Nearly 250,000 men are diagnosed each year with prostatic cancer and over 35,000 men will die. One of the therapies for this common problem is radical prostatectomy, removal of the entire prostate gland

• The development of Prostate Specific Antigen (PSA), a simple blood test, has significantly improved screening for the disease
• Improvement in biopsy methods has also helped to improve the diagnosis
• In the younger patient the disease is more malignant while in the very elderly the disease is relatively less aggressive. This may be due to the fact that slow growing prostate cancer has many more years to spread in the younger patient

Anatomy and Physiology

• The prostate is a walnut-sized gland that lies just below the urinary bladder and surrounds the urethra, the tube within the penis through which urine passes from the bladder (Figure 1)
• The glandular cells that make up the prostate gland add important nutrients and fluid to the semen, which is the fluid containing sperm
• A thin capsule of fibrous tissue, and then a layer of fat surround the gland
• The front wall of the rectum lies only a few millimeters behind the gland
• Lying on each side in the interval between the prostate and the rectum are nerves and blood vessels
• Surrounding the urethra just beyond the prostate is the urinary sphincter that prevents involuntary leakage of urine
• Leading from each testicle lying in the scrotum is a tube, the vas deferens, which conducts the sperm to the urethra as the urethra passes through the prostate
• Veins of the prostate drain towards the heart via connections that lie alongside the spine
• Lymph, a watery fluid found in all tissues, flows away from the prostate via very small channels called lymphatics to lymph nodes along the wall of the pelvis on both sides. The lymph nodes acts to filter out bacteria and cancer cells before the fluid flows further upstream towards veins that eventually empty into the heart

Figure 1 - Anatomic relationship of the prostate gland to the urinary bladder and urethra.