Anatomy :

The prostate is an accessory gland of the male reproductive system. The secretion of this gland add bulk to the seminal fluid. The firmness is due to the presence of a dense fibromuscular stroma in which the glandular elements are embedded.In the female the prostate is represented by the paraurethral glands.The prostate lies in the lesser pelvis, below the neck of the urinary bladder, behind the lower part of the pubic symphysis and the upper part of the pubic arch and in fornt of the ampulla of the rectum.It resembles an inverted cone, measuring about 4cm transversely at the base(width),3c, vertocally(length) and 2cm anteroposteriorly (thickness),Its weights about 8gms. The prostate has and apex directed downwards.

The prostate has five lobes-anterior,posterior,median(middle) and right and left lateral.

1.The antirior lobe : is a small lobe connecting the two lateral lobes in front of the urethra,it contains little or no glandular tissue and therefore seldom forms an adenoma(An adenoma is a benign tumour arising from glandular tissue)

2.The postirior lobe : connects the two lateral lobes behind the urethra. It lies behind the median lobe and the ejaculatory ducts. Adenoma never occurs here,but primary carcinoma is said to begin in this part (carcinoma or cancer is a malignant tumour)

3.The median(middle ) lobe : lies behind the upper part of the urethra, in front of the ejaculatory ducts, just below the neck of the bladder. It produces an elevation in the lower part of the trigone of the bladder.It contains much glandular tissue and is a common site for an adenoma.

4.The lateral lobes : lie one on each side of the urethra. Each lobe contains glandular tissue from which an adenoma may arise in old age.

Age changes in the Prostrate :

At the birth the prostate is small in size and is made up mainly of stroma in which a simple duct system is embedded.

At Puberty, the male hormoneds bring about rapid changes in the gland in about one year, it becomes double its prepubertal sixe due to rapid gowth of the follicles.

From 20-30 years, there occurs marked proliferation of the glandular elements with infolding of the glandular epithelium into the lumen fo the follicles, making them irregular.

From 30 to 45 years, the size of the prostate remains constant and involution starts, the epithelial infoldings gradually disappear and amyloid bodies increase in number.

After 45 to 50 years, the prostate is either enlarged or reduced(senile atrophy) in size.This changes are progressive till death.

Causes of Prostastic Obstruction :

1.benign enlargement

2.carcinoma(cancer) of prostate

3.Fibrous prostate and bladder neck destrucitons

4.Acute prostatitis with or without abscess

Clinical features :

Benign prostate hypertrophy-

The age is usually above 55years and the onset is gradual.The main symptoms are frequency of micturition especially at night.The changes are usually affect the lateral or middle lobe.In the affected area there is hyperplasia of all the constituent elemnets of prostate.The enlargement ususally occurs upward and causs an intravesical projection which grows through the fibres of internal sphincter.In the middle lobe enlargement urethra above the prostatic utricle is lenghtened,narrowed and curved.In the lateral lobe enlargement urethra may be knked.The bladder is distended as it may not be empty, due to which there may be hydonephrosis or pyelitis and the obstruction to ejaculatory duct leading to sterility also.

Carcinoma of prostate :

diagnosis of carcinoma may be made after histology of clinically diagnosed benign enlargement.The patient complains of occasional perineal pain or discomfort apart from symptoms of prostatic obstruction.The rectal examination reveals a hard prostate.Patient may or may not present symptoms of prostatic obstruction but there is sciatica,oedema of legs with metastasis in bones.

The diagnosis can be done by serum acid phosphatase- the normal value of formol stable serum acid phosphatase is 1-3 K.A. units,above 5 units is almost diagnostic.

Treatment :

Benign Prostatic hypertrohy :

The removel of prostate by different type of operation depends on the hypertrophy, and is curative treatment.

Carcinoma Prostate :

Total radical prostatectomy by millin's approach with anastomosis of membranous urethra with base of bladder this is rarely possible only in early stage.

Pallative treatment- are orchicetomy to remove the source of androgen shoud be bilateral and either total or subcapsular.Stilboestrol therapy-it is starting with 5mgm tds and gradually increasing the dosage.Honvan-acid phosphatase of prostatic carcinoma cells split the phosphate element of honvan thus releasing oestrogen locally and helping its direct action on the carcinomatous cells.Radiotherapy - most suitable in anaplastic carcinoma.