1. THE PROSTATE IN HEALTH AND DISEASE

2. 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 ).

3. …I WISH ABOVE ALL, THAT YOU PROSPER AND BE IN HEALTH. (3 JOHN 2)
AND GOD SAYS….
…I WISH ABOVE ALL, THAT YOU PROSPER AND BE IN HEALTH. (3 JOHN 2)

4. WHO’s Definition Of Health
“Health…Not merely the absence of disease, but a state of physical, emotional and social well-being”

5. 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

7. 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

9. PHYSIOLOGY Conduit …urine & spermatozoa.
Secretions…enzymes, citric acid, zinc, 70% of semen.
Endocrine, neurological control
Growth factors, apoptosis

10. AGING AND MEN.
ANDROPAUSE
ERECTILE DYSFUNCTION
BPH
PROSTATE CANCER

11. PROSTATIC DISEASE Benign Prostatic Hyperplasia (BPH) / BPE
Cancer of the Prostate
PROSTATITIS

12. Anatomy of BPH Normal BPH Bladder Prostate
Hypertrophied detrusor muscle
Obstructed urinary flow
Bladder
The prostate is situated below the bladder and surrounds the urethra. BPH involves a gradual enlargement of the prostate, such that bladder outflow becomes increasingly obstructed.1,2
This enlargement firstly develops in the peri-urethral transition zone of the prostate.2,3
The detrusor muscle of the bladder responds to this obstruction by hypertrophy, trabeculation, replacement of muscle with collagen and ultimately loss of efficiency.4
References
Anderson JB et al. Eur Urol 2001; 39: 390–399.
Wilson JD. Am J Med 1980; 68: 745–756.
Bartsch G et al. Eur Urol 2000; 37: 367–380.
Haas CA et al. Lepor H (ed). Prostatic Diseases. WB Saunders 2000: 75–79.
Prostate
Urethra
Adapted from Kirby RS et al. Benign Prostatic Hyperplasia. Health Press, Oxford, 1999

13. Diet, obesity, BMI, medications, smoking, HBP
EPIDEMIOLOGY
Age
Global
Religion
Socioeconomic class
Sexual activity
Alcohol , liver disease
Diet, obesity, BMI, medications, smoking, HBP

14. BPH is a very frequent condition in ageing men
Prevalence of histological BPH
90%
50%
20% 0%
< 30 years
41-50 years
51-60 years
> 80 years
It is the most common benign tumour in men.
It is characterised by bothersome symptoms which are experienced with increasing age

15. Clinical features LUTS
COMPLICATIONS…UTI, stone, AUR, upper tract deterioration, haematuria, sexual dysfunction,

16. The Lower Urinary Tract Symptoms (LUTS)
FILLING/STORAGE Frequency Urgency Nocturia Dysuria
VOIDING
Hesitancy
Poor urinary stream
Intermittent stream
Terminal dribbling
Feeling of
incomplete emptying

17. BPH has a significant impact on Quality of Life (QoL)
75% of BPH patients
felt impact on their QOL.
31% of BPH patients
considered their sexual
function affected.

18. Evaluation History Physical examination PSA Urine
Electrolytes, urea, creatinine
Imaging
Uroflowmetry, Urodynamic, IPSS,
Others…FBC, FBS,ECG.…CXRAY, ETC.
ULTRSOUND, CTSCAN, BONE SCAN,MRI

19. Current treatments Recommended? Watchful waiting √ Alpha-blockers
5-alpha-reductase inhibitors (5ARIs)
Combination therapy
Phytotherapy
Minimally invasive techniques
Surgery √ √ √ √ x
The current EAU guidelines recommend the following treatment options for initial management of men with LUTS suggestive of BPH.1
Reference
1. EAU BPH guidelines. Madersbacher S et al. Eur Urol 2004; 46: 547–554. √ √
EAU BPH guidelines. Madersbacher S et al. Eur Urol 2004; 46: 547–554

20. BPH treatment goals Symptom relief QoL improvements
Reduction of BPH complications
EAU BPH guidelines.
Madersbacher S, et al. Eur Urol 2004;46:547–54

21. TREATMENT OPTIONS
WAWA
MEDICAL
SURGICAL
MINIMAL ACCESS
PHYTOTHERAPY

22. CANCER OF THE PROSTATE

23. Facts
Prostate 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 / 100,000.

24. 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

25. Prostate cancer is different
Lack of symptoms in early cases
Only 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

26. Perceived Cause of Disease and Health Seeking Behaviour.
Superstition
Untrained attendants [non-medical]
No culture of prevention / routine screening
Ignorance
Late presentation

27. MOST COMMON MODES OF PRESENTATION
Clinical
Metastatic *backache *paraplegia/paraesis
*pathological fractures *unexplained anaemia
Latent
Occult
Incidental

28. 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

29. Three ways to decrease the death rate from CAP
Prevention
Early detection and treatment
Successful treatment of advanced disease.

30. Prevention of prostate cancer
Diet
Lycopene rich diet ( tomato, soya beans, melons)
Drugs
Finastride / dutastride ( 5alpha reductase inhibitors)
No conclusive evidence

31. 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.

32. 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.

33. 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.

34. "A cancer cannot be treated if it is not detected
"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

35. What to do! SCREENING ACTIVE SURVEILANCE EARLY STAGE ADVANCED STAGE
RADIOTHERAPY
RADICAL SURGERY
PALLIATION vs. CURE

36. 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

37. PROSTATITIS ACUTE CHRONIC FEATURES DIAGNOSIS TREATMENT
OUTCOME OF TREATMENT
STONES.

38. THANK YOU