Prostate

The prostate is a gland belonging to the male reproductive system.

Its main functions include :

• Producing prostatic fluid, which is stored in the seminal vesicles (located behind the bladder). This fluid combines with seminal fluid (produced by the seminal vesicles) and sperm (produced by the testes) to form semen. Prostatic secretions account for approximately 20% of the total semen volume, contributing to sperm survival, mobility, and resistance to vaginal acidity.
• Releasing enzymes in the prostatic fluid to facilitate sperm penetration through the cervical mucus.
• Preventing the mixing of urine and semen by sealing the urethra during ejaculation.
• Blocking urine from flowing into the seminal vesicles during urination.
• Converting a portion of testosterone into an active metabolite, dihydrotestosterone (DHT), which plays a hormonal role.

The prostate is located beneath the bladder, in front of the rectum. In young men, it is roughly the size of a plum. The prostate consists of two main regions :

• A central part surrounding the urethra.
• A more peripheral part.

This gland is composed of lobules, which contain supportive tissue made up of smooth muscle fibers, blood vessels, nerve endings, and glandular structures responsible for secreting prostatic fluid.

The prostate surrounds the prostatic urethra, which extends from the bladder neck to the external sphincter, allowing urine to pass from the bladder out of the body. This portion of the urethra is enclosed by two sphincters (muscular rings): one at the entrance and one at the exit.

It is also connected to the seminal vesicles via ejaculatory ducts that open into the posterior part of the prostatic urethra.

The prostate is affected by three main conditions :

• Prostate cancer
• Benign prostatic hyperplasia (BPH)
• Prostatitis

Prostate Cancer

Prostate cancer is the most common cancer in men. Diagnosis and treatment depend on several factors, but the prognosis is generally favorable, particularly when detected early.

Prostate cancer is usually an adenocarcinoma (90% of cases), most commonly arising in the peripheral posterior zone of the gland.

Symptoms often include hematuria (blood in the urine) and/or urinary obstruction accompanied by pain. Diagnosis is suggested through a digital rectal exam and prostate-specific antigen (PSA) testing, and confirmed via transrectal ultrasound-guided biopsy.

Treatment options vary depending on the case and may include total prostatectomy, radiotherapy, or hormone therapy.

Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH) is an abnormal enlargement of the prostate gland. This increase in volume primarily affects the glandular tissue surrounding the urethra.

Symptoms typically include urinary obstruction, such as weak urinary stream, difficulty initiating urination, frequent urination (pollakiuria), and nocturnal urination (nycturia).

Diagnosis is primarily based on a digital rectal exam, cystoscopy, transrectal ultrasound, and urodynamic studies. Treatment options include 5-alpha reductase inhibitors, alpha-blockers, tadalafil, and surgical interventions.

Prostatitis

Prostatitis refers to various prostate disorders that cause a combination of urinary symptoms, including irritation, obstruction, and perineal pain.

Some chronic prostatitis cases result from bacterial infections, while others the most common form are associated with non-infectious inflammatory factors and/or pelvic floor muscle spasms.

Diagnosis involves a urine culture test before and after a prostate massage.

Treatment depends on the cause: bacterial prostatitis is treated with antibiotics, while non-bacterial prostatitis may be managed with warm sitz baths, muscle relaxants, anti-inflammatory drugs, or anxiolytics.