Prostate Basics
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 Introduction:

The prostate is a gland, actually an organ, which is comprised of glandular and muscular tissue with ducts opening into the prostatic portion of the urethra in the male reproductive system. It produces some of fluid that makes up the semen, the thick fluid that carries sperm. The muscular tissue provides the force to push the ejaculation through the penis. Normally a walnut-sized gland, the prostate is located beneath a man’s bladder. The upper part of the urethra, which carries urine from the bladder, passes through the prostate. Prostate function is regulated by testosterone, a male sex hormone produced mainly in the testicles.

Key Concepts:

What is cancer?

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymphatic systems. For a detailed discussion, see: The National Cancer Institute website.

What is prostate cancer?

Prostate cancer is a malignant growth which usually starts in the glandular cells of the prostate. This type of cancer is known as adenocarcinoma. Prostate cancer is normally slow growing but some variants can be very aggressive. If left untreated, tumors can extend beyond the prostate into surrounding tissue. Prostate cancer cells can also spread via the blood and lymph systems to pelvic bones and/or lymph nodes, or beyond.

What other conditions affect the prostate?

  • Benign prostatic hyperplasia (BPH) – a common urological condition caused by the non-cancerous enlargement of the prostate gland in aging men. BPH usually starts in the middle of the prostate and can squeeze the urethra. This can cause men to have trouble urinating leading to the symptoms of BPH, also known as lower urinary tract symptoms (LUTS). For more information on BPH and to calculate Complete AUA Score – See our article: Prostate Disorders Other than Cancer – Part 2.
  • Prostatitis – an infection or inflammation of the prostate gland treatable by medication and/or manipulation. Lots of men have prostatitis with or without prostate cancer.  It can cause urinary symptoms (LUTS) similar to BPH and also may cause pain during a Digital Rectal Exam (DRE).  It often causes pain or burning sensation during urination, a sensation of a full bladder, loss of erection, burning during ejaculation or discolored semen. If a biopsy is done, the Pathologist could test for evidence of the inflammation on the biopsy slides. Even checking what is called EPS (Expressed Prostatic Secretions – drops released during DRE) is worthwhile. EPS can tell us if there is a high probability of prostatitis by microscopically and bacteriologically examining prostatic fluid expressed during gentle prostatic massage. Prostatitis is normally treated with antibiotics for about 30 days.  Chronic Prostatitis is not normally a serious health risk. However, there is some evidence that inflammation in the prostate may be a precursor to Proliferative Inflammatory Atrophy (PIA) and Prostatic Intraepithelial Neoplasia (PIN) which can be precursors to prostate cancer. With severe prostatitis that is not resolved with antibiotics, there is no way to know how much of the PSA elevation is caused by the infection or by the cancer. There are several other treatments for prostatitis, depending on the type of infection. See our article: Prostate Disorders Other than Cancer – Part 1.
  • Proliferative Inflammatory Atrophy (PIA) – chronic inflammatory prostate lesions in the prostate that may be a precursor to PIN or prostate cancer
  • Prostatic Intraepithelial Neoplasia (PIN) –a microscopic lesion in the prostate. PIN is classified as low-grade or high-grade. HG-PIN is thought to be a pre-cancerous cells.
  • Atypical small acinar proliferation (ASAP), also called atypia – cells that look like they might be cancerous when viewed under the microscope, but there are too few of them on the slide to be sure. According to ACS, if ASAP is found, there’s about a 40% to 50% chance that cancer is also present in the prostate.
  • Calcifications in the prostate – sometimes felt on rectal exam. They are common and might be related to prior inflammation in the prostate.

Page updated 8/1/11