Prostate

prostate
Enlarged Prostate
Enlarged Prostate (BPH)
Benign prostatic hyperplasia (BPH) is the nonmalignant, uncontrolled growth of cells in the prostate gland. This cell growth usually occurs in the tissue that surrounds the urethra as it passes through the prostate gland to the bladder. As BPH progresses, the gland constricts the urethra and obstructs urine outflow. The bladder no longer empties completely, creating an environment in which infections, bladder stones, and chronic prostatitis may develop. If left untreated, chronic obstruction can lead to the backup of urine into the ureters and compromise kidney function.

Anatomy
The prostate is a walnut-sized gland located beneath the bladder and in front of the rectum. It is surrounded by a capsule of fibrous tissue called the prostate capsule. The urethra (tube that transports urine and sperm out of the body) passes through the prostate to the bladder neck. Prostate tissue produces prostate specific antigen and prostatic acid phosphatase, an enzyme found in seminal fluid (the milky substance that combines with sperm to form semen).
zafar khan
Dr. Kahn
Incidence and Prevalence
It is difficult to establish incidence and prevalence of BPH because research groups often use different criteria to define the condition. Generally, most men over the age of 50 begin to experience symptoms of the condition.

Risk Factor
BPH is a condition of aging. Nearly all men over the age of 50 have an enlarged prostate.

Causes
The cause of benign prostatic hyperplasia is unknown. It is possible that the condition is associated with hormonal changes that occur as men age. The testes produce the hormone testosterone, which can be converted to dihydrotestosterone (DHT) and estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a testosterone derivative involved in prostate growth, may accumulate and cause hyperplasia. How and why levels of DHT increase remains a subject of research.

prostate
Body System
Signs and Symptoms
Common symptoms of benign prostatic hyperplasia include the following:
  • Blood in the urine (i.e., hematuria), caused by straining to void
  • Dribbling after voiding
  • Feeling that the bladder has not emptied completely after urination
  • Frequent urination, particularly at night (i.e., nocturia)
  • Hesitant, interrupted, or weak urine stream caused by decreased force
  • Leakage of urine (i.e., overflow incontinence)
  • Pushing or straining to begin urination
  • Recurrent, sudden, urgent need to urinate
In severe cases of BPH, another symptom, acute urinary retention (the inability to urinate), may be triggered by holding urine for a long time, alcohol consumption, long period of inactivity, cold temperatures, allergy or cold medications containing decongestants or antihistamines, and some prescription drugs (e.g., ipratropium bromide, albuterol, epinephrine). Any of these factors can prevent the urinary sphincter from relaxing and allowing urine to flow out of the bladder. Acute urinary retention causes severe pain and discomfort. Catheterization may be necessary to drain urine from the bladder and obtain relief.
Drugs for simple enlargement of Prostate 
  • Saw palmetto

It is a herbal extract of Saw Palmetto berries. In research studies it has proven to be useful in improving urinary symptoms due to simple enlargement of prostate. It reduces the night time trips to bathroom. The sense of urgency is also considerably reduced. Its effect on PSA and size of the prostate is still unknown. 1 tablet 2 to 3 times a day is the usual recommended dose.

  • Flomax (Tamsulosin Hcl) 0.4 mg once a day

It relaxes the smooth muscles of the prostate (70% of prostate is made of smooth muscles). When these muscles become tight, it becomes difficult to urinate. Flomax relaxes these muscles. This drug does not shrink the prostate. It simply relaxes the prostate. Following drugs act similar to Flomax:     

  • Terazosin 5 mg at bed time.

  • Uroxatral (alfuzosin Hcl) 10 mg once a day

  • Doxazosin 4 mg at bedtime

Proscar (finasteride) 5 mg once a day

This is a unique drug which acts within the Prostate and blocks the action of male hormone which is responsible for prostate enlargement. Therefore prostate gland begin to shrink. It takes 6 to 12 months to shrink the Prostate. It does not relax the muscles of the prostate like Flomax.

Combination of Proscar & Flomax

As it is clear from the description above, maximum benefit can be gained by taking the combination of Flomax and Proscar

Avodart (Dutasteride) 0.5 mg once a day

It is a newer drug, which works similar to Proscar but works on two different areas (receptors)     

SURGICAL TREATMENT

Open suprapubic Removal of Prostate.

Open Retropubic Removal of Prostate.

These surgical treatments started in 19th century Vienna, Austria. The bladder is opened with a surgical cut in the pubic area. Prostate is quickly removed either from inside the bladder (suprabubic) or outside the bladder (Rtropubic). Bleeding is quickly controlled. Frequently there is loss of one unit of blood and 3 days of hospital stay. Now a days this technique is only used when prostate gland is very large (100g or more).  

TURP-Transurethral Resection of Prostate

This technique was devolved in USA in 1950. University of Pennsylvania & Michigan played a leading role.  In this technique there is no surgical cut. The prostate is chipped away through the penis with the help of a telescope (resectoscope) by using electric cautry. The complications are much less as compared to open technique.

TUNA (Transurethral needle ablation of Prostate)

This revolutionary method for treating the simple enlargement of the Prostate has been used in Europe for many years with excellent results. Recently it was cleared by FDA for use in USA. This treatment is so good that Medicare and many other insurance companies have approved it for office use.

In this treatment no general anesthesia is necessary, only sedation and local anesthesia is used. There is no cutting of the tissues hence. There is no bleeding. This is the major advance over the previous surgical method of TURP, which has been used for more than 50 years. The procedure itself hardly takes 30 minutes. If you consider the preparations and post procedure time, the patient can leave the office in 2 hours.

In this procedure the radio frequency energy is applied to the enlarged part of the prostate. Hence multiple lessons are created deep inside the prostate as shown in the image. When these lessions shrink the urinary canal opens up. This process takes 8-12 weeks to become complete. Hence the full benefit of this technique is appreciated after 8-12 weeks. In this method there is no alteration of sexual functions, Penile erections and ejaculation remains normal. In the old technique of TURP. Patients devolved loss of ejaculation and problems with erection. Hence the advantages of TUNA are:

1.      No cutting, no incision, no bleeding.

2.      No general anesthesia.

3.      Dose not affects the sexual functions.

4.      Done in the office, no hospitalization.

5.      Covered by Medicare and many other insurances.

6.      You do not need the prostate medications after TUNA.  

 

Prostate Cancer
Adenocarcinoma of the prostate is the clinical term for cancer that begins as a tumor on the outside of the prostate gland. As prostate cancer grows, it may spread to the interior of the gland. If identified while it is confined to the gland, cancer of the prostate can be treated successfully. The longer prostate cancer is ignored, the greater the chance that it will metastasize (spread), first locally to tissues around the prostate, or seminal vesicles (sac-like structures attached to the prostate), then to other distant parts of the body, such as lymph nodes, bones, liver, lungs, and so on.
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