European Prostate Health Day: how to take care of yourself to prevent possible pathologies

On the occasion of the European Prostate Health Day, Dr. Ramirez, Urology specialist in Valencia and member of Top Doctors explains in detail the methods for the prevention of pathologies associated with the prostate.

The prostate is a gland exclusive to men and its size is similar to that of a chestnut. It is located below the bladder, enveloping the urethra and in direct contact with the sphincter muscle. The posterior part of the prostate is supported by the rectum, for this reason in the rectal examination the urologist palpates the prostate being able to evaluate the size and potential tumors. Next to the prostate run the nerves (neurovascular bundles) responsible for erection.

Most common pathologies associated with the prostate gland

The prostate has two clear structures: the capsule and the adenoma. Consequently two pathologies: prostatic hyperplasia and prostate cancer. The third pathology affecting this gland is prostatitis.

– Prostate cancer

Prostate cancer is the most prevalent tumor in men and the third most frequent cause of death. The tumor usually develops in the prostatic periphery and in its initial stage gives no symptoms. With a life expectancy of more than ten years, if undetected, the tumor is likely to grow, rupture the prostatic capsule and infiltrate the bladder neck, seminal glands or sphincter. In more advanced stages the tumor could develop metastasis. It is therefore of vital importance to diagnose the tumor in its earliest stages.

– Benign prostatic hyperplasia

Benign prostatic hyperplasia is the growth of a prostate adenoma. Such a scenario occurs as a man ages and is due to the stimulation of the prostate gland by testosterone. The growth of the gland (gorge) causes compression, the consequent narrowing of the urethral lumen. The reduction of the urethral diameter causes an increase in resistance to the passage of urine.

On the other hand, the bladder comes to resemble a muscular hydraulic pump. Over the years the bladder muscle, being subjected to a high load due to the increased urethral resistance, begins to suffer and may eventually give out. The suffering of the bladder is manifested by symptoms such as: urinary urgency, difficulty in starting urination, sensation of incomplete emptying, difficulty in starting urination, etcetera. Finally, if the obstruction is severe, the bladder may collapse and the patient may suffer from acute urinary retention.

– Prostatitis

There are four types of prostatitis. The urologist will evaluate the patient’s signs and symptoms, order some complementary tests and label the type of prostatitis:

o Acute prostatitis: that which associates fever and urinary infection. o Infectious inflammatory chronic prostatitis. o Asymptomatic chronic prostatitis o Non-infectious inflammatory chronic prostatitis or chronic pelvic pain.

Possible treatments to combat these diseases

  • Prostate cancer

In the case of prostate cancer, there are several therapeutic alternatives for its treatment in its initial stages, among them radical prostatectomy is the standard for being a treatment that has shown a better control of the disease in the long term. The procedure consists of the dissection of the prostate from its neighboring structures, separation of the levator ani muscle, the bladder, the neurovascular bundles, the rectum and the sphincter. The sphincter muscle must be preserved for the correct recovery of postoperative continence. Subsequently, for the correct exit of urine, the bladder is sewn to the urethra and a urethral catheter will be used, which the patient will wear for 7 to 10 days.

  • Benign prostatic hyperplasia
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As the symptoms worsen and/or especially as the quality of life of our patients deteriorates, precisely because of the way they urinate, we will go up steps. In the first place is phytotherapy (there is no clear and known mechanism of action but in some cases the use of these drugs is supported).

Secondly, there are the alpha-blockers (tamsulosin, silodosin, alfuzosin, etc.), which are drugs that relax the pelvic floor muscles and the muscles supporting the prostate. This relaxation facilitates the opening of the prostate during micturition, which will decrease peripheral urethral resistance and the bladder will empty with greater force and diligence.

Thirdly, there are the combined treatment modalities: duodart. This drug combines the benefits of the alpha blocker explained above with the benefits of a 5 alpha reductase inhibitor (dutasteride). The latter drug prevents testosterone from exerting its action at the prostate level and therefore reduces its size and decreases the compression it exerts on the prostatic urethra. Currently, it is also common to combine the use of an alpha blocker with an anticholinergic. The anticholinergic relaxes the bladder musculature reducing the urge to urinate.

Finally, there is the deobstructive surgery, which can be performed with monopolar, bipolar, green laser and holmium electrical energy. The best option depends on the surgeon’s experience and prostate size.

  • Prostatitis

The treatment of prostatitis differs according to the type the patient suffers from. It is true that in most cases prolonged anitibiotic treatment with antibiotics that diffuse well in the prostatic parenchyma is recommended. It is sometimes recommended that patients associate anti-inflammatory drugs, analgesics, muscle relaxants or plant extracts.

  • Other measures

Avoid irritating foods such as spicy or acidic foods and caffeinated, carbonated or alcoholic beverages, avoid stress, increase the frequency of ejaculations, etc. An important recommendation is not to self-medicate and to see a urologist. Sometimes a prolonged study time and several tests are required before a definitive treatment can be obtained.

Risk factors for contracting prostatic pathologies

The only risk factor for developing cancer is a family history of cancer. For the development of prostatic hyperplasia age is the highest risk variable. Acute prostatitis is usually caused by bacteria, in young sexually active boys it is usually classified as a sexually transmitted disease. Promiscuity is therefore associated with prostatitis.

Screening and prevention by patients

Annual screening of the male after the age of 45 years is recommended. In addition, if there is a family history, it would be advisable to bring it forward to the age of 40. During the visits, the urologist -after questioning- will decide whether tests such as flowmetry, ultrasound, blood tests with PSA evaluation and/or urine and semen analysis are advisable.