Prostate Pathology

Hello! I'm going to follow up on last week's post and get into what sort of issues a man's prostate can develop (by the way, if you're curious about what the female prostate equivalent is, that would be the Skene's gland. It's thought to play a role in female ejaculation. Neat stuff, right?). 

So what kind of problems can a prostate have? There's three of importance- inflammation, benign nodular enlargement (benign prostatic hyperplasia, BPH), and prostate tumours. BPH is by far the most common process of the three and can almost be thought of as a normal part of the aging process (90% of men have it by age 70).  Let's take a quick look at these three issues. 

Prostatitis

Inflammation of the prostate occurs in three different forms- acute bacterial, chronic bacterial and chronic abacterial. 

Acute bacterial is often going to be caused by E. coli or another gram negative rod organism. How does it happen? Usually it's from urinary reflux (urine goes back up the tube instead of down) but it may also seed through lymph and blood vessel routes. A person experiencing this might have fevers, chills, low back pain and painful urination. 

Chronic bacterial can occur through the same mechanisms as above and this person may also have a history of urinary tract infections. Antibiotics penetrate the prostate rather poorly so overtime those bugs can find a safe haven in the prostate and cause problems. This person may have low back pain, painful urination and pelvic pain, but they may also be asymptomatic. 

Chronic abacterial is the most common of these three, and it is indistinguishable from chronic bacterial but there will be no history of UTIs and any bacterial culture tests done will come up negative. 

Benign Prostatic Hyperplasia

This is a very common problem that happens in the majority of men if they live long enough- 20% of men under 40 have it, 70% of men by 60 and 90% of men by 70 will have this in some way; however, not everyone will have symptoms. The prostatic regions surrounding the urethra will start to compress it (or completely obstruct it) and cause lower urinary tract symptoms (LUTS) like hesitation, straining, weak flow, a sense that the bladder didn't empty, dribbling, painful urination, increased frequency and urgency. Retention of urine can become a serious problem if untreated, resulting in kidney damage, bladder stones, UTIs, blood in the urine and incontinence. 

How does this happen? It is mostly related to testosterone and its metabolite dihydrotestosterone (DHT), which spurs prostatic growth. Testosterone is converted to DHT in the prostate by 5-alpha-reductase which then signals growth in the area. 

Risk factors for BPH include aging (obviously), family history of BPH, obesity, hypertension, low HDL (the 'good' cholesterol), diabetes and low physical activity. 

Carcinoma of the Prostate

This is the most common form of cancer in men, and the second most deadly cancer for men in North America (behind lung cancer)- it is estimated that 66 Canadian men will be diagnosed with prostate cancer every day, and 11 Canadian men will die from it every day. Prostate cancer usually develops in the peripheral zone of the prostate (which makes it palpable on a digital rectal exam). 

This is an adenocarcinoma (meaning it is derived from glandular tissue) and spreads throughout the prostate first before going to other areas of the body. Some common places for it to spread are bony metastases on the lumbar spine, femur, pelvic, thoracic spine and ribs, the rectum and seminal vesicle, lymph nodes around the pelvic and sometimes to the visceral organs. 

In 85-90% of the cases, this cancer will be slow growing and many men will die with it, not from it. The 5-year survival for all stages of prostate cancer is nearly 100%, the 10-year survival rate is 99% and the 15-year survival rate is 94%. The issue is when a men is in the 10-15% of those cases that involve an aggressive cancer. If a man is diagnosed with a Stage IV cancer (meaning it has spread to other areas of the body), the 5-year survival rate is way down to 28%. 

The risk factors and the initial signs and symptoms are very similar to BPH, which is why the DRE is an important test to have done. A DRE is recommended to be done at least by the time you are 50, and if you have prostate cancer in your family history, usually around 40. Traditionally, the DRE and a PSA test have been what we relied on to investigate whether or not a man has prostate cancer, but as this article explains, sometimes the treatment is worse than the disease itself. 

There is far more information to learn about for all of these pathologies, and if you're interested I recommend checking out Prostate Cancer Canada, The Canadian Cancer Society, or even start on the Wikipedia Prostate Page and click your way down the rabbit hole into all sorts of interesting stuff. 

Thanks for reading! Next up I'll post some info on prevention and ideas for treatment!