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Prostate

The prostate is a small gland located under the bladder and in front of the rectum. The bladder holds your urine. The urethra runs through the centre of the prostate from the bladder till the penis, letting urine flow out from the body.

The gland’s main function is to produce fluid for semen to nourish and transport sperm cells. The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s flushed out with sperm as semen.

Endourology

Benign Prostate Hyperplasia

Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. The prostate gland surrounds the urethra. Urethra is the tube that carries urine from the bladder out of the body. As the prostate gets bigger in size, it might squeeze or partly block the urethra. This often can cause problems with urination.

Benign prostatic hyperplasia occurs in almost all men as they grow old. This is not a cancer. But an enlarged prostate can become a nuisance. Generally, it’s not a serious problem. About half of all men older than 75 have some symptoms.

Benign prostatic hyperplasia is also known as benign prostatic hypertrophy.

What causes Benign prostatic hyperplasia?

Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

What are the symptoms?

  • Difficulty in passing urine.
  • Weak urinary system.
  • Terminal Dribbling.
  • Frequency of urine.
  • Urgency.
  • Nocturia (Night time urinary frequency, etc.)

Treatment Options for BPH:

Expectant Treatment

If symptoms are not bothersome to patient’s lifestyle – just observation and lifestyle modification is offered.

Medications

If symptoms are bothering to patient then medication is started which is helpful to reduce the outflow resistance and thus ease urinary problems.

Surgery

If patient is having very serious urinary problems or urine stops then surgery is offered. It could be in the form of below:

  • Transurethral resection of the prostate (TURP)
  • Laser TURP

Here Endoscope is passed through urethra and obstructing adenomatous part of prostate is removed by TURP or LASER (Laser TURP).

Both are equally giving good outcome, but Laser TURP is preferred when patient is taking blood thinner (Anti-platelets).

Carcinoma of prostate

Prostate cancer, also known as carcinoma of the prostate, is a malignant tumour of the prostate.

A tumour is the abnormal growth and formation of mass of prostate. Some tumours are not likely to be life-threatening and others can be cancerous and potentially life-threatening. Sometimes, the cancer can be localized, and confined within the prostate. In other cases, the cancer can be present in more than one location of the prostate. Metastasis process means some cancer cells can spread outside the prostate to nearby regions. They eventually can spread to more parts of the body through the blood and lymph systems–most often to the bones. In order to determine whether the cancer is localized to the prostate or whether it has spread to distant body parts, cross-sectional imaging is done and it’s very important in selecting treatment.

Symptoms

Most of the time prostate cancer is detected even before the development of the symptoms. Prostate cancers are detected because of abnormalities in either blood test (PSA screening test) or by rectal exam (Physician feels an abnormality).

In rare occasions, men do experience symptoms that indicate the presence of prostate cancer and that include:

  • Difficulty in urinating or holding back urine.
  • Less or interrupted flow of urine.
  • Difficulty in having an erection.
  • Painful ejaculation.
  • Blood in urine.
  • Frequent pain or stiffness in the lower back, hips, or upper thighs.

Causes of prostate cancer

There are no specific causes. There are so many possible factors, including age, race, lifestyle, medications, and genetics, to name a few.

Age

Age is considered as the primary risk factor. The older a man is, the higher is his risk. Prostate cancer is rare among men under the age of 45, but much more common after the age of 50.

Genetics

Statistics indicate that genetics is definitely a factor in prostate cancer risk. It is more common among certain racial groups - in the USA prostate cancer is significantly more common and also more deadly among Afro-Americans than White-Americans. A man has a much higher risk of developing cancer if his identical twin has it. A man whose brother or father had/had prostate cancer runs twice the risk of developing it, compared to other men.

Diet

A recent study indicates that combination therapy of vitamin E, selenium and soy does not prevent the progression from high-grade prostatic intraepithelial neoplasia (HGPIN) to prostate cancer. A diet high in vegetable consumption was found in a study to be beneficial.

Medication

Some studies say there might be a link between the daily use of anti-inflammatory medicines and prostate cancer risk.

Obesity

In a study, it was found a clear link between obesity and raised prostate cancer risk, as well as a higher risk of metastasis and death among obese people who develop prostate cancer.

Sexually transmitted diseases (STDs)

Men who had gonorrhoea may have a higher chance of developing prostate cancer, according to a research from the University of Michigan Health System.

Diagnosis

  • Blood report (PSA).
  • CT Scan, Abdomen Pelvis.
  • Bone scan, etc.

Treatment Options

  • Surgery
  • Radiation Therapy
  • Hormonal Therapy

Surgery

If prostate cancer is limited to prostate gland only and patient’s general condition is ok, he can be offered surgical removal of Prostate – Radical Prostatectomy.

  • Open Radical Prostatectomy.
  • Laparoscopic Radical Prostatectomy.
  • Robotic Radical Prostatectomy.

All methods are having good outcome as far as disease control is concerned.

Radiation Therapy

If disease is localised to prostate, then therapeutic or sometimes palliative radiation is offered in metastatic prostate cancer for sever bone pain.

Hormonal Therapy

If the cancer is in advance stage, only hormonal manipulation is done in the form of medical castration (injectable hormones) or surgical castration. (Both the testicles removal).