Prostate stroma: Physiology

Abstract

BACKGROUND. The separate structural and functional activities of the prostatic stroma were only recently discovered and are still poorly understood. METHODS. This review summarizes recent literature on the structure, and on the angiogenic, contractile, proliferative, and secretory activities mediated by the prostatic stroma and its agents. RESULTS. The stroma undergirds the acinar epithelium through its fibromuscular substance. Neovascularization of its hypoxic cells, a process driven by cytokines, especially vascular endothelial growth factor, provides fuel for glycolytic empowerment of smooth muscle contraction, growth, and secretion. Signals from the stromal complement of cholinergic and adrenergic fibers, modulated by also-elaborated nitric oxide, provide tight regulation of uroflow. Apparently, autonomic control is independent of that of the powerful endothelin, secreted by the epithelium. Superimposed on these intrinsic elements of prostatic stromal control are the effects of steroid hormones and their effectors. CONCLUSIONS. The illumination of the stroma's role in prostatic physiology, coupled with advances in knowledge of its pharmacology, should aid in our understanding, management, and prevention of prostatic disease.