Disease of the Prostate

To learn more…

What prostate is and what function it has:

The prostate is an organ of men’s reproductive system. It is about the size of a walnut and is located at the base of the bladder. The prostate surrounds the proximal tract of the male urethra.
The function of the prostate is to produce fluids that feed and protect sperm cells. Fluids produced by the prostate are collected in the seminal vesicles.

Prostate disease and ageing:

Around 25% of men above the age of 50 years have a prostate condition. This increases to 50 % by the age of 70 years. The prostate disease may not show any symptoms in its early stages.
Any men in their 50s, 60s or 70s should talk to a urologist about whether they need to have their prostate gland checked and how often.
Any male patient with either a family history of prostate disease or any prostate-related concern should talk to a urologist earlier about when prostate checks might be suitable for him.
The three most common problems associated with the prostate are inflammation (prostatitis), a non-cancerous enlargement of the prostate (benign prostatic hyperplasia, or BPH) and prostate cancer. One or more of these conditions may be present in a man.

Type of prostate disease:

• Prostate inflammation/prostatitis
• Non-cancerous prostate enlargement (Benign Prostatic Hyperplasia – BPH)
• Prostate cancer – PCa

Prostate inflammation:

An inflammatory process may involve the prostate of men of any age.

Main types of prostatitis are:

• Bacterial prostatitis – an acute or chronic bacterial infection
• Non-bacterial prostatitis – inflammatory process/pelvic pain syndrome

Non-cancerous prostate enlargement (BPH)

Prostate enlargement is a normal condition of male ageing. Prostate gland enlargement can cause uncomfortable urinary symptoms, such as a poor urinary stream, frequent night trips to void (nocturia), urgency, feeling as though the bladder cannot be fully emptied. Eventually, BPH can also cause infection of the urinary tract, urine retention, damage of kidney function.
BPH may be treated with medicines aimed at relaxing the smooth muscle of the gland or reducing the size of the prostate. Another treatment option is surgery and the objective is to lastingly widen the channel of the urethra that passes through the prostate (monopolar or bipolar TURP, HoLEP, “Greenlight” laser vaporization).

Prostate cancer (PCa)

Prostate cancer is the second most common diagnosed cancer in men typically over the age of 50 years.
Family history and racial/ethnic background are associated with an increased prostate cancer incidence suggesting a genetic predisposition.
In the early stages, prostate cancer may not be associated with symptoms.

Symptoms of PCa may include:

• Difficulties urinating (poor urinary flow, nocturia, urge to urinate)
• Painful urination
  Blood in the urine or blood coming from the urethra not necessarily linked with urination

Blood in the urine is often due to factors unrelated to the prostate. Always see your urologist if you find blood in your urine.

Diagnosis of prostate disease

Prostate disease diagnosis is done using various tests, as follows:

• Digital rectal examination (DRE), where the physician checks prostate health by inserting a gloved finger into the rectum
• Blood test for prostate-specific antigen (PSA test; discuss this with your doctor)
• Mid-stream urine (MSU) tests to check the presence of infection or blood in the urine
• First-stream urine tests to look for a urethral or prostate parasite (STD’s)
• Ultrasound imaging and urinary flow studies
• Biopsies of the prostate (if DRE or PSA are abnormal)

Management approaches for prostate cancer include:

• Active surveillance
• Surgery – radical prostatectomy (removal of the prostate)
• Radiotherapy
• Ablative treatments such as high-intensity focused ultrasound (HIFU)
• Hormone treatment (androgen deprivation therapy)
• Chemotherapy
• Watchful waiting

Any of the above-mentioned approaches should be carefully discussed with the patient and his partner in order to tailor the best treatment for the specific case.