THE PROSTATE IN HEALTH AND

DISEASE

When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in tunics of the arteries, the joints begin to ache, at the same period the prostate gland usually—I might perhaps say invariably—becomes increased in size. (Sir Benjamin Brodie ).

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AND GOD SAYS….

…I WISH ABOVE ALL, THAT YOU PROSPER AND BE IN HEALTH.(3 JOHN 2)

WHO’s Definition Of Health

“Health…Not merely the absence of disease, but a

state of physical, emotional and social well-

being”

The Prostate and its function•The prostate (Greek προστατης, protector or guardian) is an exocrine gland of the male reproductive system•The main function is to store and secrete a clear and slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that, along with spermatozoa, constitutes semen

•The prostate also contains smooth muscles that help expel semen during ejaculation•In a healthy man the prostate has the size of a walnut•The function of the prostate is depending on hormones (androgens), which are responsible for the male sex characteristics

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PHYSIOLOGY•Conduit …urine & spermatozoa.•Secretions…enzymes, citric acid, zinc, 70% of semen.•Endocrine, neurological control•Growth factors, apoptosis

AGING AND MEN.•ANDROPAUSE•ERECTILE DYSFUNCTION•BPH•PROSTATE CANCER

PROSTATIC DISEASE•Benign Prostatic Hyperplasia (BPH) / BPE•Cancer of the Prostate•PROSTATITIS

Normal

Anatomy of BPHBPH

Hypertrophied detrusor muscle

Obstructed urinary flow

Prostate

Bladder

Urethra

Adapted from Kirby RS et al. Benign Prostatic Hyperplasia. Health Press, Oxford, 1999

EPIDEMIOLOGY

•Age•Global•Religion•Socioeconomic class•Sexual activity•Alcohol , liver disease•Diet, obesity, BMI, medications, smoking, HBP

BPH is a very frequent condition in ageing men

It is the most common benign tumour in men.

It is characterised by bothersome symptoms which are experienced with increasing age

0%

20%

50%

90%

< 30 years 41-50 years 51-60 years > 80 years

Prevalence of histological BPH

Clinical features

•LUTS•COMPLICATIONS…UTI, stone, AUR, upper tract deterioration, haematuria, sexual dysfunction,

The Lower Urinary Tract Symptoms (LUTS)

FILLING/STORAGE

Frequency

Urgency

Nocturia

Dysuria

VOIDING

Hesitancy

Poor urinary stream

Intermittent stream

Terminal dribbling

Feeling ofincomplete emptying

BPH has a significant impact on Quality of Life (QoL)

75% of BPH patientsfelt impact on their QOL.

31% of BPH patientsconsidered their sexual

function affected.

Evaluation •History •Physical examination•PSA•Urine•Electrolytes, urea, creatinine•Imaging•Uroflowmetry, Urodynamic, IPSS, •Others…FBC, FBS,ECG.…CXRAY, ETC.•ULTRSOUND, CTSCAN, BONE SCAN,MRI

Current treatments

Watchful waiting

Alpha-blockers

5-alpha-reductase inhibitors (5ARIs)

Combination therapy

Phytotherapy

Minimally invasive techniques

Surgery

Recommended?

EAU BPH guidelines. Madersbacher S et al. Eur Urol 2004; 46: 547–554

√

√

√

√

x

√

√

BPH treatment goals•Symptom relief

•QoL improvements

•Reduction of BPH complications

EAU BPH guidelines. Madersbacher S, et al. Eur Urol 2004;46:547–54

TREATMENT OPTIONS•WAWA•MEDICAL•SURGICAL•MINIMAL ACCESS•PHYTOTHERAPY

CANCER OF THE PROSTATE

FactsProstate cancer is the second

commonest cancer in men after Skin (USA)

Inherited prostate cancer accounts for 10% of all prostate cancer

40% of patients with diagnosed CaP Nigeria....127-134 / 100,000.

RISK •Male•Age …50 years and above•Race ….Africans, African-Americans•Family….father, brother, son with Cancer of the Prostate •Food…..Rich in animal fats.•Alcoholic beverages..•? Infection…Human papiloma virus

Prostate cancer is different•Lack of symptoms in early casesOnly active testing will lead to the detection when still localised•The extremely variable course Some patients may have indolent cancer and end up receiving unnecessary treatment•Different ways of managing it.There are many different and effective options

Perceived Cause of Disease and Health Seeking Behaviour.•Superstition•Untrained attendants [non-medical]•No culture of prevention / routine screening•Ignorance

•Late presentation

MOST COMMON MODES OF PRESENTATION

•Clinical•Metastatic

*backache *paraplegia/paraesis *pathological fractures *unexplained anaemia

LatentOccultIncidental

BURDEN •Large population of patients•Often lack of infrastructure to care for the large population.•Care givers.•Economic Burden....direct and indirect costs•Psychological ....patient & Care givers./ spouses•Prostate cancer foundation...indigent PTS

Three ways to decrease the death rate from CAP

•Prevention•Early detection and treatment•Successful treatment of advanced disease.

Prevention of prostate cancer•DietLycopene rich diet ( tomato, soya beans, melons)•DrugsFinastride / dutastride ( 5alpha reductase inhibitors)

No conclusive evidence

SCREENING •Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

•Why do we have certain cancers? what things around us cause them?•It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

•Some screening tests are used because they have been shown to be helpful both in finding cancers early and decreasing the chance of dying from these cancers•Screening tests for Cancer of the prostates include: Digital Rectal examination, Prostate Specific Antigen(PSA), ??TRUSS; ?? Biopsy of the prostate.

•"A cancer cannot be treated if it is not detected. Not all prostate cancers require immediate treatment; active surveillance, in lieu of immediate treatment, is an option that should be considered for some men. Testing empowers patients and their urologists with the information to make an informed decision”…..AUA, 2009

What to do!•SCREENING•ACTIVE SURVEILANCE•EARLY STAGE•ADVANCED STAGE•RADIOTHERAPY•RADICAL SURGERY•PALLIATION vs. CURE

Conclusion•My people perish because of lack of knowledge….Hosea 4:6•ROUTINE PERIODIC ASSESSMENT•EARLY DIAGNOSIS AND APPROPRIATE TREATMENT RESULTS IN CURE AND IMPROVEMENT OF QUALITY OF LIFE

PROSTATITIS •ACUTE•CHRONIC•FEATURES•DIAGNOSIS•TREATMENT•OUTCOME OF TREATMENT• STONES.