What is Prostate Adenoma?

The prostate is a gland that is part of the male reproductive system. It is located in the lower abdomen, we find it below the bladder, surrounding the initial part of the male urethra (conduit of the urinary and genital apparatus in men), located in front of the rectum. The prostatic gland contains cells that produce part of the seminal fluid that protects and nourishes the sperm contained in the semen.

Male hormones stimulate the growth of the prostate gland from the development of the fetus. A young man’s prostate is about the size of a walnut and, over time, increases in size. The prostate continues to grow until adulthood is reached and maintains its size as long as male hormones are produced. For various reasons, the prostate gland can undergo both acute and chronic inflammatory processes. Usually, from the age of 50 or even before, 75% of men already present some benign (BPH) or malignant transformation in the tissue of this organ (prostate cancer).

The purpose of routine control after the age of 50 is to detect in the earliest stages, the morphological alterations that may present themselves generating symptoms, also allowing the appropriate treatment to be carried out in a timely manner.

Most common prostate problems

• Prostatitis: it is an infection, generally caused by bacteria.
• Benign prostatic hyperplasia, benign enlargement of the prostate adenoma or BPH: enlargement of the prostate, which can cause (among other symptoms) dribbling after urinating or the need to urinate more frequently (especially at night).
• Prostate cancer: cancer that responds better to treatment when detected early.

BPH or Benign Prostatic Hyperplasia

What does BPH or enlarged prostate mean?

Benign prostatic hyperplasia, also known as BPH, is a benign (non-cancerous) growth in the size of the prostate gland. The causes of benign prostatic hyperplasia (BPH) are multifactorial, however it is known that two prerequisites are necessary for this disorder, aging and testosterone production by the testes. Men who have their testicles removed for various reasons or for the development of testicular cancer will not have benign prostatic hyperplasia (BPH).

Benign prostatic hyperplasia (BPH) is a very common condition in men. A small enlargement of the prostate is present in many men over the age of 40 and in more than 90% of those over the age of 80.

As the prostate gland grows, it can progressively compress the urethra and cause difficulty urinating. This happens because the compression prevents the flow of urine from going down from the bladder to the urethra and then to the outside. The possible consequences of BPH are retention of urine in the bladder (the patient is unable to urinate, even with desire), if the inflammation is very severe, it can completely block the urinary system and require the placement of a bladder catheter that is placed by a physician through the urethral meatus, usually on call. Backflow of urine into the kidneys and/or the need to urinate frequently are other possible complications of BPH.

Symptoms of BPH (benign prostatic hyperplasia)

There are two types of symptoms: obstructive symptoms and irritative symptoms.

– Obstructive symptoms are manifested by: a decrease in the caliber (smaller amount) and strength of the urine stream, difficulty in starting urination, inability to stop urination, post-micturition dribbling, feeling of incomplete emptying of the bladder, and sometimes urinary retention.

– Irritative symptoms present as multiple nighttime urination (getting up to urinate several times during the night), urinary urgency and sometimes urge incontinence. These are usually the symptoms for which most patients consult. It is important to treat benign prostatic hyperplasia (BPH), because as it progresses, it can progressively lead to other diseases. For example, incomplete emptying of urine results in residual urine in the bladder and an increased risk of urinary tract infection, bladder stone formation, since urinary stones in the bladder are formed from the crystallization of salts in the residual urine.
Acute urinary retention will lead the patient to an emergency room for the placement of a bladder catheter to be able to urinate, since he/she is unable to do it by him/herself. Chronic urinary retention is another form of progression of this pathology. Some patients who suffer from it may eventually progress to renal failure as a consequence of the obstruction. The assessment of the patient’s symptoms should be performed by a Urologist, accompanied by the necessary studies to define the magnitude of the obstruction and seek the appropriate treatment for that patient.

Diagnosis

All men over 50 years of age should have a urological consultation (if there is a history of prostate cancer in the family, the control should be before the age of 50).

The annual control with the urologist, is of utmost importance in the life of men, since what you want to control is the early onset of prostate cancer. And in parallel, to evaluate the growth of the prostate gland and its treatment.

This consultation will be the annual prostate control, which consists of a physical examination, the urologist will perform a rectal examination, which is the palpation of the prostate gland through the rectum, this may reveal an enlarged prostate and roughness or texture that could be a symptom of prostate cancer, The urologist will indicate a blood laboratory study to measure the value of Prostate Specific Antigen (PSA) and, if required by the urologist, the performance of a prostate ultrasound and/or the performance of a voiding flowmetry and/or any additional study.

Treatments

It is important to note that BPH treatment does not prevent prostate cancer and that patients already operated or undergoing treatment for BPH should continue with their annual check-ups for the prevention or early detection of prostate cancer.

Treatments for benign prostatic hyperplasia are twofold: medications or surgery.

– Medications: Finasteride and Dutasterine, these produce a decrease in the levels of hormones that collaborate in the growth of the prostate gland, with the action of these drugs reduce the size of the prostate, increasing the flow of urine and decreasing the symptoms of BPH. Usually, this medication must be injected for 3 to 6 months to achieve an improvement in symptoms. The use of these medications, usually presents side effects such as decreased sexual desire and decreased erection, are points to be evaluated with your Urologist. The alpha1-blockers (Terazosin, Tamsulosin, Doxazosin and Alfluzosin), these drugs relax the muscles of the bladder neck, allowing a stronger urinary stream. The choice of the type of medication needed should be made by your urologist, who will take into account your medical history.

– Surgery: with respect to surgery, there are basically two types: traditional surgery, in which the abdomen is opened (called open surgery), and surgery that uses an instrument that is introduced through the urethra into the prostate. This surgery is called endoscopic or TUR, which there are more than one option in terms of endocopic surgery for BPH. The Urologist will evaluate your case and will indicate the characteristics of each surgical procedure. Depending on the size of the prostate gland, the surgery can be performed endoscopically or conventionally.

Is there any relation between prostate adenoma and prostate cancer?

In principle we can say no, since when we refer to benign prostatic hyperplasia we are referring to prostate enlargement. BPH does not cause prostate cancer, however prostate cancer can develop simultaneously in the peripheral zone of the gland without being caused by the adenoma. For this reason, both pathologies are investigated in the annual urological evaluation.