The prostate, a walnut-sized gland nestled below the bladder in men, plays a key role in the reproductive system. It produces a milky white fluid that nourishes and protects sperm as it travels through the urethra, the tube carrying urine out of the body. As men age, the prostate can undergo changes that can lead to various health concerns. An enlarged prostate can lead to a group of symptoms known as Lower Urinary Tract Symptoms (
LUTS
), which warrant a visit to your doctor.
These symptoms include increased frequency of urination, a sudden and strong need to urinate, waking up more frequently at night to pass urine, difficulty starting or maintaining a steady flow of urine, urine flow stopping and starting again during urination, having to push or strain to urinate, and a sense of incomplete evacuation of urine.
If you experience any of these symptoms, it is important to visit your doctor for a proper diagnosis. Early detection is crucial, especially for
prostate cancer
. Diagnostic tools used by doctors include the Digital Rectal Exam (DRE), where the doctor feels the prostate through the rectum to assess its size and consistency, the Prostate-Specific Antigen (PSA) Blood Test, which measures PSA levels in the blood, and the
TRUS-guided Prostate Biopsy
, where small tissue samples are taken from the prostate under ultrasound guidance and examined under a microscope for the presence of cancer cells.
Preventive measures can help maintain optimal
prostate health
. Maintaining a healthy weight with a rich in fruits, vegetables, and whole grains can be beneficial. Limiting red meat and processed foods may also play a role. Regular physical activity can improve overall health and potentially reduce the risk of prostate cancer. Limiting alcohol consumption and quitting smoking are essential for overall health and might also benefit prostate health.
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While prostate cancer can affect any man, certain factors can increase your risk. The risk increases significantly with age, with most cases diagnosed in men over 50 years of age. Having a father or brother with prostate cancer increases your risk, as do certain racial and ethnic factors, with African American men having a higher risk. Certain gene mutations, such as BRCA, can also increase your risk.
Depending on the specific prostate issue and its severity, various treatment options exist. For Benign Prostatic Hyperplasia (BPH), a non-cancerous enlargement, medications can help manage symptoms like LUTS. Alpha-blockers relax muscles in the prostate and bladder neck, improving urine flow, while 5-alpha reductase inhibitors shrink the prostate by reducing a hormone that fuels its growth. Minimally Invasive Procedures (MIPs) offer quicker recovery times than surgery but may be less effective for severe BPH. Examples include the Prostatic Urethral Lift (UroLift), which uses tiny implants to hold the prostate open and improve urine flow, Water Vapor Therapy (Rezum), which uses targeted steam to destroy prostate tissue, and Microwave Therapy (TUMT), which uses heat to shrink prostate tissue.
For severe BPH or prostate cancer, surgery might be necessary. The most common option for BPH is TURP (Transurethral Resection of the Prostate), where excess tissue is removed through the urethra. Newer options like Laser Enucleation of the Prostate (LEP) and Bipolar TURP are also available for larger prostates and patients on blood thinners due to compromised cardiac health. Robotic-Assisted Radical Prostatectomy (RARP) offers a minimally invasive treatment for men with localized prostate cancer, confined to the prostate gland. During RARP, a surgeon operates from a console, controlling robotic arms equipped with tiny instruments and a high-definition 3D camera, allowing for precise removal of the prostate gland and seminal vesicles through small abdominal incisions. The benefits of RARP include smaller incisions, resulting in less pain, scarring, and blood loss, and a shorter hospital stay for faster recovery. The precision of robotic arms may reduce nerve and blood vessel damage, lowering the risk of erectile dysfunction, and potentially leading to better surgical outcomes. Suitability for RARP depends on cancer stage, overall health, prostate anatomy, and the surgeon’s experience. Recovery involves managing post-surgery pain, using a temporary bladder catheter, and gradually resuming normal activities.
(Author: Dr Manav Suryavanshi, Head of Urology Department, Clinical Lead – Uro-Oncology and Robotic Surgery, Amrita Hospital, Faridabad)