What is the prostate?
The prostate is about the size of a chestnut and encircles the urethra, secreting a fluid upon ejaculation that enables the sperm to travel. The prostate is also where the paths of the ejaculatory duct and the urethra meet.
Types of prostate disorders
Prostate disorders may have different causes. There are three main causes:
- BPH/BPS: This is a benign enlargement of the prostate, also known as benign prostatic hyperplasia (BPH). While BPH refers to the benign enlargement itself, the term benign prostatic syndrome (BPS) is used to describe the symptoms.
- Prostatitis: Around 10% of men suffer from prostatitis at least once in their lives. Typical signs of this include pain during urination and a frequent need to urinate. Prostatitis requires diagnosis and treatment by a doctor.
- Prostatic carcinoma: Prostate cancer is the most common cancer in men. Around 6,100 men fall ill with it every year in Switzerland. The tumour exhibits very few symptoms to begin with, as it usually grows in the outer area of the prostate, far removed from the urethra. This is why regular examinations are advisable from the age of 45.
From a chestnut to an orange
A frequent urge to urinate, weak urine flow or more frequent urination during the night are symptoms that could be indicative of prostate problems. The most common cause is usually benign prostatic hyperplasia (BPH), because around 40% of men experience a benign change in prostate tissue from the age of 40 onwards.
The gland begins to grow, and this is a normal part of a man’s ageing process. As the man gets older, the prostate may grow from the size of a chestnut to that of an orange. Because the prostate encircles the urethra, it can constrict the urethra. As many as one in two Swiss men over the age of 50 is confronted with BPH.
The symptoms are categorised into three different stages (Alken categorisation system):
- Stage 1: Irritation -> early signs are exhibited during urination.
- Stage 2: Incomplete urination -> you feel like you cannot completely empty your bladder.
- Stage 3: Obstruction stage, chronic urinary retention -> this is where large amounts of urine remain in the bladder and may build up in the urethra and even the kidneys. The bladder becomes overstretched and can no longer empty itself completely.
Treatment of benign prostatic hyperplasia
In the long term, constricted urine flow can damage the bladder and kidneys, which is why it is worth consulting a doctor as soon as possible. There are several approaches:
- Controlled waiting: BPH only progresses slowly over the years. The symptoms can vary greatly and may sometimes temporarily disappear. Some men do not feel hindered by this and therefore do not opt for treatment to begin with, which is why controlled waiting with regular examinations by a doctor may be a suitable option.
- Drug therapy: Herbal remedies, alpha blockers or even 5α-reductase inhibitors may provide relief. Herbal remedies in particular have proven to be a good first option due to their high tolerability. Always ask your doctor about the right treatment for you before undertaking any therapy. Certain herbal remedies for treating early-stage BPH are also available without prescription in pharmacies and drug stores.
- Prostate surgery: It is first necessary to establish whether there is actually a compelling reason for performing surgery. Such reasons may include:
- Recurrent acute urinary retention (ischuria)
- Recurrent inflammation of the urinary tract
- Recurrent presence of blood in the urine, unresolvable with drug therapy
- Bladder stones
- Dilation of the upper urinary tract (urethra, renal pelvis, renal calyx), impaired renal function or renal insufficiency
- Surgery may be a worthwhile option once a case of BPH achieves a certain degree of severity. There are different ways to reduce the size of the prostate.
How an enlarged prostate may be detected
The symptoms of an enlarged prostate develop very gradually, which is why you may not initially even notice your prostate growing. These problems only become apparent when you have problems with passing water. Typical symptoms include:
- Frequent urination during the night
- An urge to urinate
- Urinary stuttering (repeated interruption of the urine flow)
- Urinary dribbling
Before prostate therapy can begin, your doctor must perform a preliminary examination. There are several ways to examine the prostate, with each being explained briefly below:
- Medical history: A medical history can be prepared for you, where you are asked about previous and current diseases, surgery and your sex life.
- Evaluation: An IPSS score is used to determine how severely you experience symptoms. The questions of the “International Prostate Symptom Score” system are answered on several occasions at different times. These can also be compared by your doctor to allow them to draw conclusions on how a disease is progressing or how effective treatment is.
- Blood test: The prostate-specific antigen (PSA) can be detected in a blood test, which may provide indications of prostatic inflammation, prostate cancer or benign prostatic hyperplasia. However, PSA screening is not without its detractors, so do consult your doctor beforehand.
- Digital examination: A digital examination involves the doctor focusing their attention on the abdomen and reproductive organs so that they can examine the function of the nerves in the lower half of the body. For example, the size, form, consistency and sensitivity of your prostate are examined.
- Ultrasound examination: To eliminate the risk of urinary retention in the urethra and kidneys, your abdominal wall is examined for the possibility of cysts, stones or tumours in or around the bladder tissue. The prostate itself can be examined with the aid of a special ultrasound device, which is inserted via the rectum and allows tissue changes in the prostate to be effectively detected.
Tips on prevention
An increase in the urge to urinate is not necessarily the result of BPH. Stress, excessive fluid intake, or alcohol or coffee consumption can put a strain on the bladder. You can also help keep your prostate healthy with a number of tips and a healthy lifestyle:
- Diet: nuts, pulses and unsaturated plant oils such as linseed oil or olive oil are good for your health. Avoid a high-fat, high-calorie diet.
- Exercise: hiking, swimming or yoga – any sport is good for you. Not only does this apply to your heart, but also to your prostate.
- Drinking: a fluid intake of at least 2 litres a day is recommended to help flush the bladder and kidneys and to prevent bladder stones.
- Vitamins: an apple a day keeps the doctor away. Vitamins are important for the body – including the prostate. The protection afforded by antioxidants such as vitamin C, which is present in citrus fruits, and vitamin E, which is found in nuts and sunflower seeds, helps the prostate to stay healthy.