Prostate disease

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The prostate gland is roughly the size and shape of a walnut and lies immediately under the bladder, surrounding the first two or three centimetres of the urine outlet tube (the urethra) in males. The front of the wall of the rectum is immediately behind the prostate, so it can easily be felt in the course of a rectal examination.

The function of the prostate gland is uncertain. It secretes a thin, milky, slightly alkaline fluid that constitutes about 10% of the seminal fluid, and makes the sperm more active. The fluid contains various substances such as citric acid, zinc, acid phosphatase and prostaglandins, but the need for most of these substances in this location is not known.

The prostate gland is involved in three main conditionsâ€“ prostatitis, benign enlargement and prostate cancer.

The effects of prostate enlargement usually begin to appear about the age of 55. About a quarter of men over 65 have moderate to severe symptoms from this cause.

Prostate enlargement is both a hyperplasia and a hypertrophy. In hyperplasia there is an actual increase in the number of cells in the organ. Hypertrophy means that cells themselves have got bigger. In benign enlargement the connective tissue and gland cells increase in number (hyperplasia) and the smooth muscle cells enlarge (hypertrophy).

The most important enlargement occurs mainly in the part of the gland surrounding the urethra, so that its effect is to compress and narrow the tube. As the gland gets bigger, the volume and force of the urine stream is reduced, so that it takes longer to empty the bladder.

In addition, the force required to push out the urine increases steadily. Eventually a point is reached at which the muscular wall of the bladder is not strong enough to achieve complete emptying. Because some urine is always left in the bladder, it means that it fills up again more quickly.

Bacterial prostatitis is an inflammation of the prostate gland. The inflammation can be severe and happen at once (acute prostatitis), or less severe, but never quite clear up (chronic prostatitis). Symptoms include pain, mainly at the base of the penis and around the anus.

Non-bacterial prostatitis, sometimes-called Chronic pelvic pain syndrome (CPPS) causes ongoing pain in the lower pelvic region. The cause is unknown.