Diseases of the prostate gland

If you have followed the previous topic carefully, there are no more surprises in the description of the typical pathological processes (pathologies) around the prostate! One thing in advance: every man has a prostate, relatively many of them would have to be classified as “pathological” from a medical point of view, but only a fraction of these actually cause complaints! This fact forces the patient to make a very special trade-off between treatment and non-treatment.

One of the most significant male diseases in terms of numbers is the Often the two terms are confused in the vernacular, since both have something to do with growth of the prostate tissue. Besides these medical elephants, prostate cancer and benign prostate hyperplasia, there are other diseases. Worth mentioning here are the mostly bacterial inflammation of the prostate gland (prostatitis) and the extensive generic term “prostateopathy”.

Malignant prostate cancer (prostate cancer),
This is contrasted by a benign disease called “benign prostatic hyperplasia” (BPH).

Prostate cancer (prostate carcinoma) is a malignant neoplasia in the prostate (prostate gland) and is the most common cancer in men (25% of all cancers in men). It is a disease of the older man and usually occurs after the age of 60. Prostate cancer can be classified according to its appearance and the location of the cancer.

In about 60% of cases, prostate cancer is an adenocarcinoma and in 30% an anaplastic carcinoma. In rare cases, prostate cancer develops from other cells (urothelial carcinoma, squamous cell carcinoma, prostate carcinoma). Macroscopically, the prostate cancer appears as a coarse and gray-white focus in the glandular tissue of the prostate.

In most cases (75%) these foci are located in the lateral parts of the prostate (so-called peripheral zone) or in the posterior part (central zone). In about 5-10% of cases, the cancer is located in the so-called transition zone of the prostate, and in 10-20% of cases, the place of origin cannot be clearly found and named. Symptoms of prostate cancer Prostate cancer often shows no symptoms in its early stages, i.e. at the beginning of the disease (asymptomatic).

If the disease is more advanced, various symptoms may occur during urination (micturition) or an erection. These include symptoms such as more frequent urination (pollakiuria), during which only very small amounts of urine are released. This can also be painful (dysuria).

Often the bladder can no longer be emptied properly, the urine stream is weakened and there is an increase in so-called dribbling (the urine only goes off in drops) or interruptions in the urine stream. If the bladder is not emptied properly, residual urine will form in the bladder. If the prostate cancer is already advanced, blood may be added to the urine.

Pain in the lower back can also occur. These are caused by metastases of prostate cancer, which often spread to the bones. Classification Prostate cancer can be divided into different stages (I, II, III, IV).

This is done by estimating the size and spread of the cancer and by referring to possible lymph node infections and metastases. Diagnostics Prostate cancer is diagnosed by means of a detailed anamnesis and urological examination as well as further diagnostics such as ultrasound and laboratory tests. A biopsy, i.e. a sample taken from the prostate, can histologically confirm the diagnosis.

In addition, examinations such as x-rays, magnetic resonance imaging and skeletal scintigraphy are often performed to assess the extent and progress also in other tissues. Therapy There are various treatment options for prostate cancer. Depending on the age of the patient and the degree and size of the tumor, it is possible to choose between direct active therapy or a wait-and-see approach.

In this so-called watchful waiting or active surveillance, the tumor is observed and controlled more closely, so that another form of therapy can be chosen at any time. If the patient’s general condition is good and life expectancy is more than 10 years, a radical prostatectomy can be performed.In this procedure, the entire prostate is removed, as far as parts of the vas deferens and the vesicle gland. Lymph nodes are also removed.

Radiation is recommended after the operation. If the patient’s general condition is not good enough for surgery, radiation therapy can be performed directly and alone. If the prostate cancer is too advanced (stages III and IV), hormone withdrawal therapy can be performed.

This rarely provides a survival advantage, but reduces further complications caused by the tumor. If the hormone withdrawal therapy fails, chemotherapy can also be used. However, this too is only used palliatively.

The inflammation of the prostate (prostatitis) is a relatively common disease of the prostate. It is usually triggered by Gram-negative bacteria, and inflammation caused by the bacterium Escherichia coli is particularly common. However, venereal diseases such as chlamydia, Neisseria gonorrhoeae or trichomonads can also trigger prostatitis.

A distinction is made between the acute form and the chronic form, which can result from an unhealed and persistent acute prostatitis. In most cases, an acute inflammation of the prostate is caused by the ascending bacteria (ascending infection) through the urethra into the prostate ducts. Very rarely, the inflammation is hematogenic, i.e. it is carried into the prostate via the blood or by the infection spreading from a neighbouring organ.

Symptoms of the inflammation are pain, which is mainly dull and causes pressure in the perineal area. The pain can radiate into the testicles and also occur more frequently during bowel movements. It can also lead to urination problems, i.e. problems urinating.

These would be difficult and painful urination (dysuria), more frequent urination in only small amounts (pollakiuria) or increased urination at night (nocturia). Acute inflammation can also lead to increased temperatures and chills. Very rare symptoms are pyospermia (pus in the ejaculate) or hemospermia (blood in the ejaculate) as well as prostatorrhea (cloudy prostate secretion comes out of the urethra during urination).

Prostatitis is diagnosed by means of a medical history and clinical examination as well as an ultrasound of the prostate and a urine sample. Uroflowmetry or ejaculate analysis are also available as diagnostic options. Prostatitis is treated with antibiotics in acute cases.

In this case, mainly co-trimoxazole or gyrase inhibitors are used. These are given for about 2 weeks, in the maximum case of complications for 4 weeks. If urinary retention occurs during the inflammation, the use of a suprapubic catheter, i.e. urine diversion via the abdominal wall, is necessary.

If the prostatitis is chronic, it is often more difficult to treat. In this case antibiotics, but also painkillers, spasmoanalgesics and alpha-receptor blockers are used. If there is an abscess in the prostate during prostatitis, it can be punctured under ultrasound control. If the chronic prostatitis does not respond to therapy, removal of the prostate may be indicated. In the acute form, it is important to treat with antibiotics for a sufficiently long time to prevent the formation of chronic prostatitis.