The prostate is a gland that is part of the male reproductive system. It is located just below the bladder and in front of the rectum. It is about the size of a walnut and wraps around the urethra like a tire (the tube through which urine empties from the bladder). The function of the prostate is to produce the fluid that forms part of semen.
The main pathologies affecting the prostate are:
- Benign prostatic hyperplasia: This is the non-cancerous growth of the prostate that appears with age, often as the prostate enlarges, gradually compresses the urethra and obstructs the flow of urine (urinary obstruction). Men with benign prostatic hyperplasia fail to completely empty the bladder during urination. As a result, urine stagnates in the bladder, making them more prone to possible urinary tract infections and bladder stone formation. Prolonged obstruction can weaken the bladder and affect kidney function.
- Acute and chronic inflammation (prostatitis): causes a series of symptoms characterized by voiding, sexual and perineal disorders, to a greater or lesser extent, depending on the cause, whether it is infectious or not. Prostatitis is usually caused by a bacterial infection of the prostate gland. Any bacteria that can cause a urinary tract infection can produce acute bacterial prostatitis. Some sexually transmitted diseases (STDs) can cause bacterial prostatitis. Acute prostatitis is treated with antibiotic treatment and anti-inflammatory drugs. Acute prostatitis may recur or develop into chronic prostatitis.
- Prostate cancer: Prostate cancer is one of the most common types of cancer in men over the age of 50 and is due to malignant growth of the prostate. Many prostate cancers grow slowly and remain confined to the prostate gland. But while some types of prostate cancer grow slowly, other types are more aggressive and can spread. Prostate cancer that is detected early, when it is still confined to the prostate gland, has a better chance of successful surgical treatment.
Benign prostatic hyperplasia has an incidence of 8% between 40 and 50 years of age, 43% at 55 years of age, 80% in the eighth decade of life and 88% in the ninth decade. It should be noted that the increase in prostatic size is not always clinically related. Approximately 28% of men over 70 years of age have moderate to severe voiding symptoms. The prevalence of symptoms increases with age, from 14% at age 40 to 43% at age 60. It can be considered a progressive disease, which progresses slowly.
From 2 to 10% of adults present symptoms compatible with prostatitis at some time in their lives. The risk of prostatitis increases with age (men aged 50 to 59 years have a risk 3.1 times higher than those aged 20 to 39 years).
The incidence of prostate cancer increases with age. Some 90% of cases are diagnosed in men over 65 years of age. The etiology is not well known and is related to environmental exposures, lifestyles, family history and genetic factors. Early detection (or screening) with digital rectal examination (DRE) and prostate-specific antigen (PSA) will be recommended from the age of 50-55 years, or 40-45 in patients at increased risk of prostate cancer (family history of prostate and/or breast cancer, healthy patients carrying BRCA2 mutation, African-American ethnicity). Routine PSA determination in patients ≧75 years asymptomatic should be individualized. It will not be indicated in patients with that age and much comorbidity or with life expectancy less than 10 years.
Latest advances in the treatment of benign prostatic hyperplasia.
- Prostatic laser enucleation: the most advanced minimally invasive treatment due to its cutting and coagulation capacity, which makes it possible to remove the entire enlarged prostate tissue intact, with less bleeding during surgery, less time with a catheter and less hospitalization time.
- Rezum technique: minimally invasive treatment, which consists of the injection of water vapor into the prostate and produces a reduction in the size of the prostate. It has the advantage of not jeopardizing urinary continence and does not alter ejaculation. It does not prevent the application of other therapeutic techniques in the future.
What surgical treatments are available for prostate cancer?
Several modalities have been developed:
- Total laparoscopic prostatectomy: laparoscopic surgery to treat prostate cancer in which we sometimes use 3D or high resolution laparoscopic cameras to obtain the best oncological results while minimizing complications.
- DA-VINCI Robotic Radical Prostatectomy: this is a minimally invasive procedure in which a robotic system controlled by the surgeon is used. This system consists of a console located a few meters away from the patient with controls that reproduce the surgeon’s movements with greater precision and less tremor, even surpassing the mobility of the hand. The robotic surgery presents an optic that allows a 3D vision system, which gives depth vision and an enlarged image of the organs that are usually small in size, such as blood vessels or nerves. This gives the surgeon an uncommon vision capacity. It is the most advanced and precise invasive surgical procedure, facilitating and enhancing the surgeon’s skill and precision, as well as the patient’s early recovery phase.