Title Biomedical Case Study.
Prostate gland is an exocrine gland (Thomas etal, 1977, pg 945) that is found below the urethra on the pelvic musculofascial floor and forms part of the male reproductive system. It is a walnut-size organ made up of non striped muscles and fibrous tissue called the prostatic capsule. The gland is also made up of circular fibres which are coated with fats. It is supplied by blood vessels that form part of the internal pudendal inferior vesicle and the middle haemorrhoidal- Gray Anatomy, (2009). The prostate gland is separated from the rectum by a layer of Dennonvilliers fascia and is fixed to the pubic bone by the puboprostatic ligaments (Dixon et al., 1999).
Prostate gland helps in the movement of sperms by providing the sperm with an alkaline medium for motility. During ejaculation this gland secretes secretions through contraction and relaxation of its muscles. The secretions contain Prostate Specific Antigen (PSA) which is alkaline in nature. This provides an alkaline environment in the urethra to protect the sperms from the acidity of the urethra created by urine which is acidic. The Prostate Specific Antigen alkaline pH also protects the sperms from the acidity of the vagina. The contraction and relaxation of the prostate muscles also helps in the propulsion of semen (prostate gland secretions and sperm) and therefore aiding the movement of sperms and increases the chances of fusion of the sperm and the ovum. Prostate gland also has valves, one at the neck of the bladder extending halfway down into the prostatic urethra called the internal sphincter and another valve in the membranous urethra extending up through the apex of the prostate gland called the prostatic apex. These valves control the flow of urine during ejaculation by blocking the urinary bladder and hence sperm do not mix with urine during ejaculation.
This important reproductive gland can experience some disorders, the most common ones being the Prostatic Cancer and Benign Prostatic Hyperplasia (BPH). Prostatic Cancer is a condition that starts as a small growth composed of abnormal cells which increase in size with time and can spread to other nearby tissues. Benign Prostatic Hyperplasia (BPH) on the other hand is a condition in which the cells of the prostate gland grow continuously leading to an increase in the size of the prostate gland. The cells in Benign Prostatic Hyperplasia however are normal cells and cannot infiltrate nearby tissues. These two conditions Prostatic Cancer and Benign Prostatic Hyperplasia, usually result in the obstruction of the urethra and have the same symptoms. As the prostate gland increases in size, it squeezes the urethra. This ideology can be used to give possible explanation of why the two prostate conditions are very common with men between the age 40 and 60 years. Again inflammation of the prostate gland can be due to increased level of Dihydrotestosterone (DHT) and Luteinising Hormone (LH). As men grow old, their prostate glands keep on growing continuously. The level of testosterone lowers as LH and DHT levels rises age of 40 and 60 years and the result is an inflamed prostate gland. Since urine is voided from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.
Prostate cancer is also attributed to elevated levels of Prostate Specific Antigen in the semen and this usually provides the basis of Prostate cancer diagnosis.
Benign Prostatic Hyperplasia (BPH) in particular is hyperplastic since results from a response to specific stimulus. There are two types of hyperplasia namely pathological hyperplasia (or neoplastic) and physiological hyperplasia. Physiological or normal hyperplasia is a type of hyperplasia that occurs in response to externalenvironmental factors and the hyperplastic growth remains subject to normal regulatory control mechanisms. Pathological hyperplasia on the other hand is a type of hyperplasia which is intrinsic in nature. It can be defined as a form of hyperplasia that is caused by intrinsic hereditary abnormality of the affected cells, which can be modified by a biophysicochemical disequilibrium affecting the physical elements and factors or the chemical ones (Donato, 2009). Here the genetically abnormal cells proliferate in a non-physiological manner that is unresponsive to normal stimuli. Since prostatic cancer is intrinsic is nature it can therefore be classified under pathological hyperplasia. Hyperplasia may be harmless and can occur on a particular tissue. In Benign Prostatic Hyperplasia BPH also called prostate enlargement, the hyperplasia occurs in the prostate gland hence the name prostatic. Benign Prostatic Hyperplasia is benign since the resultant cells are some-what differentiated from the original cells but are not different in behavior and form from the original prostatic cells
Patients with Benign Prostatic Hyperplasia urinate frequently, experience pain at the start of urination process, feel some discomfort while ejaculating, feel frequent urge to urinate at night a condition called Nocturia ( Keir et al., 2003, pg 495), suffer from erectile dysfunction, pain in the prostate area and always feel an urge to void even when the bladder is not full. These among others serve as the symptoms for Benign Prostatic Hyperplasia and prostatic cancer and concur with some of the symptoms that the patient in this case studies shown. These with time can progress into serious conditions such as blockage of the urethra, bladder stones or can cause damage to the kidney (renal failure) some of these are fatal. (Robert et al., 2004, pg 495)
There are various therapeutic methods that can be used to determine the presence of Benign Prostatic Hyperplasia or prostatic cancer. Mostly these tests are aimed at distinguishing anatomic etiologies of the prostatic condition from the functional causes. The treatment options for BPH and prostrate cancer range from medication treatments, surgical treatments, nonsurgical treatment, behavioral therapy and thermotherapy. Medication treatment commonly prescribed by doctors is the use of finasteride an inhibitor of 5- reductase enzyme from the producing Dihydrotestosterone (DHT) (Robert et al., 2004, pg 945). Due to the fall in the level of DHT the prostate gland shrinks. Market names for finasteride include Finast, Finara, Appecia and Finprose among others. Alpha blockers which ease the flow of urine can be prescribed to patients who experience urinal pains while voiding. Anticholinergics can also be used to increase the bladders capacity hence controlling Nocturia. Antiinflammatory painkillers can also be given to reduce the inflammation of the of the swollen prostate gland thereby relieving some of the urinary symptoms
Behavioral therapy can be used to control the symptoms are proper diet, regular exercises, reducing the amount of fluid intake in the evening regular urinating cycles (Benign Prostatic Hyperplasia, Mayoclinic, 2009) thermotherapy includes treatment options that involve the use of heat to destroy excess cells in the prostate gland. The types are Microwave therapy, electro vaporization, laser therapy, radiofrequency therapy.
Microwave therapy involves use of heat in form of microwaves to destroy the growths on the surface on the prostrate gland. It advantage is that it does not cause impotency or even interfere with ejaculation. Electrovaporization therapy uses electric current to cut and vaporize the excess prostate cells. Laser therapy uses lasers to cut and seal the excess cells that on the prostate gland. The sealing minimizes bleeding and this method also does no cause impotence. Radiofrequency therapy on the other hand uses radio frequency to destroy prostate tissues that might be blocking the urethra. This method can lead to ejaculation problem
Nonsurgical methods that can be used include PSA test, Ultrasonography, CT scan and Digital rectal exam.
PSA test is the most widely used method of identifying BPH and Prostate cancer. Prostate specific antigen (PSA) is an antigen that is found in semen secreted by cells in the prostate gland, level. It is found that in prostate cancer patients produce large amounts level of PSA in their seminal fluids. Determination of the amount of PSA in semen can be used to tell whether a patient has prostate cancer or not. However PSA test can at times produce false results. A false positive result occurs when PSA is in high level in the semen while in actual sense the patient is not suffering from Benign Prostatic Hyperplasia or Prostatic cancer. A false negative result can also be obtained when the level of PSA is normal though the patient is suffering from cancer or Benign Prostatic Hyperplasia.
Another nonsurgical method that can be used is Ultrasonography, Computerized Axial Tomography (CT scan) which is quite better than Ultrasonography as it can be used for diagnosis of the obstruction up to the ureteric level. Intravenous pyelography and Invasive pyelography both of which provide detailed morphology of the obstruction only that they can not be used to differentiate urinary dilation resulting from functional obstruction from that resulting from anatomical obstruction, can be used to provide information about the obstruction of the urethra.
Digital rectal exam is test where the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to rectum (Kristi Pharm, 2009). This can be used to feel the size of the prostate gland. Rectal ultrasound is also another test that can be used to detect prostate cancer. The test uses sound waves to detect the presence of prostate cancer. The sound waves on heating the surface of the prostate gland are echoed back in patterns that can be shown on the screen. Urine flow study is also among the numerous methods that can be used to detect the presence of BPH in patients. The doctor instructs the patient to urinate in a special device that measures the speed of flow of urine. A slow flow suggests the presence of Benign Prostatic Hyperplasia. Apart from Urine flow studies, cystoscopy can also be used. In this method the doctor inserts a cystoscope through the opening of the urethra. With this device the doctor can see the size of the prostate gland thereby seeing if there is any obstruction of the urethra. Brachytherapy which employs the use of small radioactive seeds of titanium pellets containing radioactive Iodine-125 which are inserted into the prostate gland is another nonsurgical method that can be used
Surgical solutions can too be given to patients with BPH and prostate cancer. These methods are usually suggested when the level of growths is beyond control by any of the methods discussed above. Prostatectomy the main surgical procedure mostly used incase of severe growth of the prostate tissue or if the patient has developed kidney stones. Prostatectomy involves permanent removal of prostate gland. An incision is made above the pubic bone below the umbilicus then the prostate gland is removed. This usually results in impotence. This is mostly done to patients with Benign Prostatic Hyperplasia. (Keir et al., 2003, pg 495). Robotic Laparoscopic Radical Prostatectomy (for instance the da Vinci surgical program) a computer based prostatectomy, Retropubic Prostatectomy and Perineal prostatectomy are some of the various methods of prostatectomy that can be carried out on a patient in the case of severe prostate cancer Transurethral Surgery (also called Transurethral Needle Ablation, TUNA- mrisusa.com) is also among the recommended surgical methods that can be undertaken.
It is important to note that prostate cancer is curable even though it cannot be prevented. Prostate cancer can spread (metastasizes) to other tissues of the body near or relatively far from the prostate gland like the lymph nodes liver and lungs and therefore deciding to go for prostate cancer testing and Benign Prostatic Hyperplasia (BHP) biopsy is the first step towards ensuring the cancer does not spread to other tissues close to the prostate gland. As a control measure young adults at the age of 40 should go for check ups for diagnosis. Those diagnosed with Benign Prostatic Hyperplasia or prostate cancer should work closely with their heath care professionals to develop appropriate workable plans that they can use to mange their conditions.
Prostate gland helps in the movement of sperms by providing the sperm with an alkaline medium for motility. During ejaculation this gland secretes secretions through contraction and relaxation of its muscles. The secretions contain Prostate Specific Antigen (PSA) which is alkaline in nature. This provides an alkaline environment in the urethra to protect the sperms from the acidity of the urethra created by urine which is acidic. The Prostate Specific Antigen alkaline pH also protects the sperms from the acidity of the vagina. The contraction and relaxation of the prostate muscles also helps in the propulsion of semen (prostate gland secretions and sperm) and therefore aiding the movement of sperms and increases the chances of fusion of the sperm and the ovum. Prostate gland also has valves, one at the neck of the bladder extending halfway down into the prostatic urethra called the internal sphincter and another valve in the membranous urethra extending up through the apex of the prostate gland called the prostatic apex. These valves control the flow of urine during ejaculation by blocking the urinary bladder and hence sperm do not mix with urine during ejaculation.
This important reproductive gland can experience some disorders, the most common ones being the Prostatic Cancer and Benign Prostatic Hyperplasia (BPH). Prostatic Cancer is a condition that starts as a small growth composed of abnormal cells which increase in size with time and can spread to other nearby tissues. Benign Prostatic Hyperplasia (BPH) on the other hand is a condition in which the cells of the prostate gland grow continuously leading to an increase in the size of the prostate gland. The cells in Benign Prostatic Hyperplasia however are normal cells and cannot infiltrate nearby tissues. These two conditions Prostatic Cancer and Benign Prostatic Hyperplasia, usually result in the obstruction of the urethra and have the same symptoms. As the prostate gland increases in size, it squeezes the urethra. This ideology can be used to give possible explanation of why the two prostate conditions are very common with men between the age 40 and 60 years. Again inflammation of the prostate gland can be due to increased level of Dihydrotestosterone (DHT) and Luteinising Hormone (LH). As men grow old, their prostate glands keep on growing continuously. The level of testosterone lowers as LH and DHT levels rises age of 40 and 60 years and the result is an inflamed prostate gland. Since urine is voided from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.
Prostate cancer is also attributed to elevated levels of Prostate Specific Antigen in the semen and this usually provides the basis of Prostate cancer diagnosis.
Benign Prostatic Hyperplasia (BPH) in particular is hyperplastic since results from a response to specific stimulus. There are two types of hyperplasia namely pathological hyperplasia (or neoplastic) and physiological hyperplasia. Physiological or normal hyperplasia is a type of hyperplasia that occurs in response to externalenvironmental factors and the hyperplastic growth remains subject to normal regulatory control mechanisms. Pathological hyperplasia on the other hand is a type of hyperplasia which is intrinsic in nature. It can be defined as a form of hyperplasia that is caused by intrinsic hereditary abnormality of the affected cells, which can be modified by a biophysicochemical disequilibrium affecting the physical elements and factors or the chemical ones (Donato, 2009). Here the genetically abnormal cells proliferate in a non-physiological manner that is unresponsive to normal stimuli. Since prostatic cancer is intrinsic is nature it can therefore be classified under pathological hyperplasia. Hyperplasia may be harmless and can occur on a particular tissue. In Benign Prostatic Hyperplasia BPH also called prostate enlargement, the hyperplasia occurs in the prostate gland hence the name prostatic. Benign Prostatic Hyperplasia is benign since the resultant cells are some-what differentiated from the original cells but are not different in behavior and form from the original prostatic cells
Patients with Benign Prostatic Hyperplasia urinate frequently, experience pain at the start of urination process, feel some discomfort while ejaculating, feel frequent urge to urinate at night a condition called Nocturia ( Keir et al., 2003, pg 495), suffer from erectile dysfunction, pain in the prostate area and always feel an urge to void even when the bladder is not full. These among others serve as the symptoms for Benign Prostatic Hyperplasia and prostatic cancer and concur with some of the symptoms that the patient in this case studies shown. These with time can progress into serious conditions such as blockage of the urethra, bladder stones or can cause damage to the kidney (renal failure) some of these are fatal. (Robert et al., 2004, pg 495)
There are various therapeutic methods that can be used to determine the presence of Benign Prostatic Hyperplasia or prostatic cancer. Mostly these tests are aimed at distinguishing anatomic etiologies of the prostatic condition from the functional causes. The treatment options for BPH and prostrate cancer range from medication treatments, surgical treatments, nonsurgical treatment, behavioral therapy and thermotherapy. Medication treatment commonly prescribed by doctors is the use of finasteride an inhibitor of 5- reductase enzyme from the producing Dihydrotestosterone (DHT) (Robert et al., 2004, pg 945). Due to the fall in the level of DHT the prostate gland shrinks. Market names for finasteride include Finast, Finara, Appecia and Finprose among others. Alpha blockers which ease the flow of urine can be prescribed to patients who experience urinal pains while voiding. Anticholinergics can also be used to increase the bladders capacity hence controlling Nocturia. Antiinflammatory painkillers can also be given to reduce the inflammation of the of the swollen prostate gland thereby relieving some of the urinary symptoms
Behavioral therapy can be used to control the symptoms are proper diet, regular exercises, reducing the amount of fluid intake in the evening regular urinating cycles (Benign Prostatic Hyperplasia, Mayoclinic, 2009) thermotherapy includes treatment options that involve the use of heat to destroy excess cells in the prostate gland. The types are Microwave therapy, electro vaporization, laser therapy, radiofrequency therapy.
Microwave therapy involves use of heat in form of microwaves to destroy the growths on the surface on the prostrate gland. It advantage is that it does not cause impotency or even interfere with ejaculation. Electrovaporization therapy uses electric current to cut and vaporize the excess prostate cells. Laser therapy uses lasers to cut and seal the excess cells that on the prostate gland. The sealing minimizes bleeding and this method also does no cause impotence. Radiofrequency therapy on the other hand uses radio frequency to destroy prostate tissues that might be blocking the urethra. This method can lead to ejaculation problem
Nonsurgical methods that can be used include PSA test, Ultrasonography, CT scan and Digital rectal exam.
PSA test is the most widely used method of identifying BPH and Prostate cancer. Prostate specific antigen (PSA) is an antigen that is found in semen secreted by cells in the prostate gland, level. It is found that in prostate cancer patients produce large amounts level of PSA in their seminal fluids. Determination of the amount of PSA in semen can be used to tell whether a patient has prostate cancer or not. However PSA test can at times produce false results. A false positive result occurs when PSA is in high level in the semen while in actual sense the patient is not suffering from Benign Prostatic Hyperplasia or Prostatic cancer. A false negative result can also be obtained when the level of PSA is normal though the patient is suffering from cancer or Benign Prostatic Hyperplasia.
Another nonsurgical method that can be used is Ultrasonography, Computerized Axial Tomography (CT scan) which is quite better than Ultrasonography as it can be used for diagnosis of the obstruction up to the ureteric level. Intravenous pyelography and Invasive pyelography both of which provide detailed morphology of the obstruction only that they can not be used to differentiate urinary dilation resulting from functional obstruction from that resulting from anatomical obstruction, can be used to provide information about the obstruction of the urethra.
Digital rectal exam is test where the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to rectum (Kristi Pharm, 2009). This can be used to feel the size of the prostate gland. Rectal ultrasound is also another test that can be used to detect prostate cancer. The test uses sound waves to detect the presence of prostate cancer. The sound waves on heating the surface of the prostate gland are echoed back in patterns that can be shown on the screen. Urine flow study is also among the numerous methods that can be used to detect the presence of BPH in patients. The doctor instructs the patient to urinate in a special device that measures the speed of flow of urine. A slow flow suggests the presence of Benign Prostatic Hyperplasia. Apart from Urine flow studies, cystoscopy can also be used. In this method the doctor inserts a cystoscope through the opening of the urethra. With this device the doctor can see the size of the prostate gland thereby seeing if there is any obstruction of the urethra. Brachytherapy which employs the use of small radioactive seeds of titanium pellets containing radioactive Iodine-125 which are inserted into the prostate gland is another nonsurgical method that can be used
Surgical solutions can too be given to patients with BPH and prostate cancer. These methods are usually suggested when the level of growths is beyond control by any of the methods discussed above. Prostatectomy the main surgical procedure mostly used incase of severe growth of the prostate tissue or if the patient has developed kidney stones. Prostatectomy involves permanent removal of prostate gland. An incision is made above the pubic bone below the umbilicus then the prostate gland is removed. This usually results in impotence. This is mostly done to patients with Benign Prostatic Hyperplasia. (Keir et al., 2003, pg 495). Robotic Laparoscopic Radical Prostatectomy (for instance the da Vinci surgical program) a computer based prostatectomy, Retropubic Prostatectomy and Perineal prostatectomy are some of the various methods of prostatectomy that can be carried out on a patient in the case of severe prostate cancer Transurethral Surgery (also called Transurethral Needle Ablation, TUNA- mrisusa.com) is also among the recommended surgical methods that can be undertaken.
It is important to note that prostate cancer is curable even though it cannot be prevented. Prostate cancer can spread (metastasizes) to other tissues of the body near or relatively far from the prostate gland like the lymph nodes liver and lungs and therefore deciding to go for prostate cancer testing and Benign Prostatic Hyperplasia (BHP) biopsy is the first step towards ensuring the cancer does not spread to other tissues close to the prostate gland. As a control measure young adults at the age of 40 should go for check ups for diagnosis. Those diagnosed with Benign Prostatic Hyperplasia or prostate cancer should work closely with their heath care professionals to develop appropriate workable plans that they can use to mange their conditions.
Categories:
0 коммент.:
Отправить комментарий