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Are you over 50? Do you use the toilet frequently (especially at night)? Did you lose weight in a short time for no specific reason? Do you have pain when urinating?
If any of your answers are yes, read this post to learn more about prostate disease.
What is the prostate gland?
The prostate is a small gland the shape and size of a chestnut. It is located below the bladder and surrounds the top of the urethra. The prostate gland produces a thick discharge (semen).
Diseases of the prostate gland
Benign prostatic hyperplasia
With age, the prostate gland grows in size and, although this is a natural process, it can sometimes limit the urine flow. Benign prostatic hyperplasia (BPH) is so common that it is said that if men lived long enough, they would all have prostate hyperplasia. Slight enlargement of the prostate already occurs in many men over the age of 40, and in over 90% of men over the age of 80.
The most common symptoms of benign prostatic hyperplasia are: the need to use the toilet frequently, also at night, difficulty in starting voiding, slight spotting at the end of urination, reduced volume and flow of urine.
Acute and chronic prostatitis
Chronic prostatitis is a common complaint of men. It is estimated that approximately 35% of this male population suffers from this condition at some point in their lives. Inflammation can cause difficulty or pain in urinating, burning in the urethra during voiding, and urinating more often than usual. Possible fever, pain in the lower back or in the groin, perineum and testicles. This can reduce interest in sex or achieve / maintain an erection for as long as is needed for a satisfactory intercourse. Acute prostatitis is less common, but the symptoms are much more severe. Both types of disease – acute and chronic prostatitis – can easily be mistaken for lower urinary tract infections.
Prostate cancer
It is a disease that affects the cells of the prostate gland.
More information about prostate cancer can be found HERE
Warning signals
There are many warning signs that you may have prostate disease. After noticing any of them, you should consult your urologist.
Some of them are:
- difficulty or pain when urinating;
- frequent visits to the toilet, especially at night;
- urgent need to urinate;
- blood in urine or in semen;
- impotence.
Doctors agree that men over 50 should be examined by a urologist at least once a year.
What awaits you at the doctor
Your doctor / urologist will ask about your symptoms and may order a blood test. The results of the study will give information about the level of a protein called PSA (prostate specific antigen). An elevated (above normal) PSA level produced by the prostate indicates the need for further research to explain this change, as the causes of high PSA levels can vary. Your doctor may perform a physical examination to see if the prostate gland is enlarged. The finger rectal examination of the prostate (DRE) is one such examination. During the examination, the doctor uses a gloved finger to examine the prostate through the anus to feel its hard, lumpy areas with an abnormal structure. The examination takes a few minutes. If PSA is elevated and the prostate gland is abnormal, further testing will be needed.
The other commonly used examination methods are: ultrasound of the prostate gland and biopsy. The prostate ultrasound scanner has a finger-sized probe that is inserted into the anus. The probe emits high-frequency waves that pass through the prostate and other pelvic organs. The reflected ultrasound waves are recorded and then processed into a video image or photo in the camera. This allows the doctor to see the prostate from different angles, helps to assess its size and detect any abnormalities in its morphological structure.
A prostate biopsy is performed through the rectum or through the perineum using an ultrasound probe through which a biopsy needle is inserted through the anal wall into the part of the prostate where abnormalities have been found. The needles pick up small pieces of tissue that are sent for microscopic analysis in the laboratory. The results of the test will enable the doctor to diagnose ailments and diseases of the prostate. If cancer is detected, the doctor will be able to assess the degree of cancer, determine the aggressiveness and the likely extent of the disease in the organ.
Treatment options
Treatment of benign prostatic hyperplasia includes:
- Active observation (watchful waiting) – it is a careful observation of symptoms and imaging changes in the prostate gland. More than 40% of men with mild to moderate symptoms experienced improvement with this method. Slowing down the disease can be achieved by making lifestyle changes (exercise, diet). In more troublesome symptoms, we implement treatment with alpha-blockers.
- Alpha-blockers work to relax the muscles of the bladder neck and the prostate gland. By reducing the pressure in the prostatic part of the urethra, they increase the flow of urine.
- 5-alpha-reductase inhibitors block the conversion of testosterone into DHT (dihydrotestosterone) – a substance that has a large impact on the enlargement of the prostate.
- Combining therapy with alpha-blockers and 5-alpha reductase inhibitors is more effective than using the drugs alone. It prevents the symptoms of BPH from worsening, complications (such as acute urinary retention) or the need for surgery.
- Other medical treatments for relieving BPH symptoms include anticholinergics to control urgency and frequency of urination. For patients suffering from the need to pass urine at night (nocturia), vasopressin receptor equivalents may be effective with fluid restriction in the evening. These drugs work by reducing the amount of urine produced by the kidneys for 6-8 hours.
- Antibiotics are often used to treat acute and chronic inflammation of the prostate caused by infection.
Surgical methods
- Transurethral incision of the prostate (TUIP) – the procedure dilates the urethra by making several incisions in the prostate gland and in the bladder neck, without the need to remove the tissue. This procedure is believed to reduce the possibility of retrograde ejaculation – a complication after prostate removal, where the valve that separates the urethra from the bladder, which should close during orgasm to ejaculate, no longer works. Semen flows back into the bladder and is later excreted in the urine.
- Transurethral removal of the prostate (TURP) – 90% of all procedures are performed for BPH. TURP is the placement of the resectoscope through the urethra into its narrowed part inside the prostate gland. The loop of the resectoscope then cuts out the prostate tissue surrounding the urethra and coagulates the surrounding blood vessels, protecting the patient from hemorrhage.
- Open prostatectomy – a procedure that requires an incision in the skin and opening of the abdominal wall in order to reach the prostate surgically. This is necessary when the prostate gland is very enlarged or there is a high risk of risk factors.
Other treatments
There are also many different minimally invasive treatments available today that we use to treat BPH. These are:
- Laser prostatectomy – a laser through the urethra directs energy to the prostate tissue surrounding the clamped parts of the urethra. The laser energy destroys excess prostate tissue.
- Transurethral microwave thermotherapy (TUMT) – in this method, carefully controlled microwaves are sent through a catheter placed at the opening of the urethra, led to the prostate gland and directed at the prostate tissue. High temperature causes necrosis of excess prostate tissue.
- Transurethral needle ablation of the prostate (TUNA) – following the insertion of the instrument through the urethral opening, two needles are placed in the prostate gland. Thermal energy enters the needles, causing contraction of the tissues surrounding the prostate and the associated increase in urine flow.
The urologist will inform you about the most appropriate method of treatment, the choice of method depends on the patient’s age, the size of the enlarged prostate, the degree of annoyance, etc.