![Page 1: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/1.jpg)
THE PROSTATE IN HEALTH AND
DISEASE
![Page 2: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/2.jpg)
When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in tunics of the arteries, the joints begin to ache, at the same period the prostate gland usually—I might perhaps say invariably—becomes increased in size. (Sir Benjamin Brodie ).
2
![Page 3: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/3.jpg)
AND GOD SAYS….
…I WISH ABOVE ALL, THAT YOU PROSPER AND BE IN HEALTH.(3 JOHN 2)
![Page 4: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/4.jpg)
WHO’s Definition Of Health
“Health…Not merely the absence of disease, but a
state of physical, emotional and social well-
being”
![Page 5: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/5.jpg)
The Prostate and its function•The prostate (Greek προστατης, protector or guardian) is an exocrine gland of the male reproductive system•The main function is to store and secrete a clear and slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that, along with spermatozoa, constitutes semen
![Page 6: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/6.jpg)
![Page 7: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/7.jpg)
•The prostate also contains smooth muscles that help expel semen during ejaculation•In a healthy man the prostate has the size of a walnut•The function of the prostate is depending on hormones (androgens), which are responsible for the male sex characteristics
![Page 9: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/9.jpg)
PHYSIOLOGY•Conduit …urine & spermatozoa.•Secretions…enzymes, citric acid, zinc, 70% of semen.•Endocrine, neurological control•Growth factors, apoptosis
![Page 10: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/10.jpg)
AGING AND MEN.•ANDROPAUSE•ERECTILE DYSFUNCTION•BPH•PROSTATE CANCER
![Page 11: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/11.jpg)
PROSTATIC DISEASE•Benign Prostatic Hyperplasia (BPH) / BPE•Cancer of the Prostate•PROSTATITIS
![Page 12: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/12.jpg)
Normal
Anatomy of BPHBPH
Hypertrophied detrusor muscle
Obstructed urinary flow
Prostate
Bladder
Urethra
Adapted from Kirby RS et al. Benign Prostatic Hyperplasia. Health Press, Oxford, 1999
![Page 13: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/13.jpg)
EPIDEMIOLOGY
•Age•Global•Religion•Socioeconomic class•Sexual activity•Alcohol , liver disease•Diet, obesity, BMI, medications, smoking, HBP
![Page 14: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/14.jpg)
BPH is a very frequent condition in ageing men
It is the most common benign tumour in men.
It is characterised by bothersome symptoms which are experienced with increasing age
0%
20%
50%
90%
< 30 years 41-50 years 51-60 years > 80 years
Prevalence of histological BPH
![Page 15: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/15.jpg)
Clinical features
•LUTS•COMPLICATIONS…UTI, stone, AUR, upper tract deterioration, haematuria, sexual dysfunction,
![Page 16: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/16.jpg)
The Lower Urinary Tract Symptoms (LUTS)
FILLING/STORAGE
Frequency
Urgency
Nocturia
Dysuria
VOIDING
Hesitancy
Poor urinary stream
Intermittent stream
Terminal dribbling
Feeling ofincomplete emptying
![Page 17: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/17.jpg)
BPH has a significant impact on Quality of Life (QoL)
75% of BPH patientsfelt impact on their QOL.
31% of BPH patientsconsidered their sexual
function affected.
![Page 18: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/18.jpg)
Evaluation •History •Physical examination•PSA•Urine•Electrolytes, urea, creatinine•Imaging•Uroflowmetry, Urodynamic, IPSS, •Others…FBC, FBS,ECG.…CXRAY, ETC.•ULTRSOUND, CTSCAN, BONE SCAN,MRI
![Page 19: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/19.jpg)
Current treatments
Watchful waiting
Alpha-blockers
5-alpha-reductase inhibitors (5ARIs)
Combination therapy
Phytotherapy
Minimally invasive techniques
Surgery
Recommended?
EAU BPH guidelines. Madersbacher S et al. Eur Urol 2004; 46: 547–554
√
√
√
√
x
√
√
![Page 20: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/20.jpg)
BPH treatment goals•Symptom relief
•QoL improvements
•Reduction of BPH complications
EAU BPH guidelines. Madersbacher S, et al. Eur Urol 2004;46:547–54
![Page 21: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/21.jpg)
TREATMENT OPTIONS•WAWA•MEDICAL•SURGICAL•MINIMAL ACCESS•PHYTOTHERAPY
![Page 22: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/22.jpg)
CANCER OF THE PROSTATE
![Page 23: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/23.jpg)
FactsProstate cancer is the second
commonest cancer in men after Skin (USA)
Inherited prostate cancer accounts for 10% of all prostate cancer
40% of patients with diagnosed CaP Nigeria....127-134 / 100,000.
![Page 24: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/24.jpg)
RISK •Male•Age …50 years and above•Race ….Africans, African-Americans•Family….father, brother, son with Cancer of the Prostate •Food…..Rich in animal fats.•Alcoholic beverages..•? Infection…Human papiloma virus
![Page 25: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/25.jpg)
Prostate cancer is different•Lack of symptoms in early casesOnly active testing will lead to the detection when still localised•The extremely variable course Some patients may have indolent cancer and end up receiving unnecessary treatment•Different ways of managing it.There are many different and effective options
![Page 26: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/26.jpg)
Perceived Cause of Disease and Health Seeking Behaviour.•Superstition•Untrained attendants [non-medical]•No culture of prevention / routine screening•Ignorance
•Late presentation
![Page 27: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/27.jpg)
MOST COMMON MODES OF PRESENTATION
•Clinical•Metastatic
*backache *paraplegia/paraesis *pathological fractures *unexplained anaemia
LatentOccultIncidental
![Page 28: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/28.jpg)
BURDEN •Large population of patients•Often lack of infrastructure to care for the large population.•Care givers.•Economic Burden....direct and indirect costs•Psychological ....patient & Care givers./ spouses•Prostate cancer foundation...indigent PTS
![Page 29: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/29.jpg)
Three ways to decrease the death rate from CAP
•Prevention•Early detection and treatment•Successful treatment of advanced disease.
![Page 30: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/30.jpg)
Prevention of prostate cancer•DietLycopene rich diet ( tomato, soya beans, melons)•DrugsFinastride / dutastride ( 5alpha reductase inhibitors)
No conclusive evidence
![Page 31: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/31.jpg)
SCREENING •Screening is looking for cancer before a person has any symptoms. This can help find cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.
![Page 32: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/32.jpg)
•Why do we have certain cancers? what things around us cause them?•It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.
![Page 33: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/33.jpg)
•Some screening tests are used because they have been shown to be helpful both in finding cancers early and decreasing the chance of dying from these cancers•Screening tests for Cancer of the prostates include: Digital Rectal examination, Prostate Specific Antigen(PSA), ??TRUSS; ?? Biopsy of the prostate.
![Page 34: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/34.jpg)
•"A cancer cannot be treated if it is not detected. Not all prostate cancers require immediate treatment; active surveillance, in lieu of immediate treatment, is an option that should be considered for some men. Testing empowers patients and their urologists with the information to make an informed decision”…..AUA, 2009
![Page 35: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/35.jpg)
What to do!•SCREENING•ACTIVE SURVEILANCE•EARLY STAGE•ADVANCED STAGE•RADIOTHERAPY•RADICAL SURGERY•PALLIATION vs. CURE
![Page 36: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/36.jpg)
Conclusion•My people perish because of lack of knowledge….Hosea 4:6•ROUTINE PERIODIC ASSESSMENT•EARLY DIAGNOSIS AND APPROPRIATE TREATMENT RESULTS IN CURE AND IMPROVEMENT OF QUALITY OF LIFE
![Page 37: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/37.jpg)
PROSTATITIS •ACUTE•CHRONIC•FEATURES•DIAGNOSIS•TREATMENT•OUTCOME OF TREATMENT• STONES.
![Page 38: THE PROSTATE IN HEALTH AND DISEASE. When the hair becomes grey and scanty, the eyes begin to dim, when specks of earthy matter begin to be deposited in](https://reader036.vdocuments.us/reader036/viewer/2022062422/56649e705503460f94b6de5e/html5/thumbnails/38.jpg)