Generality
Prostate adenoma is a disease characterized by benign enlargement of the prostate, which typically involves the periurethral zone (around the urethra). Over time, the increase in volume of the prostate gland causes irritative symptoms and various problems with urine outflow.
The prostate adenoma is found above all with advancing age, as a consequence of the physiological aging process, due to hormonal changes or other concomitant pathologies.
The initial manifestations of this pathology include increasing difficulty in urinating (dysuria) and increasing daytime urination (pollakiuria) and nocturnal urination (nocturia). These signals must act as an alarm bell and induce the patient to undergo an accurate clinical examination, which is also important to exclude any pathologies that manifest themselves with a similar symptom picture (including prostate cancer). Moreover, if neglected, the enlarged prostate can compress the urethral canal, causing partial obstruction and interfering with the ability to urinate. The prostate adenoma can thus determine a series of long-term complications, such as urinary retention, bladder stones and chronic renal failure.
Treatment depends on the extent of the condition and can provide different pharmacological or surgical options, with the aim of improving the patient's symptoms and quality of life.
What is the prostate?
The prostate (or prostate gland ) is a small exclusively male organ, which belongs to the reproductive system, located immediately below the bladder. Its main function consists in the production of a part of the seminal fluid, therefore it helps to preserve the vitality of the spermatozoa. More in detail, the prostate gland partially surrounds the first part of the urethra (a conduit that carries urine outside the body, during urination), like a donut, at the neck of the bladder and merges with the two ducts ejaculators that cross it.
Precisely because of this position and the relationships described with nearby organs, the enlargement of the prostate can cause problems with urination, ejaculation or defecation.
What's this
Prostate adenoma (also known as benign prostatic hypertrophy ) coincides with an enlarged prostate, not associated with tumor formation . In fact, there is a benign proliferation at the origin of this condition, so it is not cancerous. As such, the increase in prostate volume is caused by the growth in the number of prostate cells that compress the tissues around (especially at the level of the prostatic urethra), without infiltrating them.
Prostate adenoma: synonyms and terminology
Prostate adenoma is commonly known as benign prostatic hypertrophy (BPH) or enlarged prostate . More correctly, the condition is also called benign prostatic hyperplasia, since the volumetric enlargement of the prostate is due to an increase in the number of cells that make up the same organ.
Causes
Prostate adenoma is a disease caused by an increase in prostate volume, due to the increase in the number of cells in the same organ. This proliferation is benign in nature: unlike a tumor, in fact, this condition compresses the surrounding tissues without infiltrating them. The prostate adenoma originates mainly from the central portion of the gland, in the transition zone that surrounds the urethra (note: the carcinoma tends to develop starting from the peripheral zone of the prostate).
Under normal conditions, the prostate generally has a size and shape similar to that of a chestnut, with the base facing up (attached to the lower surface of the bladder) and the apex facing downwards. Over the years or with the presence of some pathologies, the prostate can swell, therefore increase in volume.
In people suffering from prostate adenoma, in the absence of treatment, the gland can go up to even two or three times its normal size.
What causes prostate adenoma?
The causes of the prostate adenoma are not yet fully known, but it is now established that at the base of the pathology are involved typical alterations of aging .
With advancing age, in fact, the prostate tends spontaneously to change its consistency and its volume, in response to hormonal changes and numerous growth factors that stimulate the benign proliferation of prostate cells. For example, the release of small amounts of estrogen and the increase of dihydrotestosterone (or DHT, a testosterone metabolite) seem to favor the appearance of prostate adenoma.
Risk factors
The prostate adenoma is a very frequent alteration, which accompanies the normal aging process, therefore it is found mainly in older men. In particular, this condition begins to develop after the age of 40 and occurs mainly after the age of 50.
The incidence of prostate adenoma increases proportionally with advancing age, reaching the highest levels in the eighth decade of life. It is estimated, in fact, that between 70 and 80 years this pathology affects up to 80% of the male population.
In addition to age, factors predisposing to prostate adenoma include:
- Familiarity;
- Other concomitant diseases, such as obesity, cardiovascular diseases and diabetes;
- Physical inactivity.
Symptoms and Complications
In prostate adenoma, the increase in prostate volume ends up compressing the urethra (a channel that carries urine from the bladder to the outside). This leads to various problems affecting the urinary tract.
As anticipated, prostate enlargement is slowly progressive, so the symptoms of prostate adenoma usually present themselves gradually.
It should be noted, however, that this pathology does not always evolve with the same modality and speed. Furthermore, the increase in prostate volume does not necessarily lead to significant disorders and, sometimes, no symptoms are felt.
Prostate adenoma: how it occurs
Prostate adenoma has irritative and obstructive symptoms, such as:
- Dysuria (difficulty urinating);
- Urinal urgency (inability to delay the act of urinating);
- Increased frequency of daytime urination ( pollakiuria ) and nighttime ( nocturia );
- Difficulty in starting to urinate (voiding hesitation );
- Decreased urinary and / or intermittent jet jet strength (weak, slow or interrupted urine flow);
- Sense of incomplete bladder emptying ;
- Presence of small amounts of blood in the urine ( hematuria );
- Blood emission in seminal fluid ( emospermia );
- Pain after ejaculation or during urination ( stranguria );
- Problems with erection and maintenance;
- Drain after urinating;
- Urine retention (inability of the patient to emit the urine contained in the bladder outdoors).
Note
The irritative and obstructive urinary symptoms that occur in the prostate adenoma can also occur in the presence of bladder problems, urinary tract infections or prostatitis (inflammation of the prostate). These disorders can also be the signal of much more serious pathologies, such as prostate cancer . For this reason, it is always advisable to consult the doctor, for the most appropriate tests for his case.
Prostate adenoma: possible consequences
In the context of prostate adenoma, the narrowing of the urethra and urinary retention are responsible for problems in the correct flow of urine: the patient must exert an abdominal push to be able to expel them and empty the bladder.
Because of this overwork, the bladder wall gradually tends to weaken and, over time, it is even possible to reach acute urinary retention, or the impossibility of urinating. Prolonged obstruction of the urethra can even compromise renal function, causing organ failure .
Warning! Urinary retention is a urological urgency, which requires the placement of a bladder catheter.
Another complication to consider is the incomplete emptying of the bladder, which causes the stagnation of a urinary residue in which bacteria can proliferate and sediment any crystalline aggregates. For this reason, prostate adenoma exposes to a greater risk of urinary infections, prostatitis, pyelonephritis and stones due to the crystallization of salts in the post-voiding residue.
Alarm signals
In the context of prostate adenoma, the events that should not be underestimated, which must prompt a timely medical intervention, include:
- Total inability to urinate;
- Stimulant painful, urgent and frequent urination, with fever and chills;
- Blood in the urine;
- Major discomfort or pain in the lower abdomen and urinary tract.
Diagnosis
In the presence of symptoms suggestive of a prostate adenoma, it is advisable to consult your doctor. Through a urological examination it is possible to ascertain the real presence of the increase in the volume of the prostate and exclude other pathologies that can give an overlapping symptomatology, such as prostatitis or cancer.
For the correct evaluation of prostate adenoma some specific clinical tests are necessary, including:
- Urine test with urine culture;
- Dosage of PSA (prostate specific antigen) in the blood;
- Digito-rectal exploration of the prostate (palpation of the prostate through the rectum).
PSA is used to evaluate the possibility that a malignant tumor is present, while rectal exploration provides information on the volume and consistency of the gland. The urine test, on the other hand, allows to check the renal function or exclude the presence of urinary tract infections, capable of producing a symptomatology similar to that of the prostate adenoma.
To determine the extent of the pathology, the patient may be subjected to more thorough examinations, such as:
- Uroflowmetry : it measures the speed of urinary flow and the volume of urine emitted during urination, therefore it gives an idea, albeit rough, of any damage to the bladder;
- Trans-rectal prostatic ultrasound, followed by biopsy: allows confirmation or exclusion of the presence of a malignant tumor and is a useful tool for assessing the correct prostate volume, especially important for a possible surgical intervention.
Treatment and Remedies
The therapeutic strategies adopted for the management of prostate adenoma are different and substantially depend on the extent of the condition and the associated symptomatology. If the disease does not cause particular problems to the patient, it can simply be monitored over time; on the contrary, in the presence of complications, pharmacological or surgical treatment becomes mandatory.
Drugs and herbal remedies
In the early stages of prostate adenoma, it is possible to intervene with the use of two main categories of drugs:
- Alpha-antagonists : reduce muscle tone in the prostate and bladder neck, essentially facilitating the passage of urine into the urethra. Among the alpha-blocker drugs most used in the treatment of prostate adenoma are alfuzosin, doxazosin, tamsulosin and terazosin.
- 5-alpha reductase inhibitors : they inhibit the volumetric growth of the prostate adenoma, suppressing androgen stimulation. Drugs such as finasteride and dutasteride act, in practice, by blocking the transformation of testosterone into its active form, dihydrotestosterone (DHT), which participates in the enlargement of the prostate.
The major problems with the use of drugs for the treatment of prostate adenoma are associated with possible side effects. These include erective deficits, retrograde ejaculation and gynecomastia for 5-alpha reductase inhibitors, while hypotension, migraine, vertigo, headache and asthenia are common among alpha blockers. Depending on the case, the drugs may be sufficient to control the patient's symptoms and slow down the progression of the prostate adenoma, but it should be noted that the efficacy of these tends to decrease with long-term use.
Similarly to the 5-alpha reductase inhibitors, although with modest efficacy, some phytotherapics also act, such as the extracts of Serenoa repens and of African Pigeo.
Surgery
When drug therapy is ineffective, surgical therapy is used. The choice of the type of procedure to which the patient is subjected is essentially based on the size of the prostate adenoma.
To remember
The suitability or otherwise of the various surgical techniques is influenced above all by the extent of the prostate adenoma; in general, the greater the increase in gland volume, the more invasive the intervention will be.
The most widely used technique for treating prostate adenoma is transurethral endoscopic resection (or TURP) . As the name suggests, it is a reduction of the prostate performed by endoscopy, that is without incisions. In practice, a special instrument is introduced into the urinary channel through the penis to "slice" the prostate adenoma. In this way, it is possible to remove the internal part of the prostate increased in volume.
If the size of the prostate is excessive, on the other hand, it is necessary to proceed with an open procedure, called adenonectomy . This intervention involves the removal of the entire prostatic adenoma through a cutaneous, trans-bladder or retropubic incision.
Partial or total surgical removal of the prostate can lead to complications for patients. Among these, the one that usually worries patients the most is the risk of erectile dysfunction. However, according to recent studies this risk is to be considered null or even lower than for patients who choose not to work. A very frequent adverse effect after surgery is, instead, retrograde ejaculation; in practice, during ejaculation the seminal fluid, instead of escaping from the urethra, flows back into the bladder, causing infertility.
To treat prostate adenoma, it is possible to use alternative, less invasive, but variable efficacy techniques. These procedures aim to destroy part of the glandular tissue without damaging what will remain on site. For this purpose, depending on the method used, laser beams are concentrated (as in the HoLAP procedure), radio waves (transurethral ablation with radiofrequencies or TUNA), microwaves (eg TUMT or transurethral thermotherapy with microwaves) or chemical substances, directly to the internal prostate.
Prevention
The prevention of prostate adenoma basically consists in early diagnosis. This is possible by undergoing periodic checks after age 40-50 or, promptly, when the first complaints occur.
