The prostate is an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular and connective tissue. The prostate produces and contains fluid that forms part of semen, the substance emitted during ejaculation as part of the male sexual response. This prostatic fluid is slightly alkaline, and milky or white in appearance. The alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The prostatic fluid is expelled in the first part of ejaculate, together with most of the sperm, because of the action of smooth muscle tissue within the prostate. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid, those in prostatic fluid have better motility, longer survival, and better protection of genetic material. Disorders of the prostate include enlargement, inflammation, infection, and cancer. The word prostate is derived from Ancient Greek prostátēs (προστάτης), meaning "one who stands before", "protector", "guardian", with the term originally used to describe the seminal vesicles.
Structure The prostate is an exocrine gland of the male reproductive system. In adults, it is about the size of a walnut, and has an average weight of about 11 grams (0.39 oz), usually ranging between 7 and 16 grams (0.25–0.56 oz). The prostate is located in the pelvis. It sits below the urinary bladder and surrounds the urethra. The part of the urethra passing through it is called the prostatic urethra, which joins with the two ejaculatory ducts. The prostate is covered in a surface called the prostatic capsule or prostatic fascia. The internal structure of the prostate has been described using both lobes and zones. Because of the variation in descriptions and definitions of lobes, the zone classification is used more predominantly. The prostate has been described as consisting of three or four zones. Zones are more typically able to be seen on histology, or in medical imaging, such as ultrasound or MRI.
The "lobe" classification describes lobes that, while originally defined in the fetus, are also visible in gross anatomy, including dissection and when viewed endoscopically. The five lobes are the anterior lobe or isthmus, the posterior lobe, the right and left lateral lobes, and the middle or median lobe.
Inside of the prostate, adjacent and parallel to the prostatic urethra, there are two longitudinal muscle systems. On the front side (ventrally) runs the urethral dilator (musculus dilatator urethrae), on the backside (dorsally) runs the muscle switching the urethra into the ejaculatory state (musculus ejaculatorius).
Blood and lymphatic vessels The prostate receives blood through the inferior vesical artery, internal pudendal artery, and middle rectal arteries. These vessels enter the prostate on its outer posterior surface where it meets the bladder, and travel forward to the apex of the prostate. Both the inferior vesical and the middle rectal arteries often arise together directly from the internal iliac arteries. On entering the bladder, the inferior vesical artery splits into a urethral branch, supplying the urethral prostate; and a capsular branch, which travels around the capsule and has smaller branches, which perforate into the prostate. The veins of the prostate form a network – the prostatic venous plexus, primarily around its front and outer surface. This network also receives blood from the deep dorsal vein of the penis, and is connected via branches to the vesical plexus and internal pudendal veins. Veins drain into the vesical and then internal iliac veins. The lymphatic drainage of the prostate depends on the positioning of the area. Vessels surrounding the vas deferens, some of the vessels in the seminal vesicle, and a vessel from the posterior surface of the prostate drain into the external iliac lymph nodes. Some of the seminal vesicle vessels, prostatic vessels, and vessels from the anterior prostate drain into internal iliac lymph nodes. Vessels of the prostate itself also drain into the obturator and sacral lymph nodes.
Microanatomy
The prostate consists of glandular and connective tissue. Tall column-shaped cells form the lining (the epithelium) of the glands. These form one layer or may be pseudostratified. The epithelium is highly variable and areas of low cuboidal or flat cells can also be present, with transitional epithelium in the outer regions of the longer ducts. Basal cells surround the luminal epithelial cells in benign glands. The glands are formed as many follicles, which drain into canals and subsequently 12–20 main ducts. These in turn drain into the urethra as it passes through the prostate. There are also a small amount of flat cells, which sit next to the basement membranes of glands, and act as stem cells. The connective tissue of the prostate is made up of fibrous tissue and smooth muscle. The fibrous tissue separates the gland into lobules. It also sits between the glands and is composed of randomly orientated smooth-muscle bundles that are continuous with the bladder. Over time, thickened secretions called corpora amylacea accumulate in the gland.
Gene and protein expression
About 20,000 protein-coding genes are expressed in human cells and almost 75% of these genes are expressed in the normal prostate. About 150 of these genes are more specifically expressed in the prostate, with about 20 genes being highly prostate specific. The corresponding specific proteins are expressed in the glandular and secretory cells of the prostatic gland and have functions that are important for the characteristics of semen, including prostate-specific proteins, such as the prostate specific antigen (PSA), and the prostatic acid phosphatase.
Development
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