The prostate is a gland located below the bladder and crossed by the urethra. It has a sexual function, since it produces a secretion that forms part of the semen, to nourish and favor the arrival of the sperm on its journey to meet the egg and carry out fertilization.
What are the most frequent pathologies of the prostate?
The most frequent prostate diseases are benign prostatic hyperplasia (BPH), prostatitis and prostate cancer. BPH is a growth in the size of the cells that make up the prostate that occurs with age after 45 years of age. It is estimated that from the age of 50 years about 50% of men already have it and at the age of 80 years the incidence rises to 70-80%.
There are two types of symptoms:
- Obstructive: loss of strength, difficulty in starting urination, increased voiding frequency, intermittent urination, voiding dribbling, incomplete emptying and acute retention of urine due to inability to urinate, overflow urinary incontinence.
- Irritative: urinary urgency, sometimes with incontinence, increased frequency and nocturia.
Complications of benign prostatic hyperplasia (BPH)
- Urinary tract infections (UTI)
- Vestal stone formation
- Hematuria
- Urinary retention
Treatment
Treatment options depend on the age of the patient and the time of evolution. During the early stages, a medical treatment is used and as symptoms worsen, the physician may choose to resort to surgical treatment.
The most frequently used surgical techniques are TUR P and Adenomectomy and more recently laser interventions have been incorporated. Unlike the first two techniques indicated, laser intervention shortens hospital stay, reduces the risk of bleeding and complications with incontinence and sexual impotence.
Prostatitis
Prostatitis is inflammation of the prostate and can be acute or chronic. Acute prostatitis may result in fever, voiding difficulty, pollakiuria, dysuria or voiding pain, hematuria and even urinary retention. Chronic prostatitis, on the other hand, presents symptoms very similar to those of benign prostatic hyperplasia.
In both cases, the diagnosis is made by clinical examination, renal examination and ultrasound. As for treatment, antibiotics and anti-inflammatory drugs are usually used.
Prostate cancer
It is the most frequent cancer in men excluding skin cancer. Prostate cancer is produced by a tumor growth of prostate cells, being sometimes frequent that there are more members of the family affected with a 20% higher incidence than in the rest of those affected.
It is a cancer that increases with age, being necessary the existence of the Testosterone hormone that favors and stimulates its growth.
Diagnosis
In the initial stages, the cancer may be developing without presenting any symptoms and it will not be until the more advanced stages when these symptoms begin to appear, being similar to those of BPH.
For a correct diagnosis, the patient will be required to undergo an analysis that includes: PSA (prostate marker), rectal examination to assess the consistency (generally harder if it is an advanced cancer) and the existence of suspicious nodules.
Prostate biopsy
It is performed when cancer is suspected, either by the PSA result or by the existence of a suspicious module. The anatomopathological study of the sample will give us the diagnosis.
If the biopsy was negative but there is still suspicion of a possible cancer, the test will be repeated together with the performance of an MRI combined with a three-dimensional ultrasound, in addition to performing the biopsy in the suspicious nodule, which increases the reliability of the results.
It is necessary to make an early diagnosis in order to apply curative treatment such as radical prostatectomy.
Diagnosis in the initial stage of prostate cancer is extremely important, since in the great majority of cases a cure is achieved. In order to obtain an early diagnosis it is very important to visit a urologist once a year after the age of 45-50 years and have a urological check-up that includes PSA and a digital rectal examination, together with an ultrasound and fluxometry.
Treatment of prostate cancer
When the cancer is located, the ideal treatment is surgery or radical prostatectomy. Sometimes it is performed with lymphadenectomy, but it will depend on the stage and degree of aggressiveness of the tumor.
Other alternatives are external radiotherapy and/or brachytherapy and cryosurgery. In patients with advanced cancer, in whom surgery cannot be performed, hormonal blockade and chemotherapy are indicated.
As a future perspective, thanks to cryosurgery and the possibility of having images of the tumor with MRI, conservative interventions can be carried out, removing only the area affected by the tumor and preserving the rest of the prostate gland, avoiding problems secondary to surgery, such as urinary incontinence and erectile dysfunction (ED).
It is necessary by means of a check-up to make an early diagnosis that allows the application of a curative treatment such as radical prostatectomy.