The prostate is a walnut- sized gland sitting below your bladder through which passes a tube called the urethra through which passes the urine stored in your bladder.  Behind it and connected to it by two small ducts are two sacs called seminal vesicals. The prostate functions to make the seminal fluid that is added to the sperm as they make their way from the testes. The seminal fluid formed by the prostate nurtures the sperm and makes them ready to fertilize the egg after ejaculation. 

Below the prostate is a muscular sphincter which holds the urine in the bladder. Injury to this muscle leads to incontinence or involuntary loss of urine and can be total with no control at all or partial with some control  and loss of urine only with an increase of abdominal pressure (this is called stress incontinence) or when the muscle tires,  usually at the end of the day.

As men get older, the prostate usually gets smaller but in some men, the prostate can become larger through abnormal growth of the glandular cells. We call this BPH or Benign Prostatic Hypertrophy. This has no connection to prostate cancer although the symptoms may be the same.

When your prostate starts to obstruct your bladder neck, the bladder responds by thickening it's walls to increase the pressure in the bladder to overcome the resistance. This is accompanied by increased sensitivity and the result is increased frequency of urination by day and night and an increased urge to void though the stream becomes weak and hesitant. The increased sensitivity also leads to renewed dribbling after voiding.

Prostate cancer can cause symptoms such as these and can cause blood in the urine or semen to appear and if it is advanced, can give bone pain and weight loss and kidney failure. However most patients seen by a urologist with new prostate cancer have no or very few symptoms and this is an important point. We are suggesting treatment usually to men who feel just fine and who are in the prime of life.

We know that prostate cancer is a natural outcome of the aging process since analysis of the prostates of men in their 90's shows a very high proportion of men who have prostate cancer even though it is not clinically evident. In determining treatment, then, this fact has to be considered. Also, some prostate cancers can be quite slow-growing while others are quite aggressive and if we can predict the nature of the cancer, then perhaps we can treat the aggressive ones more aggressively. 

Prostate cancer is now the most frequently diagnosed cancer  in men and after lung, the most frequent cause of death from cancer in Canadian men.

Can we treat this disease more effectively if we can treat it earlier in younger men? The jury is still out on this but strides are being made. We will discuss some of these issues in the next few pages.





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                                     Revised: December 10, 2000 .