Understanding the Prostate: Prostate Enlargement, Prostatitis, Prostate Cancer and Its Treatment

The prostate is one of the important organs in the male reproductive system. As men age, the prostate can undergo changes that cause various complaints, particularly urinary problems such as frequent urination, difficulty starting urination, or frequently waking up at night to urinate.

These conditions are often considered a normal part of the aging process. However, these complaints should not be ignored as they may be related to various prostate problems. So, what exactly is the function of the prostate, and when should a man get himself checked?

What Is the Prostate?

The prostate is a small gland located below the bladder and surrounding part of the urethra, the tube that carries urine out of the body. The functions of the prostate include producing fluid that becomes part of semen, supporting ejaculation, and regulating urine flow by closing the urethra so that semen does not enter the bladder.

Under normal conditions, the size of the prostate is approximately that of a walnut in adult men. Generally, the prostate has a volume of around 15 to 25 milliliters (ml) or cc, with a weight of approximately 15 to 25 grams. However, as men age, the prostate can become enlarged.

At the age of 40 and above, the prostate gland may naturally begin to grow and gradually enlarge. This enlargement does not always mean cancer. One of the most common causes is Benign Prostatic Hyperplasia (BPH), or benign prostate enlargement.

Prostate Disorders

In general, several conditions commonly associated with the prostate include:

1. Benign Prostatic Hyperplasia (BPH)

BPH is an enlargement of prostate tissue that is benign. This condition is increasingly common in older men. When the prostate enlarges, the urinary passage that runs through the prostate may become narrowed. As a result, various lower urinary tract symptoms (LUTS) may occur. Symptoms may include:

1. Difficulty starting urination
2. A weaker or intermittent urine stream
3. Having to strain when urinating
4. Feeling that the bladder has not emptied completely
5. Urinating more frequently
6. A sudden urge to urinate that is difficult to hold
7. Frequently waking up at night to urinate (nocturia)

However, it is important to understand that urinary complaints are not always caused by prostate enlargement. Bladder disorders, urinary tract infections, medications, and other conditions can also cause similar symptoms. Therefore, evaluation by a doctor is necessary.

2. Prostatitis

Prostatitis is inflammation of the prostate. It may be caused by a bacterial infection or other conditions that are not always caused by infection. Symptoms may include pain in the pelvic area or around the perineum, pain or a burning sensation when urinating, frequent urination, and sexual dysfunction. In cases of bacterial prostatitis, doctors may prescribe antibiotics according to the patient's condition.

3. Prostate Cancer

Prostate cancer occurs when cells in the prostate grow uncontrollably. One important thing to know is that prostate cancer in its early stages often does not cause symptoms. Therefore, screening in men who have a higher risk can help detect the disease earlier.

Factors that can increase the risk of prostate cancer include age, family history, and certain genetic factors. Men who have a father or brother with prostate cancer have a higher risk compared to men without such a history.

Prostate Examination

Prostate examinations are tailored to the patient's age, symptoms, risk factors, and health condition. Several examinations that may be performed include:

1. Physical Examination

The doctor may perform a physical examination, including a digital rectal examination (DRE) to assess the size and characteristics of the prostate.

2. PSA Test

Prostate-Specific Antigen (PSA) is a protein produced by prostate cells and can be measured through a blood test. An elevated PSA level does not automatically mean prostate cancer. PSA levels can also increase in benign prostate enlargement or prostate inflammation. Therefore, PSA results should be evaluated together with other clinical factors.

In certain conditions, the doctor may repeat the PSA test before proceeding with further examinations. The European Association of Urology (EAU) guidelines also recommend repeating the PSA test under certain circumstances, for example, in asymptomatic men with PSA levels within a certain range.

3. Ultrasound and Urinary Tract Examination

Ultrasonography can help assess the size of the prostate, the condition of the bladder, and the amount of urine remaining after urination. The doctor may also perform uroflowmetry, an examination used to measure the speed of urine flow.

4. Prostate MRI

If there is a suspicion of prostate cancer based on PSA levels, physical examination, or other risk factors, prostate MRI can be used to help identify suspicious areas. The current EAU guidelines recommend MRI before biopsy in men with suspected localized prostate cancer.

MRI results can help determine whether a biopsy is necessary as well as identify the areas that should be targeted for biopsy. At National Hospital, MRI AI-Enhanced Transperineal Prostatic Biopsy is available, utilizing MRI imaging results and AI technology to help determine the biopsy target location more precisely.

With a more targeted approach, tissue sampling can be focused on the most suspicious areas, reducing the need to take too many tissue samples from less relevant locations. This approach helps make the biopsy process more targeted and improves the accuracy of obtaining samples from areas of concern identified on MRI.

5. Prostate Biopsy

A biopsy is performed by taking a small amount of prostate tissue to be examined in a laboratory under a microscope. A biopsy is an examination used to confirm a diagnosis of prostate cancer.

Treatment of Prostate Enlargement

Treatment for BPH does not always require surgery. For men with mild symptoms that do not significantly interfere with daily activities, doctors may recommend observation and lifestyle changes. Some measures that may help include:

1. Managing fluid intake, especially before bedtime
2. Reducing caffeine and alcohol consumption if they worsen urinary frequency
3. Avoiding holding urine for too long
4. Maintaining a healthy weight and physical activity
5. Having regular check-ups

If symptoms are sufficiently bothersome, doctors may prescribe medications such as alpha-blockers or 5-alpha reductase inhibitors, depending on the patient's condition. In some patients with severe symptoms or certain complications, surgery may be considered. Treatment cannot be standardized for everyone because it depends on the size of the prostate, the type and severity of symptoms, bladder condition, coexisting diseases, and the patient's preferences.

Conclusion

Prostate disorders, such as prostate enlargement, prostatitis, and prostate cancer, can affect men's comfort and quality of life. Symptoms such as difficulty urinating, a weakened urine stream, or frequently waking up at night should not be considered a normal part of aging.

The good news is that various prostate problems can be evaluated and treated according to their causes and each patient's individual condition. Examination by a urologist helps determine whether the symptoms are caused by benign prostate enlargement, prostatitis, or another condition requiring further treatment.

National Hospital provides Urology Surgery services supported by urologists, diagnostic facilities, and minimally invasive technology to help treat various prostate problems according to each patient's condition. Do not wait until the symptoms become more severe. Recognize the symptoms, get examined, and entrust your prostate health to the National Hospital medical team.