The prostate


What is the prostate?
What does it do?

The prostate is a sexual gland, which means that it plays an important role in the reproduction, it produces the fluid in which the sperm-cells ‘move’. It is located at the neck of the bladder, and visually can be compared to a doughnut: the prostate sits around the central opening, which is the urethra (urine duct), through which the urine will flow on its way out. With ageing this gland will almost always enlarge, this will make the opening smaller, and thus interfere with the urine flow, or may even obstruct the flow.
Sometimes the enlargement is not benign, namely when a tumour is causing the obstruction; this explains why a tumour always must be excluded whenever symptoms appear.

Prostatism is a condition, a group of symptoms which refer to a problem which most men sooner or later will encounter, symptoms related to difficulty in urinating, due to the enlargment of the prostate gland.

It is estimated that 20-30% of men will need surgery for this problem before reaching the age of 80 years.


What are the symptoms of prostatism?

The symptoms will obviously be related to this outflow obstruction:

1. A decreased amount and force of the urinary flow.

2. Terminal dribbling.

3. Hesitancy (it takes a long wait before the urine comes out), and
intermittency (the flow stops, and goes, albeit weakly).

4. Frequency, usually without burning on urinating.

5. Nocturia (this means getting up often, at night, to pass small
amounts each time).

6. A sensation of incomplete emptying of the bladder.

7. Straining to pass urine.

8. Even incontinence may develop.


Is it dangerous, what are the complications?

Due to the obstruction a urinary retention can occur; this in turn can lead to either urinary tract infections, hence often recurrent! - or to an acute prostatitis (infection of the prostate).
Sometimes the urinary tract infection can even develop into an acute kidney infection.

When the obstruction becomes severe, this retention can even become so acute that the bladder distends and swells like a balloon, which is extremely painful. When left untreated for too long this can also damage the kidneys.

The main danger however lies in the fact that, as mentioned before, there can be a cancer, a tumour present. For this reason proper screening for cancer is mandatory when any of these symptoms appear. As a matter of fact, every man above 50 years of age should yearly be checked for prostate cancer, since the cancer often grows unnoticed, without provoking any symptoms, and may only present symptoms sometime later, in more advanced stages.
In the case of a family history, we start checking earlier, already at age 40.

What makes the prostatism worse, and what can one do to avoid it ?

l Prolonged and forceful attempts to hold up the urine will irritate
the prostate even more, and aggravate the symptoms.

lLong periods of immobilisation (car or coach trips, intercontinental flights,...).

lExposure to cold.

lCertain drugs and medications.

lCoffee, and especially alcohol, irritate the prostate!

The diagnosis.

Tests include a blood test (the well- known PSA-test, which is still a reliable tool in evaluating the evolution of the problem), this is up to now our best tool.
Also we have the rectal examination, especially in case of a raised PSA level, where the doctor assesses the prostate. By evaluating the texture he can often already make a preliminary distinction between a benign enlargement, or a cancerous one, even detect the presence of a suspicious nodule or even a prostate stone.


The treatments available.

Obviously, avoiding the above mentioned trigger factors (cold, medication, alcohol...) is very important if your prostate is enlarged and causing problems.

Medication is available now, to reduce the size of the prostate. Some homeopathic drugs also have good reducing effects. Be careful however, of taking such medication without a proper check-up for cancer.

Finally, the definite way to solve this problem is by surgery. Here the prostate usually is removed by an endoscope, though the penis. Newer treatments are appearing, like Laser excision, or Vapour surgery. In certain cancers, the prostate will be removed through abdominal surgery.

In this condition, more than in any other illness, is preventive screening of paramount importance: a test exists which make early detection of cancer possible, and the problem of an enlarged prostate, be it benign or cancerous, can adequately be dealt with, before it can cause further urological problems, or before the cancer can spread to the rest of the body.