Early detection and treatment of prostate diseases (Part One)

The prostate is a gland of the male sexual apparatus located below the bladder and in front of the rectum. Traditionally, the prostate gland is presented with 4 lobes, but more commonly the subdivision according to McNeal is used, which states that the prostate consists of:

• Peripheral Zone which constitutes about 70% of the prostate tissue;
• Central Zone which constitutes up to 25% of the gland's tissue; and
• Intermediate Zone which constitutes only 5% of the prostate tissue

The prostate is traversed by a part of the urethral canal called the prostatic urethra as well as by the right and left ejaculatory ducts, as well as by many small canals. This classification is considered important because each zone has its specifics regarding the development of different pathologies that affect the prostate.

Its dimensions are those of a chestnut or with a diameter of about 3-4 cm and weighs about 20 grams. The very position of the prostate makes it such that when it undergoes disorders, these affect urination and defecation problems as well as deterioration of sexual activity in men. The function of the prostate is to produce secretions (seminal fluid) to make the semen more fluid as well as to regulate male hormones.

The most common diseases of the prostate are:

1. Benign Prostatic Hyperplasia (BPH);
2. Acute and Chronic Prostatitis;
3. Prostate Cancer.

1. BENIGN PROSTATIC HYPERPLASIA (BPH)

The enlargement of the prostate volume is associated with a physiological hormonal disorder related to the decrease in testicular activity that occurs with aging.

With aging, the level of Dihydrotestosterone (DH) hormone increases and this stimulates the growth of the prostate.

Another hypothesis links the increase in the volume of the prostate gland to the imbalance of two hormones, called testosterone and estrogen. Thus, as a man ages, less testosterone is produced and on the other hand, there is a significant increase in estrogen, to which the main cause of this pathology is attributed.

With the enlargement of the prostate, problems related to urine emptying and consequences on the health of the patient are caused. For this reason, periodic check-ups and preventive measures are required. Benign Prostatic Hyperplasia usually originates from the transitional (intermediate) zone. It is one of the most common afflictions regarding prostate diseases.

When talking about prostate enlargement or Benign Prostatic Hyperplasia (BPH), it refers to the enlargement of that part of the gland that surrounds the urethra, i.e., in the prostate, a "new kind of gland" grows that exerts pressure on the prostate itself from the outside.

BPH begins to develop very quickly, after the age of 30 years and continues with aging, but not all men grow at the same speed. There is no direct correlation between the size of the prostate and clinical signs. Literature data shows that more than 50% of men between the ages of 60 and 69, have clinical signs of BPH, while when exceeding 80 years of age, the incidence increases to 80%.

The cause of BPH is also related to ethnicity. In the African race, this disease is more common.

The pathology is chronic and progressive and although it is benign in nature, it significantly disrupts the quality of life. The growth of the prostate causes a narrowing of the initial part of the prostatic urethra and urination becomes difficult. As a result of this "forced work" of the bladder to expel urine, it provokes fatigue that is manifested by weakening of its musculature and diverticula, infections, or even calculi may form.

The group of clinical signs manifested by urination disorders is summarized in the term prostatism. This group includes two types of symptoms:

1. Irritative (Infectious) disorders;
2. Obstructive (Blocking) disorders.

In the group of irritative signs, these phenomena are included:

• During the day, the need to urinate frequently (Polyuria);
• During the night, getting up often to urinate (Nocturia);
• The need to urinate urgently may arise (Urgency to urinate);
• Burning sensation during urination (Stranguria).
• Sometimes hematuria macroscopic or microscopic occurs.

In the group of obstructive signs, these phenomena are included:

• Urination is done with a weak flow and low pressure. The urologist detects this symptom by means of uroflowmetry;
• Difficulty starting urination;
• After urination, a few drops of urine come out at the end;
• The flow of urine is not continuous but is intermittent;
• Feeling of incomplete emptying of the bladder.

Other signs

• Painful contractions of the urinary bladder with a sensation of continuous urination (tenesmus);
• Oftentimes, sexual desire significantly decreases (reduction in sexual libido).
• This condition may also be accompanied by erection disorders.