WHAT IS PROSTATE GLAND, WHERE IS IT LOCATED AND WHAT IS ITS FUNCTION?

The prostate gland is a chestnut sized organ which is located below the urinary bladder and surrounds the external urinary tract. Prostate is a secondary sex organ which is present in men only.

It forms liquid parts of the semen. This liquid includes substances required for vitality of the sperms.

It corresponds to the uterus in women.

WHAT ARE MOST COMMON DISEASES OF THE PROSTATE GLAND?

Benign Prostate Hyperplasia (BPH), Prostate Cancer and inflammatory diseases of the prostate gland (prostatitis) are most common prostate diseases.

WHAT ARE COMPLAINTS FOR INFLAMMATIONS OF THE PROSTATE GLAND (PROSTATITIS)?

25% of patients who have referred with urogenital complaints (burning and stinging sense while urination, awakening for urination at night, difficult urination, waist pain, pain on inguinal region and fatigue etc.) are diagnosed with prostatitis and 50% of men are examined because of prostatitis in any period of their life.

TREATMENT FOR PROSTATE GLAND INFLAMMATIONS?

ACUTE PROSTATITIS

The patients should be hospitalized. Serous fluid and antibiotherapy are started. Also, urinary relaxation agents, anti analgesics and anti-inflammatory treatment are applied. The patients are recommended to prevent constipation, intake fluid more and rest.

Oral antibiotherapy should continue for 30 days even the body temperature has decreased and complaints recovered.

PROSTATE ABSCESS

Long term antibiotherapy + abscess drainage

CHRONIC PROSTATITIS

Kronik prostatitin tedavisi oldukça problemlidir. Drugs effective on urinary infections may not be effective on chronic prostatitis. 4-16 haftalık trimetomoprim-sulfometaksozol tedavisi ile , %30-40 oranında kür sağlamaktadır. Suppressive antibiotic therapies may be necessary for 6 to 8 months for the patients which have continuous positive cultures. However, relapse may occur after discontinuation of the antibiotics.

NON-BACTERIAL PROSTATITIS

Doxycyclin or erythromycin treatment for 2 to 4 weeks may be useful. Anti-inflammatory and anti-cholinergic agents may be useful for recovery of the complaints.

PROSTATODYNIA (ASYMPTOMATIC PROSTATE INFLAMMATION)

Antibiotics are not effective. Alpha-adrenergic blockers facilitate the urinating. Diazepam and myorelaxant agents may be useful.

WHAT IS BENIGN PROSTATE HYPERPLASIA (BPH)

50% of the men over 60 and 80% of the men on 70-80 years have a problem of non-cancerous enlargement of the prostate, namely “Benign Prostatic Hyperplasia” (BPH). Actually, the enlarged part is not the prostate, it is a cell group called “adenoma”.

WHAT COMPLAINTS OCCUR IN BPH?

Enlargement of the prostate gland and initiation of the compression onto the urinary tract causes different complaints.

Prostate enlargement presents the following symptoms;

  • frequent urination,
  • Waking up with a urination sense at nights,
  • Waiting for a while to start the urination,
  • To discharge the urine intermittently,
  • Difficult urination,
  • Bifurcated discharge of the urine,
  • Inability to discharge the urinary bladder completely,
  • Having the sense to urinate just after the urination,
  • Feeling sudden urination needs,
  • Sometimes, urinary incontinence.

WHAT ARE TREATMENT ALTERNATIVES FOR BPH?

MEDICAL TREATMENT

Medical treatment is the first option for disturbing symptoms created by the hyperplasic prostate within the early period.

SURGICAL TREATMENT

OPEN PROSTATE OPERATIONS

It an operation that “adenoma” part of the enlarged prostate tissue is removed by an operation with a cut from the abdomen.

CLOSED PROSTATE OPERATIONS

TURP (Transurethral Prostate Resection): The enlarged prostate tissue is cut and removed by an electro-cautery endoscopically and healthy urine flow is provided again.

GREENLIGHT PVP LASER PROSTATECTOMY

SELECTIVE VAPORIZATION METHOD OF THE PROSTATE

(potassium titanyl phosphate laser – KTP LASER) It is a vaporization method of the enlarged prostate tissue with a specialized laser beam under the control on 1 to 2 mm depth.

OTHER ENDOSCOPIC TREATMENT METHODS;

  • Transurethral incision of the prostate (TUIP)
  • Transurethral microwave thermal therapy (TUMT)
  • Transurethral needle ablation (TUNA)
  • (HIFU ) High intensity focused ultrasound
  • Water induced thermo therapy (WIT)
  • Transurethral ultrasonic aspiration of the prostate
  • Visual laser ablation of the prostate (VLAP)
  • Holmium: YAG laser (HoLEPve HoLAP)
  • Interstitial laser coagulation of the prostate (ILC)
  • Cryotherapy
  • Balloon dilatation
  • Intraurethral stents

All treatment alternatives specified should be arranged according to general status of the patient, enlargement of the prostate gland and physician-patient compliance.

HOW DOES PROSTATE CANCER OCCUR?

Cells within all body tissues renew themselves within a certain control mechanism. Thus, the damages tissue is repaired and renewed. Cells which proliferate beyond control creates cell groups called tumor. Prostate cancer is unnecessary proliferation of cells forming the prostate without control.

RISK FACTORS FOR PROSTATE CANCER ?

Main factors blamed are as follows:

1. Family history

2. Aging If a man lives long enough, for example up to 100 years, prostate cancer develops in almost all men. Risk for development of prostate cancer increases by the age. 85% of prostate cancer cases are detected in men over 65 years. However, prostate cancer may develop in some men within earlier years.

3. African race is more predisposed than the white race.

4. Testosterone (masculine hormone): Prostate cancer (ca) is not seen in men who have been castrated before puberty.

5. Prostate ca is not detected in patients with chronic pulmonary diseases where estrogen hormone (femininity hormone) increases relatively.

6. Some environmental factors such as consumption of fatty foods

WHAT ARE SYMPTOMS OF PROSTATE CANCER ?

Symptoms appear after urinary tract obstruction. When any of the following complaints appear, a doctor must be consulted.

* Frequent urination (especially at nights)

* Difficult urination

* Thin and intermittent urination

* Pain or ache during urination

* Presence of blood within the urine

* Back, hip and waist pain

* Presence of blood or inflammation within the urine

* Presence of blood or pain in the ejaculate.

IS EARLY DIAGNOSIS / CHECK-UP POSSIBLE IN PROSTATE CANCER?

AS IT PROVIDES SYMPTOMS LATE, SCREENING OR CHECK-UPS HAVE A GREAT IMPORTANCE.

There are many common stages that should be done either on check-up or on suspicious conditions.

On Routine Controls:

1. Story is listened

2. PSA test is performed

3. COMPLETE ABDOMINAL ULTRASONOGRAPHY is performed for general purposes

4. Prostate examination is done with TR if necessary

WHAT IS PSA?

A differentiation is tried to be done between BPH and the prostate cancer via a blood test called PSA (Prostate Specific Antigen). This test is diagnostic and provides information about progression of the treatment for the prostate cancer as well.

PSA is a protein produced by prostate gland cells and provides liquidation of the ejaculate.

On normal conditions, total PSA should be below 4 ng/ml. Even some scientists reduce this value to 2.5.

PSA is not specific for prostate cancer. PSA may also increase in other pathologies. However, higher blood PSA level, higher possibility to have prostate cancer.

Although PSA elevation is a valuable diagnosis method, it may be insufficient solely for diagnosis of cancer and it should be coordinated with other diagnosis methods.

WHAT ARE TREATMENT ALTERNATIVES FOR PROSTATE CANCER?

* Wait-follow

* Radical prostatectomy: Retropubic – perineal laparoscopic

* Radiotherapy: External – brachytherapy

* HIFU (High intensity focused ultrasound)

* Hormonal therapy: Surgical castration – medical castration

* Chemotherapy

* Cryotherapy

The most important criteria to determined the treatment options are;

General status of the patient, PSA elevation, cell characteristics in the biopsy (Gleason’s score) and Cancer Stage.

The urologist, medical oncologist and radiation oncologist should treat the patient with a team approach and determined the treatment plan by considering many factors.