McVary K T, McKenna K E, Lee C
Department of Urology, Northwestern University Medical School, Chicago, Illinois 60611-3009, USA.
Prostate Suppl. 1998;8:2-13.
The growth of the prostate gland has been considered to be controlled exclusively by endocrine means. The abundance of alpha adrenergic and muscarinic receptors and nerve fibers suggests that the autonomic nervous system may in fact play a role in the growth maturation and secretory functions of the prostate. The predominant adrenergic input to the prostate is from short adrenergic neurons, while cholinergic nerves are closely related to the glandular epithelium, presumably affecting a secretory function. The prostate has a high density of alpha-1 and beta-2 adrenergic receptors, and the presence of these receptors, as well as their regulation by androgens, suggests and supports the direct mitogenic effect of catecholamines on prostate growth. The activated signal transduction pathways in these neural systems also appear to modulate prostatic function and growth. Denervation of the prostate results in a loss of functional and structural integrity of the gland. The effects of sympathectomy and parasympathectomy support the conclusion that the dichotomy of function in prostatic autonomic innervation has a fundamental regulatory purpose. The majority of the afferent innervation to the ventral prostate is localized to sensory nerves from the L5 and L6 segments. There is some smaller degree of innervation from T13-L2. There is evidence of extensive bilateral innervation of pelvic viscera. Despite the importance of afferent sensory feedback in regulating the control of prostate growth, its effect is of a smaller magnitude than that observed with androgens. Regardless of the specific control mechanisms suggested by neural involvement in the growth differentiation and secretory function of the prostate, the presence of innervation appears to be consistent and reproducible, and holds great potential for increasing our understanding of pathologic influences in prostate disease.
前列腺的生长一直被认为完全受内分泌方式控制。丰富的α肾上腺素能和毒蕈碱受体以及神经纤维表明，自主神经系统实际上可能在前列腺的生长成熟和分泌功能中发挥作用。前列腺主要的肾上腺素能输入来自短肾上腺素能神经元，而胆碱能神经与腺上皮密切相关，可能影响分泌功能。前列腺具有高密度的α-1和β-2肾上腺素能受体，这些受体的存在以及它们受雄激素的调节，提示并支持儿茶酚胺对前列腺生长的直接促有丝分裂作用。这些神经系统中激活的信号转导途径似乎也调节前列腺的功能和生长。前列腺去神经支配会导致腺体功能和结构完整性丧失。交感神经切除术和副交感神经切除术的效果支持这样的结论，即前列腺自主神经支配中的功能二分法具有基本的调节目的。前列腺腹侧的大部分传入神经支配定位于来自L5和L6节段的感觉神经。T13-L2也有较小程度的神经支配。有证据表明盆腔脏器存在广泛的双侧神经支配。尽管传入感觉反馈在调节前列腺生长控制中很重要，但其作用程度比雄激素观察到的要小。无论神经参与前列腺生长、分化和分泌功能所提示的具体控制机制如何，神经支配的存在似乎是一致且可重复的，并且在增进我们对前列腺疾病病理影响的理解方面具有巨大潜力。
