobe. Prostate cancer was first described in a speech to the Medical and Chiurgical Society of London in 1853 by surgeon John Adams Prostate cancer was initially considered a rare disease, probably because of shorter life expectancies and poorer detection methods in the 19th century. The first treatments of prostate cancer were surgeries to relieve urinary obstruction. Samuel David Gross has been credited with the first mention of a prostatectomy, as "too absurd to be seriously entertained" In 1941, Charles B. Huggins published studies in which he used estrogen to oppose testosterone production in men with metastatic prostate cancer. This discovery of "chemical castration" won Huggins the 1966 Nobel Prize in Physiology or Medicine. The role of the gonadotropin-releasing hormone (GnRH) in reproduction was determined by Andrzej W. Schally and Roger Guillemin, who both won the 1977 Nobel Prize in Physiology or Medicine for this work. GnRH receptor agonists, such as leuprorelin and goserelin, were subsequently developed and used to treat prostate cancer. Radiation therapy for prostate cancer was first developed in the early 20th century and initially consisted of intraprostatic radium implants. External beam radiotherapy became more popular as stronger X-ray radiation sources became available in the middle of the 20th century. Brachytherapy with implanted seeds (for prostate cancer) was first described in 1983. Systemic chemotherapy for prostate cancer was first studied in the 1970s. The initial regimen of cyclophosphamide and 5-fluorouracil was quickly joined by multiple regimens using a host of other systemic chemotherapy drugs. ==Other animals==

The prostate is found only in mammals. The prostate glands of male marsupials are proportionally larger than those of placental mammals. The presence of a functional prostate in monotremes is controversial, and if monotremes do possess functional prostates, they may not make the same contribution to semen as in other mammals. The structure of the prostate varies, ranging from tubuloalveolar (as in humans) to branched tubular. The gland is particularly well developed in carnivorans and boars, though in other mammals, such as bulls, it can be small and inconspicuous. In other animals, such as marsupials and small ruminants, the prostate is disseminate, meaning not specifically localisable as a distinct tissue, but present throughout the relevant part of the urethra; in other animals, such as red deer and American elk, it may be present as a specific organ and in a disseminate form. In some marsupial species, the size of the prostate gland changes seasonally. The prostate is the only accessory gland that occurs in male dogs. Dogs can produce in one hour as much prostatic fluid as a human can in a day. They excrete this fluid along with their urine to mark their territory. Additionally, dogs are the only species apart from humans seen to have a significant incidence of prostate cancer. The prostate is the only male accessory gland that occurs in cetaceans, consisting of diffuse urethral glands surrounded by a very powerful compressor muscle. The prostate gland originates with tissues in the urethral wall. This means the urethra, a compressible tube used for urination, runs through the middle of the prostate; enlargement of the prostate can constrict the urethra so that urinating becomes slow and painful. Prostatic secretions vary among species. They are generally composed of simple sugars and are often slightly alkaline. In eutherian mammals, these secretions usually contain fructose. The prostatic secretions of marsupials usually contain N-Acetylglucosamine or glycogen instead of fructose. ==Skene's gland==

Because the Skene's gland and the male prostate act similarly by secreting prostate-specific antigen (PSA), which is an ejaculate protein produced in males, and of prostate-specific acid phosphatase, the Skene's gland is sometimes referred to as the "female prostate". Although homologous to the male prostate (developed from the same embryological tissues), various aspects of its development in relation to the male prostate are widely unknown and a matter of research. ==See also==