Growth and Time | Prostate

Alok Anand MD

Introduction

At birth the prostatic acini are lined with sqaumous epithelia.

Stimulation of further development of the gland is dependent on maternal steroids, namely estrogens. As the levels of these hormones decrease, an involutional phase ensues during the first 5 months. Large transient surges of serum androgen, estrogen, and progesterone normally occur very early in postnatal life. This is usually between 2 to 3 months of age. At this time, levels may reach upward of 60 times normal prepubertal levels, approaching adult serum testosterone levels.

The prostate increases rapidly in size at puberty. During the fifth decade, it starts to show the effects of aging either resulting in atrophy but more commonly hyperplasia.

Getting Older and Bigger

The Story of the Prostate

The artistic rendition is of the normal prostate enlarging with time most commonly due to hyperplasia of the transitional zone. The diagram shows the normal cone shaped gland in maroon in the center with the ductus deferens (yellow) and seminal vesicles. The normal prostate is about the size of a kiwi fruit usually weighs between 20-30gms and has a maximum transverse diameter of 4cms, but can double in size

Then I grew old… and bigger and then
“The eternal battle of the streams: initially both robust,
eventually, both to rust.

Like basketball in reverse,
first shoots, then dribbles.” (Hyde)

The prostatic age is the period in a mans life when he starts to experience the clinical manifestations of the aging prostate which in the past was called prostatism but is now referred to as lower urinary tracts symptoms (LUTS). These symptoms include frequency, urgency, hesitancy, poor emptying, nocturia, and dribbling.

Large Bilobed Smooth Gland – 70 years old

The CTscan is from a patient with an enlarged prostate. The anterior aspect of the gland protrudes with two symmetrical homogeneous components likely representing an enlarged transitional zone and prostate hyperplasia though by the nature of the disease the combination of cancer and BPH commonly coexist. The urinary bladder wall is minimally thickened.

Large Gland in the Sagittal Plane – 75 years old

The CTscan reconstructed in the sagittal plane is from a patient with an enlarged prostate. The anterior aspect of the gland protrudes with two symmetrical homogeneous components likely representing an enlarged transitional zone and prostate hyperplasia though by the nature of the disease the combination of cancer and BPH commonly coexist. The matrix of the gland is heterogeneous The bladder wall is thickened anteriorly.