What surgical options are available for BPH and prostate cancer?

Mar 20, 2019 0 Comments in Male health by

We recently explained how important it is for men to have a periodic check-up with the urologist to check the condition of the prostate and the urinary system. The annual medical check-up is of the utmost importance because when men reach 40 years old, their prostate may begin to grow and, if this happens, it may entail urinary discomfort. It is desirable to control this process so we can confirm whether it is a benign increase (known as “BPH” or benign prostate hyperplasia) or a malign increase (in which case it is a carcinogenic lump). In both cases, there are several treatment options either pharmacologic or surgical; however, we will focus on the surgical options because they are different in each pathology and they usually raise doubts. We will review such options in this post.

Benign increase of the prostate: BPH or Benign Prostate Hyperplasia

As men get older, hormonal changes may cause an increase of the prostate tissue, which is known as “benign hyperplasia” in the medical language. This pathology affects more than 500 million men all around the world. Prostate is a gland located below the bladder, and it includes the urethra (known as prostatic urethra), where is located the verum montatum, a place where the ejaculatory tubes are open coming from the seminal vesicles. Prostate is located very near to the rectum, so it can be partially explored by means of a rectal examination. Its function is to produce the prostatic liquid, which is part of the seminal liquid.

Having BPH does not increase the risk of having cancer, but it may cause many discomfort in those men who suffer from it, such as intermittent urination, painful urination, decrease in the strength or the thickness of the urine stream, increased urination or constant urge to urinate.

Surgical options for BPH are the following:

    • Urolift.- This novel technique consists of a minimally invasive system that unblocks the urethra by lifting or holding the increased prostatic tissue with the help of little staples. Our centre is a pioneer in applying this technique, so we have the largest experience with Urolift in Spain. More info here.
    • Laser surgery (photovaporization).- This technique uses a laser with optical fibre that allows to vaporize soft tissues and thus eliminate completely the excess tissue of the enlarged prostate. We were the third centre in Spain that incorporated this kind of surgery with laser, and the success rate as well as the patient satisfaction rate is really high after 14 years of experience. More info here.
  • Adenectomy.- This is the name of the traditional open surgery in which the increased prostatic tissue is removed. The post-surgical procedure requires the hospitalization of the patient for a few days. The difference is that the two above mentioned surgeries have a more comfortable post-surgical process, because the patient can go back home the following day and he can resume his daily routine.

Prostate cancer

In this case, the increased tissue of the prostate contains malignant or cancerous cells. In the earliest stages, there is not almost any sign that indicates the presence of a cancer, so it is essential to carry out a blood and urine test so the specialist can assess the parameter known as PSA (Prostate Specific Antigen). If PSA shows an increased value without any apparent reason, the protocol is to perform a rectal exam as well as a multiparametric nuclear magnetic resonance of the prostate.

Subsequently, if there is a suspicious area, the specialist will perform an echodirected Biopsy of the prostate. When the tumour starts to increase, there will be symptoms such as weak or frequent urine stream, exertion when urinating or inability to completely empty the bladder, presence of blood in the urine or in the seminal fluid.

There are several treatment options for this pathology; we will explain them below.

    • Cryosurgery.- This technique has been used for more than ten years now, and it consists of creating ice spheres within the prostate that reach deep-freezing temperatures (up to -70ºC). These ice spheres destroy the prostatic tissue as well as the cancerous cells contained inside. More info here.
  • Radical prostatectomy.- This surgery removes completely the prostate as well as some of the surrounding tissues in order to remove all the cancerous tissue. It can be done in four different ways: retropubic open surgery, laparoscopic surgery, robotic surgery or perineal surgery. The specialist will decide which the most suitable option for each patient is
  • Brachitherapy.- It is a procedure that consists of inserting radioactive seed-form implants in the prostate that will destroy de cancerous cells by the emission of radiation. This is a kind of internal radiation that may lead to proctopathy or a seed migration. There is also the possibility of causing urinating problems or even erection problems.
  • Radiotherapy.- This is the option for the earliest stages of prostate cancer or for relieving its symptoms. This surgery consists of a mechanism of external radiation with high-energy rays focused on destroying the cancerous cells. Among the side effects we can find proctopathy, urinary incontinence or erectile dysfunction. Once the patient has been diagnosed and the size of the prostate is known, the specialist will determine the most suitable surgery for the patient as wells as the advantages and disadvantages of each surgical option.

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