Anatomy and physiology

The patient has a case of Prostate Adenocarcinoma and metastatic Spinal Cord
Compression. Therefore, this study shall focus on the male reproductive system, specifically the
prostate gland and the spine.

Prostate
The prostate gland is part of a man's reproductive and urinary systems. The prostate is
oval shaped with a rounded tip. It is approximately 4 cm wide and 3 cm thick. The actual size of
the prostate varies from man to man. It can range from the size of a walnut to a small apple.
The growth of prostate cells and the way the prostate gland works is dependent on the
male sex hormone, testosterone, which is produced in the testicles.
The prostate surrounds the base (or neck) of the bladder. It has 2 lobes that surround
the urethra. The urethra carries urine from the bladder, through the prostate, and out the penis.

The back of the prostate gland is close to the rectum (back passage). Near to the
prostate are collections of lymph nodes. These are small glands, about the size of a baked
bean.
Structure
The prostate gland is covered in a layer of connective tissue called the prostatic capsule.
It is made up of different types of cells: gland cells that produce the fluid portion of semen;
muscle cells that control urine flow and ejaculation; and fibrous cells that provide the supportive
structure of the gland
Some structures around the prostate are: seminal vesicles glands that produce semen and
are found on both sides of the prostate; vas deferens tubes that carry sperm from the testicles
to the seminal vesicles; nerve bundles control bladder and erectile function and are found on
both sides of the prostate; and muscles which control urination.
Zones of the prostate
The prostate gland is divided into 3 zones: Peripheral, transitional, and the central zone.

Peripheral zone
The peripheral zone is the area of the prostate that is closest to the rectum. It can easily
be felt by the doctor during a digital rectal examination (DRE). It is the largest zone of the
prostate gland. The majority of prostate tumours (approximately 75%) are found in the
peripheral zone.
Transition zone
The transition zone is the middle area of the prostate, between the peripheral and
central zones. It surrounds the urethra as it passes through the prostate. This zone makes up
about 20% of the prostate gland until the age of 40. As men age, the transition zone begins to
enlarge, until it becomes the largest area of the prostate. This is called benign prostatic
hyperplasia (BPH). When the transition zone enlarges, it pushes the peripheral zone of the
prostate toward the rectum.

Central zone
The central zone is in front of the transition zone. It is the part of the prostate that is
farthest from the rectum. Because of this, prostate tumours in this zone cannot be felt by the
doctor during a DRE.
Function
The main function of the prostate is to produce the fluid portion of semen. The gland
cells within the prostate produce a thin fluid rich in proteins and minerals that maintain and
nourish sperm. This fluid is made continuously. The excess passes from the body in the urine.
When a man is sexually aroused, the prostate produces larger amounts of this fluid. It then
mixes with sperm and is ejaculated as semen.
The prostate also plays a part in controlling the flow of urine. The urethra runs from the
bladder, through the prostate, and out through the penis. The muscle fibres of the prostate are
wrapped around the urethra and are under involuntary nervous system control. These fibres
contract to slow and stop the flow of urine.

The Spine

The spine is made up of:

Vertebrae, sacrum and coccyx bony
sections that house and protect the spinal
cord (commonly called the spine)
Spinal cord a column of nerves inside
the protective vertebrae that runs from the
brain to the bottom of the spine
Disc a layer of cartilage between each
vertebra that cushions and protects the
vertebrae and spinal cord

The spine is divided into 5 sections:

Cervical the vertebrae from the base of the skull to the lowest part of the neck

Thoracic the vertebrae from the shoulders to mid-back

Lumbar the vertebrae from mid-back to the hips

Sacrum the vertebrae at the base of the spine

Coccyx the tail bone at the end of the spine

Spinal nerves
The spine relays messages between the body and the brain. These nerve messages
control body functions like movement, bladder and bowel control and breathing. Each vertebra
has a pair of spinal nerves that receive messages from the body (sensory impulses) and send
messages to the body (motor impulses). The spinal nerves are numbered from the cervical
spine to the sacral spine.

Number

Part of spine

Function

C1 to C8
(8 pairs)

Cervical

send messages to the back of the head, neck, shoulders, arms,

hands and diaphragm

T1 to T12
(12 pairs)

Thoracic

send messages to the chest, some back muscles and parts of the
abdomen

L1 to L5
(5 pairs)

Lumbar

send messages to the lower parts of the abdomen and the back,
some of the legs and some parts of the external genital organs

S1 to S5
(5 pairs)

Sacral

send messages to the thighs, lower parts of the legs, feet, most
of the external genital organs, the groin area, the bladder and the
anal sphincter

Spinal nerves and their functions

Anatomy and Metastasis of Prostate Cancer

The pudendal nerve innervates the few striated muscles within the prostatic capsule.
The parasympathetic nerves emanate from S2 to S4 and form the pelvic nerve. The
sympathetic preganglionic nerves, which reside in the thoracolumbar region between T6 and L2,
provide the major neural input to the prostate and reach the pelvis through the hypogastric
nerve.

Prostate cancer has been shown to metastasize by following the venous drainage
system through the lower paravertebral plexus, or Batson's plexus. Although hematogenous
spread of other malignancies is most commonly to the lungs and liver, 90 percent of prostatic
metastases involve the spine, with the lumbar spine affected three times more often than the
cervical spine. Prostate cancer also spreads to the lungs in about 50 percent of patients with
metastatic disease, and to the liver in about 25 percent of those with metastases

Metastases that lead to spinal cord compression are usually located in the vertebral
column (85 percent of cases) or the paravertebral space (10 to 15 percent of cases).