Posts Tagged ‘Prostate Cancer 20/20’

The Prostate Gland: Man’s Center of Gravity

February 16, 2019

Andrew Siegel MD  2/16/19

This entry can be considered to be “Prostate 101: Introductory Level.”  The prostate gland is a mysterious male reproductive organ that can be a source of curiosity, anxiety, fear and potential trouble. Since this gland is a midline organ nestled deep within the pelvis, I like to think of it as man’s “center of gravity.”  

Center_of_pressure_in_relation_to_center_of_gravity_while_off_balance

Attribution: Jasper.o.chang [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D; image unmodified; COG = center of gravity, COP = center of pressure

Where exactly is the prostate gland?

The prostate gland is located behind the pubic bone and is attached to the bladder above and the urethra below. The rectum is directly behind the prostate (which permits access for prostate exam).  The prostate is situated at the crossroads of the urinary and reproductive tracts and completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of problems for the older male. With the aging process, this gland gradually enlarges and as it does so, this prostate enlargement can compress and obstruct the urethra, giving rise to bothersome urinary symptoms.  Note normal prostate on left and enlarged prostate on right in image below.

Benign_prostatic_hyperplasiaImage above, public domain, Wikipedia, illustrator unknown

What is the prostate, what purpose does it serve, and how does it function?

The prostate is a male reproductive gland that functions to produce prostate fluid, a nutrient and energy vehicle for sperm. The prostate consists of glandular and fibro-muscular tissue enclosed by a capsule of collagen, elastin and smooth muscle. The glandular tissue contains the secretory cells that produce the prostate fluid.

Semen is a “cocktail” composed of prostate fluid mixed with secretions from the seminal vesicles and sperm from the epididymides. The seminal vesicle fluid forms the bulk of the semen. The seminal vesicles and vas deferens (tubes that conduct sperm from testes to prostate) unite to form the ejaculatory ducts.

Prostate And Seminal Vesicles

At the time of sexual climax, prostate smooth muscle contractions squeeze the prostate fluid through prostate ducts at the same time as the seminal vesicles and vas deferens contractions squeeze seminal fluid and sperm through the ejaculatory ducts. These pooled secretions empty into the urethra (channel that runs from the bladder to the tip of the penis).  Rhythmic contractions of the superficial pelvic floor muscles result in the ejaculation of the semen.

What are the zones of the prostate gland?

The prostate gland is comprised of different anatomical zones. Most cancers originate in the “peripheral zone” at the back of the prostate, which can be accessed via digital rectal exam. The “transition zone” surrounds the urethra and is the site where benign enlargement of the prostate occurs. The “central zone” surrounds the ejaculatory ducts, which run from the seminal vesicles to the urethra.

Prostate Zones

Curious Facts About the Prostate

  • The prostate functions to produce a milky fluid that serves as a nutritional vehicle for sperm.
  • Prostate “massage” is sometimes done by urologists to “milk” the prostate to obtain a specimen for laboratory analysis.
  • The prostate undergoes an initial growth spurt at puberty and a second one starting at age 40 or so.
  • A young man’s prostate is about the size of a walnut, but under the influence of aging, genetics and testosterone, the prostate gland often enlarges and constricts the urethra, which can cause annoying urinary symptoms.
  • In the absence of testosterone, the prostate never develops.
  • The prostate consists of 70% glands and 30% muscle. Prostate muscle fibers contract at sexual climax to squeeze prostate fluid into the urethra.  Excessive prostate muscle tone, often stress-related, can give rise to the same urinary symptoms that are caused by age-related benign enlargement of the prostate.
  • Women have a female version of the prostate, known as the Skene’s glands.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

The content of this entry is excerpted from his new book, PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families

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Preview of Prostate Cancer 20/20

3-minute video trailer for Prostate Cancer 20/20

Andrew Siegel MD Amazon author page

Prostate Cancer 20/20 on Apple iBooks

 

 

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PROSTATE CANCER 20/20: A Practical Guide To Understanding Management Options For Patients And Their Families

January 26, 2019

Andrew Siegel MD    1/26/2019

NEW BOOK!

front 3d smallFor the past year I have been busy writing a book on prostate cancer geared for newly diagnosed patients and their families. It originated in the form of a 50-page monograph  that I crafted about a decade ago, conceived out of frustration from the lack of availability of a streamlined, practical, accessible and trustworthy medical resource to help patients and their families navigate through the formidable process of prostate cancer diagnosis and management. The manual proved to be beneficial for my urology patients and was reprinted in 2011.

In early 2018, with few copies remaining and time for a reprint, I recognized that since the previous iteration there had been an unprecedented number of advances in prostate cancer diagnosis and management. These included improvements in screening, increasingly sophisticated imaging techniques, the development of genomic and genetic testing, the availability of an array of new medications, continued technical advances in surgical, radiation and focal therapies and the blossoming of the era of “active surveillance.”

Because of the need for a major content update, I decided to expand the monograph into a more comprehensive format that could be of value not only to the patients in my urology practice, but also to any man confronting the challenges of a prostate cancer diagnosis. I aimed to stay true to my original goals of providing a concise, straightforward and easily understandable resource.

I had numerous medical colleagues help me to bring this book to fruition: my robotic urology partners (Drs. Wright, Christiano, Lovallo, Ahmed, Esposito, Goldstein, Lanteri),  radiation oncologists (Dr. Harrison and Dr. Gejerman), medical oncologists (Dr. Alter and Dr. Orsini), a urologist with expertise in high intensity focused ultrasound (Dr. Grunberger), a radiologist with expertise in prostate MRI (Dr. Waxman) an anatomical pathologist (Dr. Peters), a sexual educator who is the president of the E.D. foundation (Paul Nelson) and a pelvic floor physiotherapist (Niva Herzig).

Because most patients with prostate cancer have an excellent prognosis, the long-term consequences of the disease are often, in fact, the side effects of treatment.  Therefore, I considered it vital to provide in-depth information on the most common complications following treatment, namely sexual dysfunction and urinary incontinence, quality of life issues that are sometimes given short shrift or neglected in the patient education process. Furthermore, I elected to cover the important topic of bone health, which can be compromised by prostate cancer itself, as well as by some of the treatments for the disease.  Perhaps the most challenging area to cover was castrate resistant prostate cancer, made complex by the profusion of exciting new treatment options.

The title of the book— PROSTATE CANCER 20/20: A Practical Guide To Understanding Management Options For Patients And Their Families—is the same as that of the preceding monograph with the exception of the addition of “20/20.”  I did so to specify the year that looms in the near future, signifying the up-to-date content, and secondly to refer to “20/20” vision, the clarity and perspective that I wish to impart.

Along with my professional relationship with prostate cancer, I also have a personal relationship with it. In 1997, the senior partner in my urology group practice—my father—was diagnosed with prostate cancer.  The news was shocking to me and I clearly remember the day of diagnosis and the long run I went on to help me process it. Fortunately, he was successfully treated with an open radical prostatectomy and today is a thriving octogenarian.  Despite this, the emotional events of the day of his surgery, my interaction with his surgeon, his time in the hospital, the drive home on his day of discharge, and my removal of his surgical drain, skin staples and catheter will be forever seared into my memory.

Every case of prostate cancer is unique and has a variable biological behavior, which creates the need for treatment that is individualized and nuanced. The bewildering array of management options available can cause a great deal of confusion for the individual (and his family, friends and others who support him) grappling with trying to determine how best to be treated. My intent of the book is to provide knowledge and information to help guide the reader and his loved ones through his therapeutic journey, reviewing the advantages and disadvantages of each management option in as impartial a means as is possible. Being informed empowers the prostate cancer patient to be actively involved as a participant in decisions about his care, which enables making the choice of the best option in order to minimize decisional conflict and regret.

Prostate Cancer 20/20 preview

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States.

Andrew Siegel MD Amazon author page 

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