A Brief Anatomy Lecture

Read This First

There's a “Read This First” in every chapter of this book. This is because prostate cancer - the last thing most men would ever choose to think about - is not just a scary subject to deal with, it's tough to understand. The disease itself is complicated, and the decisions about what to do next can be agonizing. Before you can chart your next course, you've got to sort through, and attempt to make sense of, many things.

If this were a potboiler novel, the kind of page-turner you start on page one and don't put down until you've savored the last word on the last page, you wouldn't need any guidance on how to read it; you'd just get going. If, on the other hand, this were an academic textbook, you might approach it with a highlighter in hand, emphasizing key points and “take-home messages” in bright yellow marker. This book falls somewhere in between, and people read it in different ways. They kick the tires, in effect - flip through the pages; maybe they head directly to a specific section, such as impotence, or biopsy, then backtrack and read about how prostate cancer gets started, or jump ahead to chapters on treatment.

With this in mind, in every chapter we've done our best to give you the highlights - what you really need to know - up front. Consider this your briefing. All of these overviews will familiarize you with the main ideas you'll be covering on the next pages.

That said, this is what you need to know about the anatomy of the prostate:

What is the prostate? The prostate is a small, and probably expendable, organ. Men can live quite comfortably without it. The prostate's biggest job, as far as we know, is to provide part of the fluid that makes up semen. But even this contribution does not appear to be crucial for reproduction - which is why some scientists think the prostate's main role may be to safeguard the reproductive tract from infection in the urinary tract. (In fact, its name in Greek means “protector.”) It is not a vital organ. Thus, the major importance of the prostate is not what it does, but what goes wrong with it - the problems it causes to nearly all men who live long enough. These are:

• Cancer of the prostate, the most common cancer in men;
  
  
• BPH (benign prostatic hyperplasia, also called “enlargement of the prostate”), one of the most common benign tumors in men and a major source of misery as men get older; and
  
  
• Prostatitis, the most common cause of urinary tract infection in men.
  
  

If it's not a vital organ, why is it important? Although it's only as big as a walnut, the prostate is a miniature Grand Central Station, a busy hub at the crossroads of a man's urinary and reproductive tracts. It has a highly strategic location, right at the outlet to the bladder. Urine and semen cannot leave the body without passing through the prostate. It is also tucked away, deep within the pelvis, surrounded by vulnerable structures - the bladder, the rectum, the sphincters responsible for urinary control, major arteries and veins, and a host of delicate nerves, some of them so tiny that we've only recently discovered them. This is why any form of treatment for prostate cancer can produce side effects including incontinence, impotence, and rectal bleeding.

What else about prostate anatomy do I need to know? The prostate is like a complicated sponge, with five distinct parts, called “zones.” The two most important here are the peripheral zone, which is located next to the rectum, contains most of the glands in the prostate, and is the main site where cancer develops; and the transition zone, which surrounds the urethra, and is the principal site where BPH begins. The prostate's growth and function are stimulated by hormones: Testosterone, produced in the testicles, is converted to another hormone, called dihydrotestosterone (DHT)-the most active male hormone-in the prostate.

The bottom line: In short, the prostate is a gland that does much more harm than good, located in a terrible area that complicates any attempt to treat it. Despite this, as you will learn in this book, there has never been more hope in the treatment of all prostate disorders - especially cancer.

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Tags: Prostate Cancer, Cancer

About the Author

Janet Farrar Worthington is a science writer and commentator on American Public Radio. More

Patrick C. Walsh, M.D., urologist-in-chief at Johns Hopkins Hospital and director of the Department of Urology at Johns Hopkins University School of Medicine is the surgeon who created the Nerve-Sparing Technique (also known as the Walsh procedure), which has made it possible to preserve potency in men who lose their prostate. More