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Physiology and Pharmacology of the Prostate

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Urologic Principles and Practice

Part of the book series: Springer Specialist Surgery Series ((SPECIALIST))

Abstract

The prostate is a tubulo-alveolar gland and part of both the reproductive and urinary system. The prostate is, next to the seminal vesicales and the bulbourethral glands, part of the male accessory sex glands and produces seminal fluids which, during ejaculation, mix with sperm cells to neutralize the acid vaginal milieu and nourish spermatozoa. Lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH) and prostate cancer (PCa) are the most common prostatic diseases. Knowledge of the anatomy, physiology and receptors of the prostate is crucial for effective treatment of LUTS/BPH and PCa.

α1-Adrenergic receptor antagonists (α1-blockers) competitively bind to α1-adrenoceptors at the neuro-muscular junction of sympathetic nervous system, reduce the smooth muscle cell tone of the prostate and bladder outlet, decrease urethral resistance, and improve LUTS/BPH quickly and effectively. α1-blockers also significantly increase the chance of spontaneous voiding in patients with acute urinary retention. Phosphodiesterase type 5 inhibitors (PDE5i) act on the non-adrenergic, non-cholinergic neurotransmitter pathway by blocking the conversion of active cyclic guanosine monophosphate (cGMP) to inactive guanosine monophosphate, thereby prolonging the muscle relaxing effects of protein kinase G. PDE5i quickly and effectively ameliorate LUTS/BPH and also concomitant erectile dysfunction. 5α-reductase inhibitors (5ARIs) interfere with the intracellular metabolism of androgens and block the conversion from testosterone to dihydrotestosterone by blocking 5α-reductase type 2. Treatment with 5ARIs slowly reduces prostate size, improves LUTS/BPH and decreases disease progression, thereby reducing the chance of acute urinary retention and need for prostate surgery. Anti-androgens block androgenic effects and estrogens as well as agonists or antagonists of gonadotropin releasing hormone reduce androgen production to effectively treat androgen-sensitive PCa.

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  1. Department of Urology, Pediatric Urology and Urologic Oncology, Prostate Center North-West, St. Antonius Hospital, Gronau, Germany

    Matthias Oelke

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    Christopher R. Chapple

  2. Department of Urology, University of Virginia, Charlottesville, VA, USA

    William D. Steers

  3. Department of Urologic Surgery, University of California, Davis, Sacramento, CA, USA

    Christopher P. Evans

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Oelke, M. (2020). Physiology and Pharmacology of the Prostate. In: Chapple, C., Steers, W., Evans, C. (eds) Urologic Principles and Practice. Springer Specialist Surgery Series. Springer, Cham. https://doi.org/10.1007/978-3-030-28599-9_8

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