About the prostate


British GP talking to senior man in surgery

 

The prostate is a gland located immediately below the bladder, in front of the rectum which serves as the junction between the urinary and sexual systems. It produces fluid that protects and enriches sperm. The prostate is located under the bladder neck, (at the junction between the urethra and the bladder), just ahead the rectum. The prostate can have the shape of a chestnut and weighs between 15 and 20 grams when it is normal). Surrounded by a thick capsule of connective tissue, this gland has a central part that surrounds the ejaculatory ducts, two lateral lobes, an anterior zone and a peripheral zone representing around 75 % of the volume of the gland. Its main function is to secrete and stock the seminal fluid, one of the semen components.
A doctor should be consulted if any of these symptoms are experienced.

Common symptoms of prostate diseases include:

  • A need to urinate frequently, especially at night
  • Difficulty starting urination or holding back urine
  • Weak or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • Painful ejaculation
  • Blood in urine or semen
  • Frequent pain or stiffness in the lower back, hips, or upper thighs

A doctor should be consulted if any of these symptoms are experienced.

Common prostate diseases:

 

  • Prostatitis is an inflammation of the prostate gland, often resulting in swelling or pain. Prostatitis can result in four significant symptoms: pain, urination problems, sexual dysfunction, and general health problems, such as feeling tired and depressed.Prostatitis can be treated with dietary changes, antibiotics, prostate massage and occasionally, surgery.

 

  • Benign prostatic hyperplasia (BPH) is an enlarged prostate. The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. BPH is not cancer and is common in aging men. About half of all men between the ages of 51 and 60 have BPH. Up to 90% of men over age 80 have BPH.BPH can be treated medicinally or through a surgical procedure – Transurethral Resection of the Prostate (TURP) is the most common surgery for BPH. During surgery, after anesthesia, the surgeon inserts a resectoscope through the tip of the penis into the urethra. The resectoscope has a light, valves for irrigating fluid, and an electrical loop. The loop cuts tissue and seals the blood vessels. The removed tissue flushes into the bladder and out of the body through a catheter that is placed into the bladder through the penis.

 

Prostate cancer

Prostate cancer is the second most common cancer in men -1 in 6 men will experience prostate cancer in their lifetimes. It differs from most other cancers in the body, in that small areas of cancer within the prostate are very common and may stay dormant (inactive) for many years. Prostate cancer occurs when cells of the prostate begin to multiply out of control. These cells may spread, which in medical terms is known as metastasis. For more information on prostate cancer see here.

 

Prostate cancer is a slow growing cancer compared with other cancers and is usually diagnosed in the early stages before it starts to spread outside the prostate gland. But in some men, the prostate cancer will be advanced when it is first diagnosed. Advanced prostate cancer can also occur in men who have previously been treated for early or locally advanced prostate cancer but their cancer has come back (relapsed or recurred). Prostate cancer is categorized in different stages:

  • Early (localised) prostate cancer

    Early cancer of the prostate gland (early prostate cancer) is when the cancer is only in the prostate and has not spread into the surrounding tissues or to other parts of the body. It is also called localised prostate cancer.

  • Locally advanced prostate cancer

    Locally advanced prostate cancer is cancer that has spread into the tissues around the prostate gland. Cancer that has spread to other parts of the body is called metastatic prostate cancer.

  • Advanced (metastatic) prostate cancer

    Advanced or metastatic cancer of the prostate gland is when the cancer has spread beyond the prostate gland to other parts of the body.

Prostate treatment options

For surgical and non-surgical prostate treatment options, please refer to your Urologist for advice on all options here.

About radical prostatectomies

 

A radical prostatectomy is the current gold standard for patients who are in good health, have a long life expectancy and have cancer that appears to be confined to the prostate gland. It is a surgical procedure that removes the prostate gland and attached seminal vesicles. Lymph nodes near the prostate can be removed at the same time. The procedure is associated with a limited risk of side effects and major complications are very rare. See live prostatectomy robotic-assisted surgery by Dr Greg Boustead here (not for sensitive viewers).

The first objective of prostatectomy is to remove the cancer. The second objective is to spare the nerves bordering the prostate so that the patient can recover their normal pre-operative functional outcomes – bladder control and erectile function.

 

Robotic Radical Prostatectomy is also the most common treatment used for prostate cancer today in the United States. Robotics are utilised in approximately 80 – 85% of radical prostatectomies.

Robot-assisted prostatectomy

The da Vinci® Surgical System improves patient experiences and outcomes by enabling surgeons to offer an effective, minimally invasive surgical approach for prostatectomy. The visualization, precision, dexterity and control provided by the da Vinci Surgical System offers a breakthrough in surgical capabilities.

  • Robot-assisted prostatectomy compared to traditional surgical approaches:

    • More precise removal of cancerous tissue
    • Low risk of infection, complications
    • Less chance of needing follow-up surgery
    • Less chance of nerve injury
    • Less chance of injuring the rectum
    • Shorter operation time
    • Excellent cancer control
    • Less blood loss and transfusions
    • Shortened hospital stay
    • Less pain
    • Reduced risk of erectile dysfunction and a faster return to normal erectile function
    • Improved early outcomes for urinary continence
    • Fast recovery and return to normal activities
    • Small incisions for less scarring