Understanding prostate function and hyperplasia symptoms helps protect men's health.

The Role of the Prostate in the Male Body

The prostate is the largest unpaired solid organ among accessory glands, possessing important endocrine and exocrine functions. The prostate is divided into five lobes (anterior, middle, posterior, and lateral lobes), located on the anterior inferior wall of the pelvis, surrounding the posterior urethra. From birth to puberty, prostate growth is slow; after puberty, the growth rate accelerates, and around age 30, its size and weight remain stable, with a diameter of approximately 3-4 cm and a weight of approximately 20 g. After age 35, the prostate gradually enlarges in most men. In some individuals, the enlarged prostate compresses the posterior urethra, causing difficulty urinating, a condition known as benign prostatic hyperplasia (BPH).

1. Exocrine Function of the Prostate

In normal adults, the prostate continuously secretes a thin, acidic fluid with a pH of approximately 6.5. Prostatic fluid accounts for about 1/10 to 1/3 of the ejaculated semen. Prostatic fluid contains a large number of active substances related to metabolism, such as acid phosphatase (ACP), amylase, lactate dehydrogenase, polyamines, carbonic anhydrase, proteins, citrate, zinc, copper, and iron. A deficiency or insufficient secretion of these substances can cause abnormalities in certain bodily functions. For example, a deficiency in the trace element zinc can affect semen quality and also have varying degrees of impact on sexual function.

Normal prostate tissue contains a high concentration of zinc; the zinc content in prostatic fluid can reach 110.6 μmol/L, while the zinc content in other human tissues is only 12.24 μmol/L. The zinc content in semen is significantly lower than that in prostatic fluid, indicating that prostatic secretions are diluted by a large amount of semen. Estrogen can reduce the uptake of zinc by the prostate in normal animals; castration of all male animals reduces their zinc levels. Zinc plays a crucial regulatory role in testosterone metabolism, inhibiting or promoting the conversion of testosterone to dihydrotestosterone (DHT), a highly active form of testosterone in the human body. Zinc in semen is essential for promoting sperm motility and resisting microorganisms. Furthermore, zinc is a vital component of many enzymes in prostate tissue; zinc deficiency can lead to insufficient activity of these enzymes, affecting semen coagulation and liquefaction. Zinc deficiency can affect sperm viability and motility, and can also impact sexual function to varying degrees.

Deficiencies in other enzymes or trace elements can also cause abnormalities in certain bodily functions.

2. Endocrine Function of the Prostate

Previously, it was believed that the prostate was a target organ for male hormones and did not secrete hormones. Recent studies have discovered that the prostate secretes various hormones, such as thyroxine-releasing hormone, adrenocorticotropic hormone (ACTH), relaxin, endorphins, prostaglandins, prolactin, and inhibin. These hormones have complex metabolic processes and important physiological functions in the body, which will not be detailed here. Insufficient secretion of these hormones can also cause a series of abnormalities.

(II) Benign Prostatic Hyperplasia (BPH)

BPH is a major cause of bladder neck obstruction and urinary dysfunction in men. Previously known as prostatic hypertrophy, hyperplasia and hypertrophy are completely different concepts pathologically. Hyperplasia is an increase in the number of tissue cells, while hypertrophy is an increase in the volume of tissue cells (or organs). The increase in prostate volume is not due to an increase in cell volume, but rather an increase in the number of glands and glandular epithelium. Therefore, it is more accurate and scientific to call this condition of the prostate "benign prostatic hyperplasia" (BPH).

BPH mostly occurs in men over 40 years of age, and its incidence gradually increases with age. Foreign data reports that the incidence of BPH in men over 40 years of age is 95.5%. Although the incidence of BPH is high, not every patient with BPH requires clinical treatment. Whether treatment is needed depends on whether the enlarged prostate gland obstructs the urinary tract, not on the size of the enlarged prostate. In some men, the enlarged prostate may be quite large, yet it doesn't cause difficulty urinating. This is because the enlarged gland grows away from the urethra, not compressing it, and therefore urination remains unaffected, requiring no clinical treatment. However, in others, although the glandular enlargement may not be very pronounced, the enlarged gland grows towards the urethra, quickly compressing it and causing local urethral narrowing, resulting in difficulty urinating. For example, enlargement of the lateral lobes of the prostate can directly compress the posterior urethra, while enlargement of the middle lobe can cause narrowing at the bladder neck opening. These pathological changes can all obstruct urine flow, leading to a series of clinical manifestations of benign prostatic hyperplasia (BPH). These patients should receive timely and effective clinical treatment. Without treatment, bladder and kidney function will be affected, and in severe cases, it can lead to retrorenal obstructive renal insufficiency.

1. Early Symptoms of Benign Prostatic Hyperplasia (BPH)

Early symptoms of BPH are often difficult for patients to detect. The main symptoms include delayed urination initiation, sometimes requiring standing for several seconds to several minutes to urinate; a thin and weak urine stream with a short range. This is primarily due to increased resistance in the posterior urethra, requiring the bladder detrusor muscle to contract more forcefully to overcome this additional resistance, thus delaying urine output. The increased resistance in the posterior urethra further counteracts the force of the bladder detrusor muscle contraction, resulting in a weak urine stream that cannot reach its normal range. In addition, urinary frequency and increased nocturia are also early symptoms of BPH. These are mainly caused by obstructed bladder emptying. Because the bladder detrusor muscle's contraction force is insufficient to overcome all urethral resistance, some urine remains in the bladder after each urination, relatively reducing bladder capacity. Even a slight increase in urine volume can cause a feeling of bladder fullness and the urge to urinate, leading to increased urinary frequency and nocturia.

Many patients with benign prostatic hyperplasia (BPH) are unaware of the early symptoms mentioned above, believing them to be inevitable results of aging. They fail to seek timely medical attention, only seeking treatment later when the obstruction becomes severe, leading to acute urinary retention, thus suffering avoidable pain.

Therefore, patients experiencing these symptoms should promptly seek medical examination and treatment. Long-term urethral obstruction can cause thickening of the bladder detrusor muscle or impaired kidney function, and can also easily induce urinary tract infections, hematuria, urinary retention, and other late-stage symptoms of BPH.

2. Late-Stage Symptoms of Benign Prostatic Hyperplasia

Building upon the early symptoms, urination becomes increasingly difficult. Each urination requires straining and increased abdominal pressure to expel urine; even slight relaxation results in interrupted urination. Sometimes, standing urination is impossible, requiring squatting. Acute urinary retention and incontinence frequently occur, with occasional dribbling and wetting of the pants. Urinary tract infections are common, exacerbating symptoms of difficulty urinating, urgency, and frequency, and may also cause significant hematuria. Frequent straining during urination can increase abdominal pressure, worsening symptoms of conditions such as hernias and hemorrhoids. Prolonged elevation of intravesical and renal pelvic pressure can decrease glomerular filtration function, hindering the excretion of metabolic waste products, leading to their retention in the body. If left untreated, this can further damage kidney function, causing renal insufficiency and renal failure, clinically manifested as azotemia and acidosis.

3. Recommendations for Patients with Benign Prostatic Hyperplasia (BPH)

Generally, men with only benign prostatic hyperplasia that does not affect normal urination and who do not have prostate infections do not require clinical treatment. However, patients with early signs of BPH should promptly consult a specialist. Most importantly, they should undergo an ultrasound examination of the bladder and prostate to assess the extent of benign prostatic hyperplasia and to measure residual urine volume. If there is a large amount of residual urine in the bladder, effective treatment should be received under the guidance of a doctor, including drug therapy, physical therapy, and surgical treatment.