The Prostate Gland: An Overview
The prostate gland is an exclusive gland of males. It is about the size of a walnut and is located below the urinary bladder. Through this gland, the urine passage passes out from the urinary bladder into the penis to take urine from the bladder to the exterior. The prostate gland starts developing in boys at the age of puberty. The main function of the prostate gland is to produce seminal fluid which will nourish the sperms and allow them to survive both in the body as well as in the female genital tract. The growth and development of the prostate is dependent on the male hormone testosterone. Many men, especially after the age of 50, may experience issues such as an enlarged prostate, which can affect urinary flow and overall prostate health.
Conditions Affecting the Prostate
Various conditions can affect the prostate. The commonest conditions affecting the prostate are infection and natural enlargement of the prostate that occurs with age. Infection may occur at any age, although it is less common in males less than 45 years than in males older than 45 years.
Acute Prostatitis: A Bacterial Infection
When does prostate infection occur? it is called acute prostatitis and is usually due to bacterial infection. The patient will present with high fever and chills, frequent urination, severe burning sensation while passing urine, difficulty in passing urine and sometimes even blood in the urine. The patient is fairly sick and may even need admission for parenteral antibiotic treatment. When acute bacterial prostatitis is suspected, the patient is investigated by urine culture serum PSA levels which is a blood test which increases when there is infection or malignancy in the prostate. Also the blood counts may be elevated and the C-reactive protein in the blood may be elevated.
Treating Acute Bacterial Prostatitis
How do we treat acute bacterial prostatitis? A suitable broad spectrum antibiotics such as augmentin or injectable medications like 3rd generation cephalosporins or amikacin are required. In the acute phase, 3-4 days of injectable antibiotics may be needed. Once the general condition of the patient improves, antibiotics need to be continued for at least 3-4 weeks unlike other urinary infections where just maybe 5-7 days of antibiotics may be necessary. Why is this so? You can consider the prostate to be like an apartment building with 50 flats. One week of antibiotics will only probably clear one-third of the flats of their occupants. Therefore, at least 3 weeks of antibiotics will be needed to completely sterilize all the flats within this apartment called the prostate. Inadequate treatment will lead to relapse of the infection and the patient may come back within a couple of weeks with similar symptoms. It is important at the end of treatment to confirm by urine culture and blood test that the infection is completely resolved.
Chronic Prostatitis vs. Enlarged Prostate: Symptoms and Differences
There is another condition called chronic prostatitis or chronic prostate pain syndrome. This is a condition a little difficult to diagnose and treat because all investigations may be normal. This usually occurs in young adult males who complain of a vague discomfort in the entire pelvic region including the urethra, the testicles, the perinium, even the anal region, the lower back and the lower abdomen. This nagging discomfort greatly affects the quality of life and it is sometimes called the pelvic and perineal pain syndrome. They are often anxious and highly stressed patients either due to the nature of stress or due to the nature of their profession or personal relationships. Most investigations will be negative in such a situation and very often the symptoms are attributable to spasms of the muscle in the prostate as well as spasm of the stomach and intestinal muscles causing the striad of symptoms of bloating, irritable bowels and prostatic pain. In my experience I have found that destressing methods like exercise, healthy lifestyle, meditation and even yoga help these patients much more than any form of medical management.
Understanding Prostate Enlargement
What is prostate enlargement? After the age of 45 or 50 the prostate undergoes a normal aging process and starts enlarging. Now that it has served its purpose for fertility purposes it becomes a little bit of a nuisance. As I mentioned earlier the urine passage leaving the bladder passes through the center of the prostate. When the prostate enlarges it impinges upon the urinary tract causing symptoms in many patients after the age of 50.
Symptoms of Prostate Enlargement
Symptoms are classified as obstructive symptoms and irritative symptoms. Obstructive symptoms are due to obstruction to the urine passage due to narrowing of the urethra within the prostate. There are five classical symptoms, hesitancy to pass urine, straining to pass urine, feeling of incomplete evacuation, thinning of the stream of urination and finally even complete blockage or retention of urine. The irritative symptoms are due to changes in the bladder behavior due to obstruction to the flow of urine. This includes urgency to pass urine, frequency of urination, slight burning during urination and waking up frequently at night to pass urine or nocturia. These symptoms may be mild or they may be sufficient to affect the quality of life of the patient.
Prostate Cancer: A Risk After 60
After 60 the prostate is also a common site for cancer development. In fact after intestinal cancers it may be the second most common cancer in men after the age of 60. Unlike the normal enlargement of the prostate which occurs in the internal part of the gland, prostate cancer develops in the periphery of the gland and very often there may not be any symptoms till an advanced stage of the disease. So the symptoms of prostate cancer may be similar to the symptoms of benign enlargement of the prostate. In addition they may also have signs of spread of the cancer either around the prostate, outside the prostate or to distant site. When the prostate cancer infiltrates into the bladder it may present with blood in the urine. When it blocks the passages of urine from the kidney to the bladder it may cause obstruction to the kidneys and kidney failure. And when it spreads distantly it usually spreads to the bones of the back and other bones in the body causing severe bony pain and back pain that may be excruciating.
Routine Prostate Evaluation
Therefore it is generally recommended that any patient after the age of 50 should have at least a visit to the urologist once a year or once in two years irrespective of whether he has symptoms or not. The evaluation of the prostate is a very simple process. It involves a detailed history taking from the patient. A physical examination which includes a digital rectal examination where we can actually gently feel the prostate and assess its enlargement and the texture. A blood test called PSA or prostate specific antigen is also performed and a urine test as well as an ultrasound of the prostate before and after urination is also performed. Based on the findings of these tests majority of patients can be treated with simple medications to improve the quality of their life. And early detection of prostate cancer by the blood test can detect prostate cancer at a stage when it is completely curable.
Dr. H Sanjay Bhat, a renowned Indian urologist, is a Senior Consultant Urologist at Al Zahra Hospital Dubai, Al Barsha, Dubai. He specializes in advanced prostate treatment, offering highly effective solutions tailored to individual patient needs through cutting-edge techniques. Recognised as one of the best Indian urologists, Dr. Sanjay Bhat brings extensive experience in managing prostate conditions, including infections, enlargement, and cancer, alongside other complex urological issues. His expertise in urology and commitment to patient care make him a top choice for those seeking world-class, minimally invasive treatments in Dubai.
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