The
prostate is a chestnut-shaped gland of the male
reproductive system and is about the size of a
walnut. The prostate is located in front of the
rectum and just below the bladder, and surrounds the
beginning of the _urethra (the tube that carries
urine and semen out of the body).
The main
purpose of the prostate is to produce fluid for
semen, which transports sperm during the male
orgasm, and to protect the bladder against bacterial
invasion. The nerves involved in penile erection are
located posteriorly on each side of the prostate
gland. Therefore, the prostate is also considered to
be an accessory sex organ.
The prostate
normally increases in size around the age of puberty
and then usually remains constant until the age of
45 to 50 years, at which time it may begin to
undergo varying degrees of enlargement stimulated by
rising levels of the male hormone testosterone. This
non-cancer-related process is called benign
prostatic hyperplasia (BPH) and can cause urinary
problems in older men. Approximately 33% of men over
the age of 50 have BPH.
The prostate can
also develop cancer. Carcinoma of the prostate is
the most commonly diagnosed male malignancy in the
U.S. Because it grows so slowly, it often produces
no symptoms and men often die of other causes before
the cancer becomes an issue. Early detection is the
key to successful treatment with a 5-year survival
rate of greater than 80%.
In general,
prostate cancers grow very slowly. It is known that
the growth rate of prostate cancers increases in
response to the presence of male hormones
(androgens). Therefore, several treatments are
targeted at reducing or eliminating androgens in the
body.
In its advanced stages, prostate
cancer can spread (metastasize) to other parts of
the body including the lymph nodes, bone, spine,
liver, lungs, adrenal glands and the brain.
The
first decision in the management of patients with
prostate cancer is how aggressively the cancer is to
be treated. Aggressive treatment usually includes
surgery, radiation, and/or hormonal therapy. Less
aggressive therapy may consist of hormone therapy
alone, either at the time of diagnosis or later,
when symptoms appear.
The decision to
aggressively evaluate and treat a prostate cancer
depends on several factors, including age, life
expectancy, general health status, stage of the
tumor, the desire to maintain erectile function, the
individual wishes of the man regarding the desire
for cure versus palliation.
It is
important to learn as much as possible about all
available treatment options and the potential
effects on sexual functioning, continence, and other
aspects of life, so that the most appropriate
decision can be made for the individual.
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