Functions of the prostate

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-Definition:

It is a sexual accessory gland to the male reproductive system whose shape and size resembles, in young adults, a chestnut or walnut, weighing approximately between 12 and 20 grams. It is located below the bladder, next to the beginning of the urethra, which surrounds behind the pubis and in front of the anal canal.
Its conformation resembles a sponge, formed by thousands of small cavities where a secretion is formed, and through multiple very fine ducts, is poured into the so-called prostatic urethra.It is important that the prostatic fluid helps neutralize the acidity of the vagina after ejaculation and facilitates the mobility and fertility of sperm.
It consists of three well-differentiated zones: the cranial zone and the intermediate zone, generally the seat of benign growth processes, and the caudal zone, the most common location of malignant processes.
Its development and growth, which begins at puberty, is under the control of male sex hormones (testosterone). All mammals have a prostate, but only in men and in canine species, can the pathological processes of benign hyperplasia and cancer develop.

How it works:

The prostate gland produces a secretion that constitutes 25% of the volume of semen, being a fluid that protects sperm. The secretion consists of enzymes such as prostate-specific antigen (often abbreviated as PSA) and mainly zinc, prostaglandins, citrates, acid phosphatase, magnesium, fibrinolysine and spermine mainly. .
During ejaculation, the prostate contracts and pours its secretion into the prostatic urethra, where it mixes with the secretions of the seminal vesicles and vas deferens to form semen. In other words, the prostate plays a very important role in fertility and any pathological process that may damage it will affect the male’s reproductive capacity.
During orgasm, sperm are transmitted from the vas deferens to the urethra through the ejaculatory ducts that enter the prostate. Men are able to ejaculate by stimulating the prostate through a prostate massage.

-Diseases of the prostate:

The most common diseases are benign prostatic hyperplasia, prostate cancer and acute or chronic prostatitis:
Prostatitis: An inflammation that may or may not be infectious. It can produce symptoms of urinary tract infection, but with negative urine cultures. Acute prostatitis can be caused by sexually transmitted diseases.
They often have many symptoms and even a fever. Chronic prostatitis usually settles in the large prostate glands of people over 50 with benign prostatic hypertrophy. Symptoms usually go unnoticed. Antibiotic treatment usually lasts for weeks in prostatitis.
Benign prostatic hyperplasia: (BPH) or prostatic adenoma. It is not cancer, but the growth of the organ until its volume increases. These are normal changes in the prostate in men as they ageing. It can cause symptoms of bladder irritation, such as urgency to urinate, decreased force in the urine stream, or repeated urination, this is called prostatism.
It has different complications, such as repeated urinary tract infections, complete urinary retention, kidney failure, hematuria, and bladder lithiasis. Treatments with alpha-blocking drugs up to surgery, including transurethral resection of the prostate .
Prostate cancer: It is very common in men. Studies corroborate its presence in older men through a prostate biopsy. There may be a genetic basis and its frequency increases from 45 to 50 years.
In the majority of men it evolves gradually without the cancer affecting their quality of life. in recent decades, prostate cancer has become the most frequent neoplasms in both Europe and the United States and its incidence has been progressively increasing. In the USA, it is currently the second leading cause of cancer death in men, and the situation is similar in Europe.
The concept of “grey zone” defines the group of patients with PSA values between 4.0 and 10.0. A PSA concentration of less than 4.0 micrograms/L does not definitively exclude the possibility of prostate cancer either.
The total free PSA/PSA ratio is of particular interest when deciding on the need for a biopsy in the gray zone of PSA. Prostate biopsy is recommended not only when the PSA concentration is greater than 10 ng/ml or the rectal examination is suspicious, but also in patients with a PSA concentration between 4.0 and 10 ng/ml and a free PSA percentage lower than the discriminatory value, which depending on the measurement technology used may vary slightly, a ratio greater than 0.13 is generally indicative of the absence of prostate carcinoma.
In addition to the total and free PSA marker, transrectal ultrasound may also be used. The probe is used to bounce ultrasound waves off internal tissues of the prostate and create echoes. The echoes form an image of body tissues. Transrectal ultrasound may be used to perform a biopsy.
In a few cases, the cancer is aggressive. Depending on the stage of the neoplasm, treatments vary, from surgery and radiation therapy for curative purposes to palliative treatments with hormone therapy, usually the treatment, is accompanied by long-acting LHRH analogs, which will cause a chemical castration, is an injectable every 6 months. If this is no longer effective, an antiandrogen medication and chemotherapy are added.
Several promising new drugs against prostate cancer are currently being tested, including vaccines, monoclonal antibodies, and other recent types of drugs.

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