The prostate (prostate gland) is located between the bladder and pelvic floor (which forms the external sphincter muscle). Directly behind it lies the rectum. It has the size and shape of a chestnut. The urethra passes through the prostate. Flow Into the prostate flow the deferens canals, the ducts of the seminal vesicles into the so-called colliculus (“seminal hill”).
The prostate consists of glandular tissue, muscle and supporting tissue. As a Gland as it produces a milky fluid, which is necessary for the mobility of the spermatozoa (sperm). So it takes over the "Catering" for the sperm. About one-quarter of the amount of semen is made of this liquid. Together with the internal (bladder neck) and the external sphincter muscle, the prostate gland provides the ejection of semen to the outside.
The digital rectal examination (DRE) can discover evident changes.
The measurement of the urinary jet and of the sonographic residual urine complement the assessment of bladder emptying.
The determination of prostate specific antigen (PSA) from the blood may provide an indication of pathological changes. Changes in PSA levels may have different causes. Thus inflammation, cycling, sexual intercourse, but also prostate cancer can lead to elevated PSA value. Important: the PSA level is a laboratory value and not a diagnosis!
Transrectal ultrasound (TRUS)
A transrectal ultrasound probe is passed into the back passage and the prostate gland examined to identify any obvious abnormalities. The ultrasound machine will detect differences in the sonographic echoes observed within different parts of the prostate. This examination is usually not painful.
Tissue sampling (biopsy)
There are some basic reasons why it may be recommended that prostatic biopsies carried out:
There is an elevated PSA level >4 ng/ml
The prostate feels suspicious on digital rectal examination
There is a significant change in the standard PSA level over time (PSA velocity)
For the tissue sampling, we prefer the perineal approach (through the perineum) under local anesthesia. This has the advantage that no antibiotic prophylaxis must be given. Nevertheless, the inflammatory complications are much less common than in the removal of tissue through the rectum.
The prostate grows from about the age of 45 and increases about 3% in volume. This is quite normal. Only when it comes to discomforts through this growth, it becomes a disease. From the age of fifty on almost every second man is affected.
To describe the changes and potential problems more clearly, the following definitions were established:
BPE ( „benign prostatic enlargement“), describes a benign enlarged prostate.
BPO ( „benign prostatic obstruction“), describes the obstruction of urine flow caused by a benign enlarged prostate.
LUTS („lower urinary tract symptoms), describes the urinary symptoms such as urge, burning, urination during the night, etc.
BPS („benign prostate syndrom), describes the actual disease (clinical picture), i.e. a man with LUTS caused by benign enlargement (BPE) with obstruction of urinary flow (BPO).
BPH is the histological description of benign prostate changes. It requires a biopsy.
Inflammation of the prostate (prostatitis)
Prostatitis in the proper sense is acute inflammation of the prostate. It is favored by urinary obstruction (residual urine, urethral stenosis, etc.).
Chronic prostatitis is more difficult to define in its cause clarification and treatment. Although it occurs quite frequently (about 5% of men between 20 and 50 years of age have a prostatitis) the detection and treatment is difficult. It can be caused by chronic infections, nevertheless it fails very often to make a germ proof. Due to the constant complaints, coupled with a poor urinary flow, a narrow neck of the bladder and with that a related intraprostatic reflux (urine flows into the ducts of the prostate) the pains can become independent in the sense of a pelvic pain syndrome.
Prostate cancer (PCa) is for men the most common cancer in Germany . The biggest proportion of those affected (more than 80%) is older than 60 years at the time of diagnosis. Approximately every third over 70 years has a so-called latent prostate cancer! But it will remain life long not active and must therefore not be treated. Because prostate cancer usually progresses less aggressive than other cancers (eg colon cancer, lung cancer, etc.) it is in particular in the early stage (locally limited) well treatable. In the past prostate cancer was mostly very late and in an advanced stage detected, due to improved methods of diagnosis it is nowadays in most cases possible to make an early diagnosis. Since a prostate cancer arises mainly in the peripheral areas of the prostate, it causes for a long time no complaints.
Development of prostate cancer over time (years)
Development of prostate cancer over time (years)
The latent prostate cancer is not active and does not also cause damages
Only in the locally limited stage healing is a possible
In locally advanced stage (cancer grows out of the prostate - but has not yet built metastases) the survival time may be extended through aggressive treatments (surgery and radiotherapy).
Metastatic prostate cancer can be kept in check for some time through hormonal deprivation (removal of testosterone, hormone-sensitive period).
Should it then under this come to a further growth of metastases, a chemotherapy is carried out.
As a prostate center, we offer a wide range of treatment options for benign and malignant lesions of the prostate. With 7 different methods of treatment for those affected, we can select the best therapy.
endoscopic transurethral (through the urethra)
resection of the prostate (both mono- and bipolar)
TURP (transurethral resection of prostate)
TURIS (bipolar resection of prostate)
Green light laser prostatectomy - a minimally invasive approach for the treatment of an enlarged prostate.
Removal by benign enlargement (BPH)
Complete removal by prostate cancer (so-called free radicals prostatectomy). This will be - if possible - performed nerve-sparing technique.
Bipolar resection - TURIS: Image on the vapor cushion by the sling electrode..