Do you know that at least half a percentage of men aged over 50 years, experiences problems related to their prostate gland? The range of such conditions varies from benign to malignant, but what matters the most is to identify the problems which require prompt intervention in order to ensure a healthy life. This might even make you feel little bit insecure, but the late diagnosis when it comes to a cancerous growth in your prostate gland can end you up in a disaster. This is of course if advanced treatment modalities are not carried out as soon as possible.
“The Prostate gland is situated, deep down in the male abdomen just underneath the bladder. The urethra, the tube which carries urine from the bladder to the outside, runs through the middle of this prostate gland. (Figure 1) Therefore any significant change in the gland directly affects the urinary functions of men. The Prostate gland produces fluid which facilitates the optimal function of sperms and it has less significance when one has passed the reproductive age” explains Dr. Nishantha Liyanapathirana, Consultant Urological Surgeon.
The majority of conditions affecting the prostate gland are non-cancerous, but it’s quite important to seek medical advice at the earliest possible as the symptoms can be similar.
All these conditions can present with similar symptoms, collectively called Lower Urinary Tract Symptoms. Since the prostate gland sits just around the outlet of the urinary bladder, the diseases can directly manifest with trouble passing urine.
Prostate diseases may not always present with symptoms. It’s quite important to note that prostate cancer is a silent killer and may not even present any of the above symptoms at the early stage.
“In Sri Lanka still we see a large number of patients who come to us with late stages of prostate cancer with back pain, body aches, blood in the urine and blocked kidneys. This happens when the cancer is spreading outside the prostate gland to the bones and other organs of the body where we can only offer some limited treatment” underscores Dr. Liyanapathirana.
Diagnosis
When a patient comes to see a Urological Surgeon with the above symptoms, doctors do a thorough physical examination and few important investigations including,
Digital rectal examination (Finger examination of the prostate gland)
The Prostate gland is easily felt with the finger in the rectum by trained professionals. This helps medics assess the size as well as to pick up any suspicious features of prostate cancer in the gland.
Figure 2 Finger examination of Prostate
Ultra Sound Scan of Urinary System
Prostate Specific Antigen Blood Test (PSA test)
Uroflometry (Flow Rate Test)
However, doctors decide on the exact investigations required, depending on the presentation and its severity. In case of suspected Prostate cancer, Prostate biopsy and MRI scan of the prostate is recommended.
Benign Prostatic Hyperplasia (BPH)
“As men age, their prostates enlarge due to hormonal changes. This is not cancer hence named benign prostatic hyperplasia. By the age of 65 years, 50% of men would have a benign enlargement of the prostate and at the age of 90, 90% of men have prostatic enlargement (BPH). When a man presents with urinary tract symptoms we described earlier, it’s important to differentiate BPH from prostate cancer by doing the aforementioned tests” explains the doctor.
Figure 3 Enlarged Prostate gland blocking the urine out flow of bladder
Treatment of BPH depends on the severity of the disease
BPH with minimal symptoms could be controlled by adjusting a few things in the daily routine, which are called Lifestyle modifications.
- Regular exercises and weight control
- Limiting Alcohol and Coffee
- Avoid constipation
- Taking time and emptying the bladder fully
- Reducing fluid intake after 6 pm
Significant Symptoms need to be treated with medications/oral tablets. The role of the medicine is to relax your prostate and shrink it down in size which would significantly improve your urinary flow.
Patients with Severe troublesome symptoms, who are not responding to the above medications, can have complications due to significant blockage of urinary flow; if we ignore or delay treatment. These include:
- Complete urinary blockage needing a catheter tube insertion
- Blockage causes back pressure effect on kidneys leading to kidney damage or impairment.
- Frequent urinary infections in spite of proper treatment.
We recommend bladder outflow surgery for these patients. In modern day treatment almost all the urological surgeries are carried out in a minimally invasive manner using either endoscopes or laparoscopes (key hole), which ensure patients don’t experience skin cuts or tiny key hole cuts compared to the old days. This also ensures less pain and the early return to work with an excellent outcome.
TURP (Trans Urethral Resection of Prostate)
TURP is the commonest and most widely performed surgery for BPH. This is carried out by inserting a small telescope through the penis under anesthesia, to core out the Prostate gland. The surgery is highly effective with a fast recovery and early return to the work. This may be used as an alternative option for patients who don’t like to be on long-term oral pills for BPH.
Prostate Cancer
“Prostate cancer is a silent killer affecting men mostly above the age of 55. It’s more common in the western world affecting 1 out of 9 men during their lifetime. Fortunately, in Sri Lanka it’s not very common, but we see more and more patients being diagnosed recently due to changes in the modern lifestyle and unhealthy food habits” says Dr. Liyanapathirana.
Prostate cancer may not manifest with symptoms until it reaches the late stages which could be incurable. Patients may present with urinary tract symptoms discussed earlier, but the condition is usually diagnosed by a blood test called PSA in men above 50 years.
Men with suspected prostate cancer are assessed by a finger examination of the prostate (DRE) and PSA, subsequently may be subject to needle biopsy of the prostate as described earlier which could confirm the diagnosis.
Prostate cancer, if detected early is curable. Surgery is performed to remove the prostate gland completely (Radical Prostatectomy) or patients may be subjected to Radio-therapy by an oncology specialist. A small percentage of these cancers can be monitored without any intervention, but a very close follow-up is needed with regular tests and biopsies. A dismal outcome is expected if the disease is presented in later stages. Here the disease spreads outside the prostate gland. Although it’s not completely curable, several treatment choices can be offered at this stage to control the condition effectively, unlike many other cancers where treatment options are limited.
According to the doctor, adopting a healthy diet rich in fruits, vegetables, green leaves, low animal fat and maintaining a healthy weight with routine exercises are known to prevent prostate cancer.
Prostatitis
Prostatitis is an inflammation of the prostate gland. This could manifest as an acute or chronic inflammation which may or may not to be due to an infection. It can affect men of all ages and in addition to aforementioned urinary tract symptoms, these patients can present with burning sensation on passing urine and discomfort in the genital area, which may be misdiagnosed as a simple urinary tract infection.
“After assessment we start oral treatment depending on the causative factors. A chronic form can recur time to time and may need long-term treatment,” says Dr. Liyanapathiyana
Take Home Massage
Diseases of the Prostate Gland are commoner in men over age 50.
Symptoms are neglected by many, assuming it’s a disease of elderly.
The three most important conditions of the prostate include Benign Prostatic Hyperplasia (BPH), Prostatitis and Prostate cancer which can present mimic urinary tract infection.
Prostate cancer is a silent killer which may not show symptoms until late stages.
A healthy lifestyle is the mainstay of prevention.
If you are above 55 and concerned about Prostate Cancer, have a discussion with a Urological Surgeon to get a prostate assessment and PSA blood test.