Prostate Diseases

What is the prostate?

The prostate, also referred to as the prostate gland (from the Greek word: prostates – meaning the one who stands before), as it lies directly below the bladder at the entrance of the male urethra. It is approximately the size of a chestnut and produces about one third of the volume of seminal fluid. The secretion of the prostate has a thin, milky consistency and is alkaline, which protects the sperm from the acidic environment of the vagina, promotes sperm motility, and gives semen its typical odor. The ducts from the testes and seminal vesicles open into the prostate and drain into the urethra, through which the ejaculate passes.

What prostate disorders are there? 

Common prostate disorders include benign enlargements (benign prostatic hyperplasia – BPH), inflammatory conditions (prostatitis), and malignant tumors (prostate cancer).

The latter is particularly common in older men and is often diagnosed at a late stage. The peripheral zone of the prostate is typically affected, which can be palpated well during a rectal examination. Therefore, the rectal examination, alongside a blood test and transrectal ultrasound, is offered for screening.

In contrast, BPH mainly develops in the inner zone of the prostate, which surrounds the urethra. The prostate becomes enlarged due to hormonal influences and may compress the urethra, thereby impeding urine flow.

Inflammatory diseases can be caused by bacteria, as seen in urinary tract infections. They can be acute or chronic but may also appear without any detectable pathogens are referred to as chronic pelvic pain syndrome.

Prostate disorders: An overview of causes and risk factors 

BPH

• The exact cause is unclear. It is thought to be a combination of hormonal factors, genetic predisposition, and excessive release of growth factors in the prostate gland
• Risk factors: obesity, advanced age, elevated blood sugar levels (e.g., diabetes mellitus), and dyslipidemias (elevated blood lipid levels)

Prostatitis

• Pathogens include E.coli and other enterobacteria that are found in the gastrointestinal tract
• In chronic pelvic pain syndrome, no pathogen can be detected. Possible causes include infections that are difficult to detect (e.g., bladder infections), neuropathic pain, and immune system dysfunction
• Risk factors: bladder emptying disorders and manipulations of the urogenital tract (e.g. surgical procedures or a urinary catheterization)

Prostate cancer

• Main risk factors: advanced age, residence in northern Europe or North America (likely due to dietary and socioeconomic factors), as well as a family history of prostate cancer
• Additional risk factors: smoking, a high-meat and high-fat but low-fish diet, selenium deficiency, chronic prostatitis, sexually transmitted diseases, obesity, elevated blood sugar levels, and dyslipidemia

Symptoms of prostate disorders

Prostate disorders usually cause urinary symptoms. These include difficulty in emptying the bladder, increased urinary urgency and frequency with small amounts. Another symptom is urinary retention which can ascend to the kidneys and cause further complications. Prostatitis (inflammation of the prostate) can cause burning on urination. Additional symptoms include sexual dysfunction, pressure in the pelvic area, and nonspecific lower back pain.

When prostate cancer is detected, bone metastases are often already present, causing bone pain in areas such as the spine or ribs, which may present as the first symptom. In some cases, urinary symptoms may be absent, especially if the tumor does not compress the urethra.

How are prostate disorders diagnosed?

The diagnostic evaluation begins with a detailed medical history, during which the patient is asked about their symptoms, previous medical conditions, and risk factors. Afterwards, a digital rectal examination of the prostate is performed, which can provide important clues. In addition, the genitals are examined to exclude other causes of urinary symptoms such as phimosis or penile cancer.

If prostatitis is suspected based on clinical presentation, various laboratory tests are available. Urine can be examined for pathogens. Rapid tests are available that detect bacteria or immune cells in urine. A blood test can assess inflammatory parameters. If fever is present, additional blood cultures should be taken to check for present bacteria in the bloodstream.

If no prostatitis is suspected, a transrectal ultrasound is performed to further assess the prostate, and the PSA level (prostate specific antigen) is measured. If prostate cancer is suspected, a biopsy is performed to confirm the diagnosis. Once malignancy is confirmed, further imaging should be conducted including bone scintigraphy, pelvic MRI, and abdominal ultrasound to determine the extent of the tumor spread and resectability. If lymph node metastases are suspected, pelvic lymph nodes can be laparoscopically removed and examined.

If the enlargement of the prostate is benign, as in BPH, an ultrasound examination should be performed to rule out complications involving the bladder and kidneys. Moreover, urinary retention can be assessed using uroflowmetry, which may be relevant for decisions regarding treatment.

Treatment of prostate disorders

Depending on the disease, various treatment options are available, including medical and surgical interventions.

Prostate cancer is often treated surgically. However, in some cases, it can also be monitored under active surveillance. In addition, other treatment approaches include radiotherapy, chemotherapy, and hormonal therapy. This depends on the cancer stage, patient age, and patient preferences.

Similar approaches are used for the treatment of BPH, which can be initially managed with active surveillance if symptoms are mild and the risk of disease progression is low. In cases of more severe symptoms or a high risk of disease progression, different medications are available to facilitate bladder emptying and reduce urinary urgency. 

If symptoms do not improve despite treatment, or complications of urinary retention (e.g., leading to renal impairment) arise, surgery is required. In most cases, the surgery can be performed through the urethra without needing abdominal surgery.

The treatment of prostatitis depends on the specific cause of the disease. If it is caused by a bacterial infection, antibiotics are prescribed. Chronic or non-infectious cases often require additional therapies, such as medications that facilitate bladder emptying, and anti-inflammatory drugs. 

Course and prognosis of prostate disorders

Prostate cancer has the poorest prognosis, which primarily depends on the malignancy of the tumor, its operability, and the presence of metastases. With favorable prognostic factors, the 15-year mortality rate is below 25%, whereas with unfavorable prognostic factors, it may reach about 75%. It should be noted that the median age at diagnosis of prostate cancer is around 70 years.

BPH may remain stagnant or progress slowly. If the symptoms persist despite medical treatment, surgery can provide a complete cure. However, surgical procedures always carry inherent risks.

Acute prostatitis can be treated with antibiotics and usually resolves within a few days. However, the treatment of chronic inflammation usually takes longer. An estimated 60% of affected individuals become symptom free within six months, while 20% remain symptomatic, and another 20% experience recurrences. 

What physicians and clinics specialize in prostate disorders in Germany and Switzerland?

Prostate disorders are generally treated by urologists. We will help you find an expert for your condition. All listed physicians and clinics have been carefully reviewed for their outstanding specialization in the field of prostate disorders and look forward to your inquiry.