Prostate problems

Urology treatments

Prostate problems

The prostate is a gland in the male reproductive system that lies just below the urinary bladder, around the urethra, and in front of the rectum.

Prostate problems

Table of Contents

DEFINItion

What is the prostate?

The prostate is a gland in the male reproductive system that lies just below the urinary bladder, around the urethra, and in front of the rectum.

Two important pairs of reproductive pathways flow into this gland, the vas deferens (which ascend from the testicles carrying sperm) and the seminal vesicle ducts (the two small glands that make up nearly 60 per cent of all semen).

General anatomy of the prostate 

General anatomy of the testicles

This glandular organ is similar in shape and size to walnut or chestnut, so although it is “very famous”, we are talking about a very small area of the body. Even though it is small, it performs key functions for male reproduction, including:

This last function is one of the most important ones performed by the prostate since sperm are true living cells whose mission is to spend a great number of hours outside the man’s body to fertilize the egg inside the woman’s body.

Keeping sperm alive is achieved by creating an ideal microenvironment, this would be the semen. The seminal fluid (better known as semen) is a body fluid produced by the man in which the sperm move and nourish.

The prostate secretes nutritious and protective substances for the sperm and these include:

Male hormones (testosterone being the main one) exert the gland's regulation. Therefore, any alteration of these could trigger imbalances in the function and shape of the prostate.

The vast majority of prostate diseases (infectious and non-infectious) manifest clinically as an unusual inflammation of the male gland.

These pathological inflammations of the prostate can produce uncomfortable signs and symptoms in male patients, most notably difficulty in urination, involuntary urination, constant dribbling of urine, pain, certain erectile problems and in some more severe cases, persistent urinary tract infections.

Along with heart disease and certain metabolic disorders (such as diabetes mellitus), prostate conditions are the most prevalent diseases among older men.

WATCH VIDEO: Large or swollen prostate, what is a normal PSA?

MEDICAL EVALUATION

Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH), also known as prostatic enlargement, refers to the non-malignant enlargement of the prostate that results in difficulty in urination and loss of voluntary bladder control.

Healthy prostate

Prostate with inflammation

Signs and symptoms

BPH is the most common cause of urination problems in male patients. The increased size of the prostate gland often leads to signs and symptoms such as:

Increased intravesical (i.e. inside the urinary bladder) pressure from the mechanical blockage produced by the enlarged prostate around the urethra can trigger even more diffuse symptoms, such as abdominal pain and a higher risk of urinary tract infections (UTIs).

Causes

According to several studies, BPH often has a multicausal pathophysiological root that includes hormonal factors, dietary factors, and ageing.

Testosterone
Testosterone

Testosterone (along with other male sex hormones) plays a major role in regulating gland function. In cases of BPH, a significant increase in the hormone or specialized receptors for this hormone in the prostate tissue's cells has been demonstrated.

La testosterona
La testosterona

La testosterona (junto a otras hormonas sexuales masculinas) cumple un papel fundamental en la regulación de la función de la glándula. En casos de HBP se ha evidenciado un aumento significativo de la hormona o de receptores especializados para esta hormona en las células del tejido prostático.

In the prostate, conversion of blood testosterone (produced in the Leydig cells in the testicles) to dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase occurs. DHT is about ten times stronger than testosterone but produces an exaggerated increase in the cells responsible for transforming it. This is known as hyperplasia. Under normal conditions, the rate of hyperplastic cells is very low and does not usually cause major problems, but in the event of BPH, dihydrotestosterone is usually increased and measured in the blood.

A poor diet is also a major cause of BPH. A diet high in animal fat or protein may be associated with an increased risk of prostatic hyperplasia, in addition to obesity, overweight and sedentary lifestyle.

The vast majority of BPH cases are usually found in patients over 45 years of age, which establishes that ageing favours an increase in prostate size, especially if other factors such as diet and hormones are added.

Diagnosis

The clinical diagnosis of BPH is based on a medical interview to gather information about the symptoms of the lower tract and the type of discomfort during urination and physical examination, especially digital rectal examination.

With the digital rectal exam, the physician can determine in situ and in vivo the actual size of the prostate without the need for additional tests.

However, certain accessory tests are also usually indicated, such as:

Treatment

The treatment of BPH involves changes in habits and lifestyle such as:

Drug therapy includes alpha-blockers (such as tamsulosin, doxazosin, among others) and 5-alpha-reductase inhibitors (the enzyme responsible for prostate enlargement, such as finasteride).

If drug therapy fails, surgical treatments are indicated, most notably transurethral resection of the prostate (TURP) in which the gland is partially or completely removed through laparoscopic methods.

Laser surgery of the prostate has proven to be highly effective in the treatment of BPH, especially because it is precise and offers a very low probability of postoperative complications.

Laparoscopic prostate surgery

TUR trans urethral resection of the prostate

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Medical evaluation

Prostate cancer

Prostate cancer is the most common malignancy in men over 50 years of age. In Europe, it is estimated that slightly less than a quarter of a million new cases occur each year. However, it usually has a good prognosis when detected in early stages, so prevention and early diagnosis are key in the fight against this type of cancer.

General anatomy of the prostate

Signs and symptoms

Prostate cancer usually progresses slowly so it tends to go unnoticed for years or even decades.

The most relevant clinical manifestations of prostate cancer are

With metastasis, prostate cancer has a predisposition to invade bone tissue and cause pain and weakening of bones, fractures, and problems in the vertebrae, pelvis, or ribs. Life expectancy for prostate metastasis varies from one to three years.

Diagnosis

The diagnosis of this disease is made with the digital rectal examination technique (to feel the prostate directly), blood tests to determine the blood concentration of prostate-specific antigen (a substance that increases in cases of prostate cancer), biopsies and CT scans.

The most effective method of detecting any neoplasm in the prostate is the digital rectal exam, which can be used to determine the actual morphology of the gland quickly, safely and inexpensively. Men over the age of 40 should have an annual urological consultation to rule out prostate hyperplasia or neoplasm.

There are also a number of genetic studies aimed at molecular detection of prostate cancer. These tests are highly sensitive and include gene testing, fusion guided biopsy, PCA3 gene testing, PSA and 4Kscore.

In today’s most recommended test, the PCA3, genes are obtained by special laboratory methods from a conventional blood sample. They can be used to detect oncogenes (present in cases of prostate cancer) or to measure the probability of developing the disease in the future.

Prognosis of the disease

The prognosis for the vast majority of prostate cancer cases is usually very good when the cancer is located in a portion of the prostate, thus facilitating its removal (with surgical methods).

However. Many men with this disease do not know they have it and therefore, do not seek timely medical help and the tumour is spreading more and more.

Fortunately, the old social paradigms about the rectal exam are being left behind and more and more men are beginning to be screened early to extend their lives and to treat any problems in a timely manner.

Partial or total resection of the prostate, as well as accessory therapies, usually generate in many patients mild or severe problems of incontinence or erectile dysfunction, something that we treat extensively in other sections of our website.

Treatment

Treatment of prostate cancer depends on the stage of cancer, the type of cancer, and the exact location.

For localized cancer within the prostate, surgery to resect the tumour, complete gland (prostatectomy), or radiotherapy is indicated.

When cancer invades sites outside the prostate, treatment is hormone therapy, radiotherapy or chemotherapy. They can also be combined.

Medical Evaluation

Prostatitis

Prostatitis comprises a group of conditions of the prostate that manifest themselves as urinary discomfort produced by inflammation in this gland, generally due to infectious processes or as a response to mechanical stress or trauma.

Healthy prostate

Prostatitis 

Types of prostatitis

In practical terms, generic inflammation of the prostate is classified according to its aetiology. Among them:

This type of prostatitis can be rapid-onset (acute prostatitis) or long-term (chronic bacterial prostatitis), depending on the length of time the disease occurs and the symptoms associated with it.

In this case, prostatitis is caused by the invasion of bacteria into the prostatic tissue, most of the time bacteria from urinary tract infections (escherichia coli, proteus mirabilis or klebsiella pneumoniae) that have passed from the urinary tract into the gland. In other cases, bacterial prostatitis may be caused by chlamydia trachomatis.

These bacteria invade the prostate after a severe or antibiotic-resistant urinary tract infection.

It's less frequent than the bacterial one. Its mechanism is still unknown but it is related to mechanical factors such as incomplete relaxation of the urinary sphincter that would produce reflux of urine, increased intravesical pressure and inflammation of the prostate in response to this increase in pressure.

Signs and symptoms

The most prominent symptoms of prostatitis, regardless of its aetiology, include

In addition, bacterial prostatitis may give rise to systemic signs and symptoms, such as

Chronic prostatitis may not cause specific signs and symptoms, so its diagnosis is hampered (asymptomatic prostatitis).

Diagnóstico

Prostatitis diagnosis includes digital rectal examination and urinalysis.

The digital rectal exam is used to determine the size of the gland. However, in cases of acute bacterial prostatitis, the inflammation may be such as to cause excessive pain with minimal palpation, so it must be done carefully.

Urinalysis includes tests to measure the concentration of white blood cells in the urine (increased in cases of urinary tract or prostate infections) and bacterial cultures, which help determine the aetiological agent that is causing the infection.

An antibiogram can be added to the bacterial culture to help determine which type of antibiotic offers the best range of action against the given aetiological agent.

Treatment

Prostatitis treatment depends on its aetiology.

Bacterial prostatitis is fought with antibiotics, physical rest, and painkillers to treat the pain.

Non-bacterial prostatitis is treated with warm sitz baths and muscle relaxants such as thiocolchicoside.

medicación posoperatorio

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Frequent questions

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Can you have sex while having a prostate condition?

In acute prostate inflammations or in cases of terminal prostate cancer, total abstinence from sexual relations is recommended because constant compression of the prostate could aggravate the patient’s clinical condition.

In any case, the urologist will be in charge of determining if there is any risk of increasing the inflammation of the gland with sexual relations.

Can a child develop inflammation of the prostate?

Yes, it could be possible. Although rare and isolated, cases of prostatitis and benign prostatic hyperplasia can occur in boys even before they have reached sexual maturity.

These cases usually have a high genetic component. The clinical management of the diseases is the same as in adult men.

How can prostate cancer be prevented?
The greatest predisposition to prostate cancer comes from genetic factors but with certain healthy lifestyle habits, the risk of the disease can be considerably reduced. Some tips for preventing prostate cancer are:
  • Maintain a balanced diet, low in fat and highly processed or fried foods. High in vegetables and lean meats.
  • Avoid sedentary lifestyles.
  • Engage in moderate physical exercise, at least three times per week (this helps to maintain, among other things, proper blood testosterone levels).
  • Avoid smoking and alcoholism.
  • Perform medical and urological checkups once a year for men over 40 years of age. Tests should include blood tests (to measure prostate antigen levels) and digital rectal exam.
What complications could result from bacterial prostatitis?
If bacterial prostatitis is not adequately treated, it can get out of control and lead to major, life-threatening problems. The most common complications of prostatitis are:
  • Prostatic abscesses, in which a sac of pus and dead cell material originates inside the prostate, increasing the inflammation of the gland and complicating its treatment. It causes pain and is considered a urological emergency.
  • The passage of bacteria into the blood (bacteremia) can lead to sepsis and septic shock.
  • Passing of bacteria into the testicles, epididymis and scrotum.
Can medicines for prostate hyperplasia treatment cause erectile dysfunction?

The answer is yes, although in low proportion. Medicines to treat enlarged prostate are drugs that minimise the number of androgen receptors, partially desensitising the gland and therefore causing less hyperplasia. It creates more problems, for example, with regard to ejaculation. Something we deal with in other sections of our website such as retrograde ejaculation and delayed ejaculation.

The decrease in androgen receptors (mainly for testosterone) can occur not only in the prostate but in other body tissues, especially the central nervous system, lowering the body’s response to this hormone and thus, the effects it produces. Sexual desire may be diminished, as well as the erectile response of the penis and ejaculation.

It should be noted that these drugs do not interact negatively with retardant medications (such as sildenafil, tadalafil or vardenafil), so they may be used to treat erection problems while treating the prostate.

 

Dr. Natalio Cruz

Author

Dr. Natalio Cruz


El Dr. Cruz, con 25 años de experiencia médica, ha sido hasta 2016 Jefe de la Unidad de Andrología en el Servicio de Urología del Hospital Virgen del Rocío de Sevilla, Coordinador Nacional de Andrología de la Asociación Española de Urología (AEU) y Secretario General de la ESSM, cargos que ha delgado para centrarse de lleno en el ilusionante proyecto de ofrecer una consulta médica privada de alto nivel en Sevilla.

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