The enigmatic gland: A historical look at the enduring diagnostic difficulty of the prostate

“ Any condition leading to disturbance of the function of the bladder, such as enlargement of the prostate, stricture of the urethra, stone, or injury, may cause cystitis by preparing the way for bacillary invasion. The bacilli of tuberculosis and of typhoid fever may set up cystitis by coming down into the bladder from the kidneys with the urine, or they reach it by the blood-stream, or invade it by the urethra. Another way of cystitis being set up is by the introduction of the germs of suppuration by a catheter or bougie sweeping them in from the urethra ”

“ Some of these causes are external, and wholly under the control of the patient, while others depend upon diseases that are curable; it frequently happens that while other diseases are being remedied, the piles disappear Without any special attention.
Diseases of the urinary apparatus, as stricture of the urethra, enlargement of the prostate gland, and stone in the bladder, dysentery, diarrhea, and constipation,—all cause piles, by the irritation, and determination of blood, which they induce; these difficulties must be removed by appropriate treatment. ”

“ Gonorrhea, or clap; stricture of the urethra, which impedes the free flow of the urine; enlargement or inflammation of the prostate gland; gravel, and stone in the bladder, are all capable of creating a frequent desire to pass water. Whatever the unhealthy condition may be which gives rise to this troublesome symptom, it calls for prompt and skillful treatment, for the most trivial affections of these organs often pass into those that are exceedingly intractable, if not incurable. ”

“ Aged individuals of the male sex, in whom the prostate is prone to enlargement, and the urethra to organic stricture, are hence more subject to the formation of stone in the bladder, than youths, in whom these causes of obstruction are less frequent, or than females of any age, in whom the prostate is absent, and the urethra simple, short, readily dilatable, and seldom or never strictured. ”

“ The foreign body, when the patient is standing, walking, or riding, falls by its own gravity on this sensitive spot; when in a recumbent position, it rolls away from this sensitive trigone into the back part of the bladder, where the mucous membrane is less sensitive; consequently, the patient suffering from stone in the bladder is more easy at night, whereas, one suffering from prostatic disease, whether it be inflammation of the prostate gland, or enlargement of that organ, is usually worse in bed. ”

“ In some diseases the lustre of the eye increases, as in consumption. But if it decreases with the attack of violent disease, it indicates great debility and prostration.
Examination of the Urine. All medical authors and physicians of education, freely admit and even insist upon the importance of critically examining the patient's urine, in all cases in which there is reason to suspect disease of the kidneys or bladder. In chronic affections it is particularly serviceable, especially in derangements of the liver, blood, kidneys, bladder, prostate gland, and nervous system. ”

“ Although we cannot yet prevent prostate cancer, we know that early detection and treatment often make the difference between life and death. Screenings available include blood tests and physical examinations that can help detect the cancer at earlier, less dangerous stages. Researchers and scientists are also working to find more effective treatments that will give patients and their families greater hope. My Administration is committed to funding vital research and finding a cure for prostate cancer. ”

“ We do not fully understand the role of environmental and dietary factors in prostate cancer. We do not fully understand why the disease progresses at such varying rates in different men. We do not yet know why prostate cancer disproportionately affects African-American men. And we do not yet know how to eliminate the risks of treatment for prostate cancer that discourage too many men from seeing their doctors.
The only way we will ever answer these questions and the only way we will ever beat prostate cancer is by continuing to invest in research. ”

“ Difficulty in passing the urine is a symptom, which comes on very early in diseases of the prostate gland, and arises entirely from this lobe being increased in size, since any enlargement in the lateral portions of the gland widens the canal instead of diminishing it, and they do not require much force to separate them ”

“ The size of the prostate gland varies considerably with the age of the person. In early life it weighs but a few grains. As puberty approaches it becomes larger, and in the adult weighs from half an ounce to an ounce. In old age it enlarges considerably, and sometimes presses upon [pg 828] the bladder so as to impede the flow of urine. This condition is often confounded with stricture, gravel, or stone in the bladder, by inexperienced physicians. Hypertrophy, or enlargement of the prostate gland, is not an unfrequent disease in the adult or middle-aged man. ”

“ Hypertrophy and Dilatation.—When there is long-continued obstruction to the flow of urine, as in stricture of the urethra, or enlargement of the prostate, the bladder-wall becomes much thickened, the muscular fibres increasing both in size and number; the condition is known as “hypertrophy.” Hypertrophy may be accompanied by dilatation of the bladder, a condition which the bladder may assume when the voiding of its contents is interfered with for a length of time.
Paralysis of the bladder is a want of contractile power in the muscular fibres of the bladder-wall. ”

“ The surface of the mucosa is discolored, mottled and variegated, slaty blue, brown, red, purple, or even black, with ulcers, encrustations of triple phosphate, and fungoid elevations. In dogs especially, the prostate is often enlarged.
Symptoms. Frequent urination accomplished with pain, groaning, or whining and it may be with sudden arrest. There may be incontinence, the urine dribbling almost continuously from the penis or vulva and in the latter case trickling down the thighs. The presence of pus and mucus tends to mat the hairs, and a strong urinous and ammoniacal odor is emitted. ”

“ Diagnosis is based on frequent and painful urination in jets, tenderness of the urethra under palpation or catheterization, redness and swelling round the urethral orifice, and the oozing of pus. In the absence of any external injury one should always ascertain if cystitis is present. ”

“ My experience leads me to remark, that the latter seldom exists without the former, but that prostatorrhœa commonly exists as an independent disease; and when the flow of semen does not amount to sufficient, in frequency, to consider it a cause or a consequence of disease. In my judgment, this flow of glary, viscid fluid is most commonly observed while straining at stool from constipation. Young men very commonly apply to specialists and exhaust their funds and return to the less pretentious family doctor for a more satisfactory and truthful statement. ”

“ On urine being passed into a glass, a cloudiness is seen, and material like pieces of vermicelli or broken threads may be noticed. These are the castings from the long tubular glands, and are characteristic of chronic inflammation of the prostate. The occasional passage of a large metal bougie, the use of weak lotions of nitrate of silver, the administration of quinine and iron, and the application of blisters to the perineum, may be tried as circumstances direct. The patient should lead a quiet life, free from sexual excitement. ”

“ Internal symptoms, rectal exploration, vaginal, urethral, straining, ureters, bladder, calculi, neoplasms, prostate, urethritis.
External Symptoms. With inflammatory or painful affections of the urinary organs the animal tends to roach the back or loins, tuck up the abdomen, move the hind limbs stiffly and with a straddling gait, protract and withdraw the penis which may be semi-erect, retract and drop the testicles alternately, and stretch himself and strain to pass urine without success. Lying down and rising may be accomplished with marked effort and groaning. ”

“ Poisonous agents must be eschewed or used with the greatest circumspection.
CHRONIC PROSTATITIS. Causes. Follows acute. Same causes less potent. Lesions: as in acute, or sclerosis, and abscess. Symptoms: delayed urination, last glairy or purulent, constipation, defecation followed by urethral discharge, little genital ardor, rectal palpation, tenderness of prostate to hand or catheter, atony of hind limbs. Treatment: open air life, idle, milk or succulent diet, saline laxatives or enemata, avoid generative excitement, castrate, check masturbation, iodine, camphor, antiseptic irrigations. ”

“ Even with this little discharge of prostatic fluid, and when no sign of spermatorrhœa existed with it, the young man may experience all the phenomena of true and long-standing spermatorrhœa. His mind suffers, as well as his body, with imaginary nervous phenomena too numerous to mention. But in these conditions it is not uncommon to find very troublesome disease of the prostate gland, brought on by gonorrhœa, sexual excesses or masturbation, existing alone or with true spermatorrhœa. ”

“ Hence we can readily see that not only by reflex nervous irritation are those parts debilitated, through the contraction of the urethra, but the affection is apt to extend by continuity of the mucous membrane, and thus become more and more manifest, through symptoms of disease of the testicles, prostate gland and seminal vesicles, and these disorders become more and more seated the longer the morbid condition of the urethra is allowed to run on, until there may be an entire loss of the sexual functions, occurring at an age when there should be present the most vigorous manhood. ”

“ The anus is sore to manipulate, and at stool, when scybala pass over the prostate gland, a sensation of pain is felt, and fluid is forced out of the ducts into the canal and drips from the end of the penis. The veins of the spermatic cord are varicose, the erections are deficient in power (see Impotence) , and seminal fluid is thin and watery. The spermatozoa are deficient in size, shape, and amœboid movements. The urine is of a low specific gravity and contains a superabundance of urates. The orgasms are feeble and often imperceptible, and the proportion of spermatozoa to fluid is not great. ”

“ When such men as Bangs and Keyes are agreed on a subject of this kind, then even though in a certain number of cases the changes in the prostate leading to its enlargement are evidently inflammatory, it is well to consider that the functional over-activity of the gland superinduced by the practice may lead at least to an enlargement of the glandular elements with the consequent interference with urination which so frequently comes in old age. ”

“ Disease of the Prostate Gland is frequently caused by solitary indulgence. Venereal excesses produce congestion and the gland is overnourished. It becomes greatly enlarged, a condition called hypertrophy. This affection gives rise to a heavy feeling or pressure in the region below the bladder, and often interferes seriously with urination, and gives great pain and uneasiness, and often results in grave and dangerous complications. ”

“ All sorts of educated people come to us to be reassured that some trivial digestive disturbance does not mean cancer of the stomach, or, when they are between forty and fifty, come to make sure that some slight disturbance of urination is not an enlarged prostate. Brain workers of all classes come over and over again to be reassured that they are not breaking down because of organic brain disease, of which they show absolutely no sign. ”

“ Occasionally something arouses the attention of the possessor of the redundant tissue and he gets the idea that it is the source of reflex irritation even for distant parts of his organism. It is an interesting study in suggestion to see how symptoms develop in various organs as a consequence of the cultivation of this thought. Urination becomes frequent, the patient even wakes at night to urinate and the urine, as in many neuroses, becomes more abundant and of lower specific gravity—the typical nervous urine of the hysterical, and there may be much worry and emotional disturbance. ”

“ Last, but not least in importance among organs of the male sexual system, is the Prostatic Gland. The prostatic gland resembles in form a chestnut, and is located deep under the urinary bladder, right between the seminal vesicles. This gland is very rich in muscles, which surround the deep part of the urethral canal, where it starts from the bladder, and takes an active part in closing up and opening the bladder in time of urination. The Prostate Gland is also very rich in nerves, which connect it with almost every part of the body. ”

“ The median line, AA, drawn from the symphysis pubis above, to the point of the coccyx below, is seen to traverse vertically the centres of the urethra, the prostate, the base of the bladder, the anus, and the rectum. These several parts are situated at different depths from the perinaeal surface. The bulb of the urethra and the lower end of the bowel are on the same plane comparatively superficial. The prostate lies between these two parts, and on a plane deeper than they. The base of the bladder is still more deeply situated than the prostate ”

“ The prostate being in contact with the rectum, the surgeon is enabled to examine by the touch, per anum, the state of the gland. If the prostate be diseased and irregularly enlarged, the urethra, which passes through it, becomes, in general, so distorted, that the surgeon, after passing the catheter along the urethra as far as the prostate, will find it necessary to guide the point of the instrument into the bladder, by the finger introduced into the bowel. The middle or third lobe of the prostate being enlarged, bends the prostatic part of the urethra upwards. ”

“ Immediately behind the prostate, the vesiculæ seminales may be distinguished as two softish masses situated one on either side of the middle line. Internal to them, the whipcord-like feel of the vasa deferentia can be readily traced over the bladder to the sides of the pelvis.
‘The bladder is easily recognised, when moderately distended, as a soft fluctuating tumour behind the prostate; when empty it cannot be distinguished from the intestines, which then descend between the rectum and the pubes. The arch of the pubes can well be defined when the bladder is empty. ”

“ A large irregular shaped mass, a, grows from the base of the right lobe, and distorts the prostatic canal and vesical orifice. When the lobes of the prostate increase in size in this direction, the prostatic canal becomes much more elongated than natural, and hence the instrument which is to be passed for relieving the existing retention of urine should have a wide and long curve to correspond with the form of this part of the urethra. ”

“ Enlargement of the prostate exists in a considerable proportion of men of about sixty years of age and onward. It consists of an uncontrolled growth of the normal muscular and glandular tissue of the prostate, interfering with, or absolutely stopping, the outflow of the urine. Gently pushing the bladder upwards and backwards, it increases the length of the urethra, so that in order to draw off retained urine the catheter must be longer than ordinary, but inasmuch as there is no actual narrowing of the passage it may be of full calibre. ”

“ The prostate gland may become acutely inflamed as the result of the backward extension of gonorrhoeal inflammation of the urethra; it may also be attacked by the germs of ordinary suppuration as well as by the bacilli of tuberculosis. A sudden enlargement of a large gland lying against the outlets of the bladder and the bowel renders micturition difficult, painful or impossible, and interferes with defaecation. ”

“ It is a fact that most of the diseases of the female sexual mechanism are followed by alterations in the intestines, due, in part, to their close proximity to the pelvic organs, but, in a greater degree, to the intimate relation of these regions to the nerves that control the intestines. The same is true to a lesser degree in man, so that after troubles with the prostate, or after chronic gonorrhœa, a regulation of the bowels is an important matter, constipation being usually very obstinate in such cases. ”

“ In the vertebræ, it is attended with a painful form of paraplegia, which may involve the lower or all four extremities. On the other hand, the disease may show itself clinically as a tumour of bone, which may attain a considerable size, and may be mistaken for a sarcoma, unless the existence of the primary cancer is discovered.
The cancers most liable to give rise to metastasis in bone are those of the breast, liver, uterus, prostate, colon, and rectum; hyper-nephroma of the kidney may also give rise to metastases in bone. ”

“ Although papillomas are primarily innocent, they may become the starting-point of cancer, especially in persons past middle life and if the papilloma has been subjected to irritation and has ulcerated. The clinical features and treatment of the various forms of papilloma are considered with the individual tissues and organs.
Adenoma.#--An adenoma is a tumour constructed on the type of, and growing in connection with, a secreting gland. In the substance of such glands as the mamma, parotid, thyreoid, and prostate, adenomas are met with as encapsulated tumours. ”

“ Cancer may arise on any surface covered by epithelium or in any of the secreting glands of the body, but it is much more common in some situations than in others. It is frequently met with, for example, in the skin, in the stomach and large intestine, in the breast, the uterus, and the external genitals; less frequently in the gall-bladder, larynx, thyreoid, prostate, and urinary bladder. ”

“ The Prostate Gland.—Surrounding the ejaculatory ducts and their openings into the urethra at the base of the bladder is the prostate gland, which produces a peculiar secretion which forms a considerable portion of the seminal fluid, being mingled with the secretion of the testes during its ejaculation. This gland sometimes becomes the seat of somewhat serious disease. In old age it usually becomes somewhat indurated, and often to such an extent as to seriously affect the health and comfort of the individual by interference with urination and by occasioning pain. ”

“ In the event of its being impossible to pass a catheter by the urethra, in cases of retention of urine threatening rupture, the base or the summit of the bladder, according as either part may be reached with the greater safety to the peritonaeal sac, will require to be punctured. If the prostate be greatly and irregularly enlarged, it will be safer to puncture the bladder above the pubes, and here the position of the organ in regard to the peritonaeum, 1, becomes the chief consideration. ”

“ If a house is on fire and one refuses to turn in an alarm until the fire has spread from cellar to garret, neither blame nor disparagement must be placed upon the fire department if it failed to save the burning house. So with cancer; if the public refuses or neglects to operate for cancer at the time when it can be eradicated, the public cannot censure or belittle surgery. A cancer is like a green and ripe thistle. ”

“ Studies have shown that men with certain risk factors are more likely to develop prostate cancer. Age is the most significant factor—most men with prostate cancer are older than 65. Family history, a diet high in animal fats or meat, and certain other factors may also increase the likelihood of developing this disease. As we work to better understand the factors contributing to prostate cancer, I urge all men to talk to their doctors about the best course of action to reduce their own risk. ”

“ Men over the age of 50, African-American men, and men with family medical histories that include prostate cancer face the greatest risk and they can realize the greatest benefits from early detection, when treatment is most effective. All men should discuss their risk of prostate cancer with their physicians, determine the best screening and early-detection options, and adopt healthy lifestyles. Young men are also encouraged to find out whether a family member has ever been diagnosed with prostate cancer and to seek medical advice at an earlier age if a medical history exists. ”

“ Today we are reaping the rewards of our long-standing efforts to combat cancer as researchers make remarkable progress virtually every day. Over the past several years, for example, scientists have identified genes involved in a number of cancers, including cancers of the breast, prostate, kidney, skin, and colon. ”

“ This morning I want to talk to you about our overall vision of cancer care and research as we approach the 21st century. This is a time of striking progress, stunning breakthroughs. With unyielding speed, scientists are mapping the very blueprint of human life, and expectations of the human genome project are being exceeded by the day. We are closing in on the genetic causes of breast cancer, colon cancer, and prostate cancer. New tools for screening and diagnosis are returning to many patients the promise of a long and healthy life. ”

“ It is probable also that some increase has taken place in consequence of the increased average duration of life; a larger proportion of persons now reach the age at which cancer is frequent.
The prognosis largely depends on the variety of cancer and on its situation. Certain varieties—such as the atrophic cancer of the breast which occurs in old people, and some forms of cancer in the rectum—are so indolent in their progress that they can scarcely be said to shorten life ”

“ Understanding risk factors and the importance of a healthy lifestyle plays a vital role in our efforts to save lives and reduce the number of women who suffer from ovarian cancer.
As with many cancers, the chance for successful treatment of ovarian cancer increases with early detection. The medical community continues to work on developing an effective screening test that can detect the disease in its early stages when symptoms may not exist or are very difficult to diagnose. ”

“ Scientists are examining risk factors to identify ways to prevent prostate cancer, and they are finding ways to detect this disease earlier, when it is easier to treat. In addition, newer treatments are helping to slow or stop the spread of prostate cancer in men with advanced stages of the disease. This progress offers hope to men who are living with prostate cancer and those who are at risk. ”

“ Early detection is important in successfully treating prostate cancer. Preventative screenings can reveal a man's current health status and identify whether he needs to adjust his diet or behavior. I urge men, particularly those over 50, to learn more about the disease and to talk to their doctors about when to start preventative screening. Healthcare providers can advise men as to which tests are most appropriate. Through early detection and treatment, we can reduce the number of deaths caused by prostate cancer. ”