The Prostate

PROSTATE-small gland-big problem

What is the prostate?

The prostate is the male sexual gland located below the bladder and surrounding the urethra. It is about the size of a chestnut and it reaches its normal size after puberty when it weighs about 20 g. It consists of glandular tissue, which is surrounded by a membrane (prostate capsule). The functioning of the gland is influenced by the male sex hormone testosterone, which is produced by the testicles. The secretions of the prostate are mainly seminal fluids, where semina flow down the urethra.

The prostate can be felt through the intestine. A normal prostate is smooth, elastic and is not painful to the touch.

Prostate diseases

In middle-aged men, the most common disease is prostate inflammation or prostatitis, which is diagnosed either as acute or as chronic. After the age of 50, benign prostatic hyperplasia (BPH) often develops, which means that the prostate enlargement is benign and not cancerous . BPH causes urination problems. This disease is most commonly treated with drugs and rarely with surgery. The most common malign prostate disease is prostate cancer – adenocarcinoma.

PROSTATE CANCER

What is prostate cancer?

Prostate cancer is a disease that is becoming increasingly frequent in men. However, due to the improvement in diagnosing and treating cancer, the mortality rates of prostate cancer patients are decreasing. Prostate cancer – the most common form of cancer in Europe – is changing from an aggressive form to a chronic disease of older men.

Prostate cancer causes prostate cells to multiply and grow in an unregulated manner, which results in a tumor. Contrary to normal cells, cancer cell growth is not being controlled. Cancer cells outlive normal cells and continue to form new abnormal cells. Prostate cancer is mostly formed of many smaller tumors located in the prostate. At this stage, the disease is treatable with surgery or radiation therapy. At an early stage, prostate cancer does not cause problems or causes only few problems and is thus harder to detect.

Metastatic prostate cancer

Prostate cancer grows relatively slowly, which means that it can take several years before it spreads outside the prostate or to other organs. If prostate cancer is not treated, the cancerous cells can spread to other organs, which is called metastasis. The disease spreads through lymph vessels and blood vessels, and at first, most commonly into the skeleton. Cases where prostate cancer grows rapidly and aggressively are rare. Unfortunately, it is also hard to predict rapid- and aggressive-growing cancer.

How common is prostate cancer?

Prostate cancer is the most common cancerous disease in men. In Europe, 2.6 million people get cancer every year. Prostate cancer makes up 11 percent of all newly diagnosed cancerous diseases. In Slovenia, cancer is detected in more than 1,000 men every year.

Prostate cancer treatment

There are several treatment options at hand. The proper treatment depends on the spreading of the cancerous cells, the patient’s general health and his decision. Cancer can be treated with:

• Observation-watchful waiting,
• Surgery-prostatectomy,
• Radiaton therapy,
• Hormonal therapy,
• Chemotherapy.

Prostate cancer – can it be cured?

It is generally known that the sooner the cancer is detected, the better the chances of recovery. Recovery in this case means that the patient has no signs of malignant cells after completing the treatment. If cancer is diagnosed at an early stage, the chances of recovery are high. A cancer diagnosis is followed by a decision on how to treat the disease appropriately.

RISK FACTORS AND PRECAUTIONS

The probability of prostate cancer development increases with age. In men under 40, only one out of 10,000 is diagnosed with prostate cancer. This ratio changes to one in 38 men aged from 40 to 59 and one in 15 men aged from 60 to 69. As many as 60 % of all prostate cancer patients are older than 65. Men with relatives in the first degree (father, brother, son) who have been diagnosed with prostate cancer are twice as likely to suffer from prostate cancer themselves. If two or more relatives suffer from this disease, the probability of cancer development increases by four to ten times.

The main risk factors for developing prostate cancer are age, race, disease in the family and the environment we live in.

What you can do to prevent prostate cancer from developing

1. Eat low-calorie food and maintain a healthy body weight. Cut down on the intake of animal fat. Do not exceed the recommended dose of calcium, which is 1500 mg per day. Eat plenty of fish. Your diet should contain a lot of cooked tomatoes. Eat more soya.

2. Drink green tea.

3. Selenium and vitamin E reduce the probability of developing cancer in smokers. However, mind that overdosing can be dangerous. Eat an apple a day to supply your body with more antioxidants than are contained in a big dose of vitamins. We recommend that you eat oranges, vegetable soups and broccoli as well.

4. If you are in the risk group, we advise you to get a digital rectal examination done annually and to regularly check your PSA values.

When to visit a doctor

Urination problems are the most common symptoms of prostate cancer. Do visit a doctor if you have the following problems:

• Weak urine flow,
• Interrupted urine flow,
• Flatulence before urination,
• Frequent urination,
• Sudden urge to urinate,
• Frequent urination at night,
• Feeling that the urinary bladder is not completely emptied,
• Pain and burning sensation during urination,
• Blood in urine or seminal fluid.

In general, we advise men over 50 to have a prostate examination done even if they do not have urination problems. The examination also includes determining the patient’s PSA values and a digital rectal examination.

PSA

PSA is a glycoprotein produced by prostate gland cells that enters the blood circulation in small amounts. If the patient suffers from prostate cancer, larger amounts of PSA are released into the blood. Higher PSA values can be detected in cases of prostate cancer, benign prostatic hyperplasia (BPH) and prostate inflammation. In some men, prostate cancer develops despite a low PSA value.

Therefore, also a digital rectal examination is recommended to correctly diagnose the prostate disease.

RECOMMENDED PSA VALUES

aged 40 to 49    PSA  up to 2,5 ng/mL

aged 50 to 59    PSA  up to 3,5 ng/mL

aged 60 to 69    PSA  up to 4,5 ng/mL

over 70      PSA  up to 6,5 ng/mL

Moreover, the rise of the PSA value has to be monitored closely. PSA levels must not increase by more than 0.75 ng/mL per year.

Digital rectal examination

During a digital rectal examination, the urologist inserts a gloved finger into the colon and feels the prostate. The urologist checks the size, shape and firmness of the prostate. Often, cancerous changes or an enlarged prostate due to benign prostatic hyperplasia can be detected by a digital rectal examination.

• The prostate is a gland about the size of a walnute and it is located below the bladder. The urethra is a tube that runs through the prostate. Its function is to secrete both urine and semen. A muscle is located below the prostate which squeezes the urethra and plays an important role in urine control. The last part of the colon lies behind the prostate. Nerves run along the prostate and are important for the erectile function. Moreover, both spermatic ducts and both seminal vesicles discharge into the prostate.