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AGE AND PROSTATE DISORDER

Age and Prostate Disorder –A Case of Abakaliki, Ebonyi State


 

CHAPTER ONE                                 

INTRODUCTION

The prostate (from Greek προστάτης, prostates, literally “one who stands before”, “protector”, “guardian”) is a compound tubuloalveolarexocrine gland of the male reproductive system in most mammals (Romer and Parsons, 1977). It differs considerably among species anatomically, chemically, and physiologically .The prostate is a gland located at the base of a man’s bladder, behind the pubic bone and in front of the rectum.

This gland, which is roughly the size and shape of a small crab apple, weighs only about an ounce in young men. It surrounds the urethra, the tube that carries urine away from the bladder and transports semen during ejaculation. A good way to envision the prostate is as an apple with the core removed, with the urethra passing through the middle. The prostate’s primary function is to produce prostatic fluid, a component of semen. Also, during ejaculation, smooth muscles in the prostate contract to help propel semen through the urethra. Technically the prostate is not part of the urinary system. But because of its location and relationship to the urethra, the prostate can (and often does) affect urinary function. Prostatic disorder, any of the abnormalities and diseases that afflict the prostate gland in the male reproductive system. The prostate gland is dependent on the hormonal secretions of the testes for growth and development. When production of the male hormone (androgen) decreases, the prostate begins to degenerate. Boys who are castrated before reaching puberty do not develop an adult-sized or functioning prostate. Normally changes occur in the prostate as a man ages. Between the fourth and sixth decades there is atrophy of the smooth muscles and an increase in fibrous scar tissue, collagen fibres (protein strands), and numbers of lymph cells. When a man passes the age of 60 years, the organ is largely replaced by fibrous tissue (Dineen et al., 2008). In men over the age of 60 years, enlargement (hyperplasia) of the prostate is relatively common. In the vast majority of cases it causes no symptomatic difficulties, though infection may occur, as may rupturing of blood vessels. Enlargement may cause compression of the urethra with progressive obstruction of the flow of urine, incomplete emptying, or inability to void; there may also be a constant dribbling of urine. The bladder is never totally emptied, however, and the remaining urine becomes stagnant and infection sets in. The stagnant urine may cause the precipitation of stones in the bladder; the bladder muscle thickens to overcome this obstruction. If urine begins to back up in the kidney, progressive damage may ensue, which can lead to kidney failure and subsequent uremia (the toxic effects of kidney failure) (Dineen et al., 2008). Cancer of the prostate is one of the most common cancers. It may manifest itself in three forms: (1) cancer producing symptoms leading directly to the prostate, (2) hidden cancer that causes no prostatic symptoms but spreads to certain other parts of the body, and (3) latent cancer, where a slow-growing mass is found, usually at autopsy. Latent tumours are found in 25 percent of the male population over the age of 40 years. The cancerous prostate is usually hard and dry and shows small islands of yellow cancer cells distributed throughout the tissue. The cancer may spread from the prostate to the floor of the bladder and to all of the reproductive ducts leading into the prostate. The pelvic and spinal lymph nodes are involved early, as well as the bones of the pelvis. Cancer may spread to the liver, lungs, or bone by way of the blood system; about 70 percent of the cases show bone involvement. Infections of the prostate are common and are usually caused by bacteria that inhabit the stool. Gonorrhea, a venereal disease, may also affect the prostate. Treatment is usually administration of antibiotics (Dineen et al., 2008). Prostatitis is inflammation of the prostate gland. There are primarily four different forms of prostatitis, each with different causes and outcomes. Two relatively uncommon forms, acute prostatitis and chronic bacterial prostatitis, are treated with antibiotics (category I and II, respectively). Chronic non-bacterial prostatitis or male chronic pelvic pain syndrome (category III), which comprises about 95% of prostatitis diagnoses, is treated by a large variety of modalities including alpha blockers,

phytotherapy, physical therapy, psychotherapy, antihistamines, anxiolytics, nerve modulators, surgery, and more. (Verhamme et al.,2002). More recently, a combination of trigger point and psychological therapy has proved effective for category III prostatitis as well. (Anderson et al.,2006) Category IV prostatitis, relatively uncommon in the general population, is a type of leukocytosis (Dineen et al., 2008).

1.2     AIM AND OBJECTIVES

The aim and objectives include the following:

  1. To assess the prevalence of prostate disorder cases in Abakaliki.
  2. To determine the age limit of the highest frequency of the most prevalent prostate disorder in Abakaliki.

CHAPTER TWO

LITERATURE REVIEW

2.1.   INFLAMMATORY LESION (PROSTITIS)

Inflammatory is a complex reaction to injurious agents such as microbes and usually necrotics cells and consists of vascular response, migration and activation of leukocytes. Inflammatory lesions may be divided into the following.

  1. Acute and chronic bacterial prostitis
  2. Chronic bacterial prostatitis
  3. Granulomatous prostatitis

Etiologies of acute and chronic bacterial prostatitis include:

  1. Various strains of Escherichia coli, other Gram-negative rods, enterococci, and staphylococci.
  2. Catheterization, cytoscopy, urethral dilation, or resection procedure.

Etiologies of chronic Abacterial prostatitis

Unfortunately, little is known about the causes of chronic abacterial prostatitis. However, health professionals believe that possible causes include:

  1. Blocked urine flow
  2. Abnormal movement of urine
  • Prostate secretion into the prostate
  1. Autoimmune diseases
  2. Chemicals normal found in the urine, such as uric acid which may get into the prostate and cause irritation.
  3. Abnormal nerve or muscles functions (Kumar et al.,2005)

Etiologies of Granulomatous Prostatitis

  1. Installation of Bacillus Calmette – Guerin (BCG) into the bladder this is used the treatment of cancer of the bladder.
  2. Fungus: This is used seen in immunocomprosied host.

Symptoms

  1. Fever
  2. Chills
  3. Dysuria
  4. Low back pain
  5. Perineal and suprapubic discomfort

As the prostate surrounds the urethra any abnormality of the gland is a potential source of urinary tract obstruction, and undoubtedly the most common cause of urinary obstruction is benign prostate hyperplasis (Christensen, T.L and Andriole, G.L. 2009.)

2.2     BENIGN PROSTATE HYPERPLASIA

This is an enlargement of the prostate due to increase of both glandular and interstitial cellular tissue and disrention of the acini of the gland (Nogel and Brosig, 1965). This is characterized by hyperplasia (increase in cell number) of the prostatic stomal and epithelial cells, resulting in the formation of large, family discrete nodules in the periurethral region of the prostate.

2.2.1  INCIDENCE

Histomorphological evidence of nodular hyperplasia can be seen in approximately 20% of men 40 years of age, a figure that increases to 70% by age 60 years and 90% by age 70. It is more prevalent in patients between 70-79 years old (Kumar, et al.,2007)

2.2.2  ETIOLOGIES OF BENIGN PROSTATE HYPERPLASIA

  1. Luteinizing hormone and follicle stimulating hormone (non-androgenic hormones).
  2. Prolactin
  3. Estrogen
  4. Testosterone
  5. Dihydrotestosterone

Luteinizing Hormone (LH) is one of the non-androgenic hormones that are linked to prostate problems (Manni and Santen, 1995). It is synthesized by the pituitary gland and is involved in testosterone production and its feedback control. LH stimulates the leydig cells of the testes to produce testosterone when there is deficiency in blood ( Myers, R.P. 2000). Prostates enlargement has been reported to be closely linked to the action of androgens (Patel,et al., 2012). High stress levels in elderly men stimulate the pituitary gland to secret as luteinzing hormone and follicle-stimulating hormone (FSH). The increased level of prolactin at low zinc levels stimulates the synthesis of the enzyme, 5a-reductase, type 2. The enzyme is localized principally in the stromal cells of the prostate gland, and hence these cells are the main sites for the synthesis of dihydrtesterone (DHT). Testosterone is the most important androgen secrected in the blood.

Circulating testosterone is converted to dihysdrostestosteropne in the prostate by the enzyme 5a-reductase (Pollard, 1989). The metabolism of testestrone to dihydrotestosterone and its aromatization to estradiol and recognise as the key wants in prostatic steroid response (Flam, F. 2006.). The increased levels to testosterone as a result of high levels of LH leads accelerated conversion of testosterone to DHT (Garcia, A. et al 2006). DHT has ten times more affinity for the androgen receptor than does testosterone which allows it to accumulate in the prostate even circulating levels of testosterone in the prostate are mediated by the andogen receptor protein (AR) (Culig,2000). While DHT appears as the major tropic factor mediating prostate hyperplasia, estrogen also appears to play a role, perhaps by rendering cells more susceptible to the action of DHT stimulates the prostate cells to guide and multiply at a faster rate. This results in more prostate cells leading to prostate enlargement and other prostate problems (Pollard 1989).

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