Prostate (prostate gland) disorders are among the most common men diseases. Every second man over 50 years suffers from them.
The most common prostate diseases are benign prostatic enlargement (benign prostatic hyperplasia), prostate cancer, acute prostatitis (prostate inflammation), chronic prostatitis, chronic non-bacterial prostatitis (prostatodynia / vegetative urogenital syndrome) and others.
The following diagnostic and therapeutic methods are used in Germany for prostate diagnosis and treatment:
- Minimally invasive diagnostics (non-bioptic diagnostic, using modern methods of laboratory analysis of blood and urine tests to determine the risk of prostate cancer; synchronous ultrasound elastography)
- Brachytherapy (permanent implantation of radioactive seeds)
- High-intensity focused ultrasound ablation
- Benign prostatic hyperplasia treatment, using a diode laser system EVOLVE, company Biolitec
- Thermotherapy with the use of microwaves and others.
Classification of pathologies is based on similar features of manifestations. All possible diseases of the prostate gland in men are nominally divided into 4 groups:
- Inflammatory diseases. Triggered by pathogenic microorganisms. Often act as sequelae affected by urogenital system organs infection. This group includes: acute and chronic prostatitis, prostate vesiculitis, prostate cystitis, tuberculosis, abscess, and other diseases.
- Tumor processes. If the pathology develops with preservation of cellular structures, we speak about hyperplastic changes in tissues. Such masses belong to the category of benign, but involves irreversible damage due to the organ size's increase. In case of malignant tumors - cancer cells replace healthy ones.
- Connective tissue pathology. Dense connective tissue structures form a kind of frame of any organ. Their growth causes elasticity and density decrease, atrophy occurrence. As a result, cysts and fibrosis are formed. The preceding factors are injuries and inflammatory diseases.
- Parasitic lesions of the gland. Unlike the digestive system organs, parasites invade the prostate gland vary rarely, due to the lack of nutrients. But if it ever happens, the local immunity decreases rapidly, which may cause other pathologies.
The following list of diseases consists of the most common ones. Most of them can be successfully treated in the early stages.
Prostate gland diseases in men may occur both singly or in combination with other illnesses. In the latter case diseases result from infections of other organs: cystitis, urethritis, vesiculitis, etc.
The causative agents of the disease can be viruses, bacteria, fungi, mycoplasma. They penetrate the urethra, lymphatic vessels, rectum or urinary tract.
There are many external factors that create favorable conditions for the development of the inflammatory process:
- Sedentary lifestyle. It's a common cause among patients who are spending a lot of time sitting, due their job or other circumstances.
- Hypothermia of pelvic organs. Hypothermia decreases local and general immunity, weakens the protective functions of the body, which leads to the unobstructed penetration of pathogens and the pathologies development.
- Overeating. Excessive consumption of junk food leads to obesity. Overweight provokes irreversible pathological changes. Repleted intestines squeeze the prostate, disrupting the blood supply and the secretion process.
- Tobacco and alcohol addiction. Regular toxins poisoning of the body causes psychological, physiological and genetic imbalance.
- Prolonged abstinence or too frequent sex acts with different partners. In the first case, inflammatory congestive processes are formed that affect metabolic processes. In the second - the risk of venereal diseases infection increases.
- Mechanical trauma. Such as: severe kick to the groin area, pelvic bones fracture, improper massage of the prostate, bougienage of the urethra, etc.
No man can avoid age-related changes in the prostate tissues. It increases in size and squeezes the urethra. The risk of oncological diseases grows rapidly.
In old age, preventive treatment is required, even in the absence of any negative symptomatics.
Prostate diseases in men are always accompanied by urogenital organs disorders and sexual dysfunction.
Clinical implications are similar to the symptoms of many pathological processes, therefore, the differentiation of diseases requires high-quality comprehensive diagnosis.
General symptoms that require getting urgent medical help:
- Changes in the process of urination. Frequent urination urging, especially at night, difficulty in emptying the bladder and jet weakening are obvious signs indicating inflammation.
- Pain syndrome. Infectious prostate diseases in men are often accompanied by acute pain, burning, discomfort during urination and at rest. In cases of oncology, prostatitis or adenoma, the pain manifests in the later stages.
- Erectile and ejaculation dysfunction - decreased libido, sexual weakness, insufficient sperm or pain during ejaculation. Provoked by hyperplastic changes in the tissues, inflammatory, inflammatory and congestive processes.
- Blood additive in semen, urine. Occur in cases of hyperplasia, tumor destruction, renal failure, inflammatory processes, injuries. Each cause poses a serious threat to a healthy life.
- General uneasiness The body's natural reaction to inflammation is increased body temperature, weakness, and joint pain. Rapid weight loss indicates parasitic prostate disease or a late-stage malignant tumor.
During the first visit of a medical institution the doctor conducts a patient intake - he asks about the way of life, chronic illnesses, period of first symptoms occurrence and their character, medication intake.
After the patient intake physician conducts a visual examination using the palpation method. Based on the data collected, at the physician's discretion, additional laboratory and instrumental examinations are prescribed:
- Rectal examination. It involves inserting a finger into the rectum. Allows to estimate the size and location of the prostate gland.
- Pelvic ultrasound. Detects inflammatory processes, structural changes.
- Urine and blood tests. The results of general examinations, as well as biochemical, specific indicators are informative for any prostate gland disease in men.
- Level of prostatic specific antigen (PSA). Indicates the organ's functionality. The relative norm depends on the age of the patient.
- MRI and CT. Computer methods of examination are considered the most informative among all existing ones. They help to evaluate the structure of the organ, its blood supply, any changes in tissues.
- Histological examination. Indispensible in the differentiation of malignant & benign tumors.
Preventive examination will not include a whole range of measures. When prostate diseases are in question, only comprehensive diagnosis will give an accurate result.
Prostatitis is most commonly detected in men aged 45 years and older. More than 50% of males are vulnerable to this disease.
Prostatitis is divided into:
- chronic bacterial and non-bacterial;
- asymptomatic chronic.
Acute prostatits is triggered by the immunity decrease of the prostate gland as well as in the whole organism. This factor causes penetration of pathogenic microorganisms into the body that leads to the development of the inflammatory process. Chronic prostatitis occurs due to a variety of reasons. It can be easily triggered by the penetration of pathogenic microorganisms.
In addition, the disease occurs due to:
- Genetic disposition;
- predominantly sedentary lifestyle;
- regular mechanical pressure on the prostate ("Truckers" disease);
- prolonged urination delays;
- irregular or on the contrary, active sex life (in the latter case it's about frequent change of partners);
- other pathological processes occurring in the urogenital system organs, and venereal diseases.
About 90% of patients complaining of prostate gland problems are diagnosed with chronic non-bacterial prostatitis. Today, unfortunately, doctors can not find the true causes of this pathology.
It is assumed to be triggered by:
- Urinary system diseases. Pathogenic microorganisms penetrate the prostate gland through the urethra.
- Infections that penetrated the urethra from the bottom up. That is, this disease is formed due to domestic microorganisms penetration (very rarely) or during sexual intercourse.
- Reduced prostate immunity.
In case of acute prostatitis the patient notes the following symptoms:
- A sharp increase in temperature caused by the intoxication of the body;
- pain, localized in the perineum, as well as manifested during urination or ejaculation;
- difficulty urinating, characterized by yet weakening.
The danger of bacterial chronic prostatitis is that the pathology can be present for several years without a clear clinical picture: the man does not feel any discomfort.
In most of the cases symptoms of this disease are manifested during the recrudescence period and are as follows:
- Decreased urine output;
- pain in the pelvis and lower back;
- reduced erection.
Similar symptoms are typical for chronic non-bacterial prostatitis.
There are several main reasons for the formation of prostate gland stones:
- Irregular sex life;
- predominantly sedentary lifestyle;
- old or recent injuries to the groin area;
- excess of salty and spicy food;
- inflammatory processes affecting the prostate gland;
- sulfa drugs intake.
If you do not get rid of prostate gland stones as soon as possible, they tend to grow gradually. Enlarged masses violate the integrity of the ducts, which leads to urine leakage. As a result, the patient experiences severe pain when emptying the bladder.
- Pain (cutting, pressing, burning, arching) in the perineum, often radiating in the anus, the penis and the sacrum;
- severe pain after sexual intercourse, discomfort during ejaculation;
- blood in the semen or urine;
- erection weakening, decreased libido;
- constant prostatitis aggravation despite its high-quality treatment;
- changes in the structure and size of the prostate;
- difficult, painful and frequent urination.
The main diagnosis method is palpation of the prostate gland. The physician examines the affected organ and detects seals indicating the presence of the disease. However, in some cases, the prostate does not change its structure.
To confirm the diagnosis it is necessary to conduct ultrasound and X-ray examination. An ultrasound specialist detects stones, with dimensions often exceeding 3 mm.
In 70% of cases X-ray is ineffective, because some calculi are not displayed on the image. For accurate diagnosis of the disease, it is necessary to undergo CT (Computer Tomography) or MRI (Magnetic Resonance Imaging) of the pelvic region.
Treatment of prostate stones can be conducted in 3 ways:
- Conservative method. The patient is prescribed a set of medications: antibiotics, vitamins, anti-inflammatory drugs. In case of prostate stones massage is prohibited.
- Surgical method. This method is used extremely rarely. Surgical intervention is advisable only if the stones cause severe inflammation of the prostate.
- Laser method. This method is painless and comfortable enough for the patient. It is performed in the following way: Sensors are attached to the skin in the affected organ's area, then the laser targets neoplasms disintegrating then into sand, which is easily excreted naturally. The treatment includes 10 procedures.
A disease-causing infection penetrates the gland through the blood. Then, tuberculosis tubercles appear in the affected organ, and merge forming infiltration centers. The next stage is the caseous necrosis formation, sometimes accompanied by the abscess process. Purulent discharge often falls into the urethra, causing a sharp pain attack.
Strong immunity - is the key to healthy body, where pathogens can stay for a long time without giving any signs of their presence. Bacillus Kochii is no exception. Bacteria enter the body by inhalation and may penetrate any organ hematogenously. As medical practice shows, in 20% of cases it's the prostate gland, ovaries or seminal vesicles.
The main way for tuberculosis infection to invade body is contact with the patient, namely:
- smoking one cigarette;
- use of the shared dishes.
Sometimes it is enough to be present during an emotional conversation with a patient in order to become infected with tuberculosis.
Ways of the prostate gland's tuberculosis infection:
- Pathogenic bacteria that have previously struck the urinary system organs;
- through the blood (hematogenous way) from the primary foci of infection: more often from the lungs and rarely from bone tissue;
- by direct spreading from neighboring foci of tuberculosis, namely from the urethra.
The initial stage of prostate tuberculosis is asymptomatic. First signs, namely, painful sensations in the perineal region, observed in 40% of patients and indicate the growth of inflamed lesions. The doctor can identify the disease after rectal examination.
As a rule, the first symptoms of prostate tuberculosis appear when the urethra, bladder or testicles are involved in the pathological process. The further spread of the infection is the cause of characteristic fistulas formation.
Sometimes prostate tuberculosis causes the decrease in the quantity and quality of sperm, which over time can lead to infertility.
In the later stages of the disease development, the prostate gland becomes firm to the touch, and visually shriveled. At this stage, half of the male patients suffer from impaired urination.
Diagnostic measures involve several methodological studies: palpation of the prostate, x-rays, a number of tests. As a result, an enlarged gland is detected, sometimes thick to the touch.
Urine analysis allows to determine the localization of tubercule bacillus, in our case - in the prostate gland. But this method cannot detect the cause of the disease.
If the inflammatory process is localized in the center of the prostate, the disease cannot be diagnosed by palpation. Alternative methods should be resorted to.
More specific data can be obtained after bacteriological analyses. In this case, the problem is that infectious microorganisms of the male urinary system develop very slowly and in small groups.
The final diagnosis can be made after the secretion examination for the presence of pathogenic bacteria, although transrectal biopsy is considered the most efficient method. A course of treatment can be prescribed on its basis.
Tuberculous prostatitis therapy is a debilitating long-term process. Sometimes it is possible to stick to traditional medical treatment only, although the option of surgery is also probable.
Drug treatment takes at least a year. In the future, support therapy must be practiced for three years. Tuberculosis is considered cured when no infectious bacteria causing the gland disease is detected in the blood and semen.
Chemotherapy is a popular treatment for prostate tuberculosis. In this case, the rectal injection of chemicals (isoniazid, rifampicin, ethambutol) is combined with the dimexidum injection into the rectum. The latter is necessary for better drugs absorption by the prostate tissues.
Lymphotropic chemotherapy is also commonly used. During the procedure antibiotics are injected into the lymph system. It normalizes the gland functioning, and also increases the effect of treatment up to 90%.
Surgery is an extreme measure in the treatment of tuberculous prostatitis. The patient is prescribed the two-week course of chemotherapy before the procedure can be performed.
At first, to diagnose benign gland enlargement, it is usually needed to define patient’s individual symptoms with the help of a specially developed anamnesis form. It is highly important to point at all previous diseases (surgeries, diabetes, neurological diseases, accidents and injuries, disk prolapse). Only when the doctor is aware of all the features of your disease history, can he figure out the prognosis or offer treatment.
The next step is usually rectal test, performed digitally, aimed at finding out the main characteristics (size, form) of gland, as well as diagnosing any inflammations (painful sensation when pressuring) and potential prostate carcinoma signs(indurations in the gland). Alongside with lab tests (PSA, bacteria presence, blood admixtures, cancer cells), it is also possible to carry out uroflow-metry; it’s a technique for urine stream measuring, which helps to determine urination flow rate. Other ways of diagnostic examination, preceding adenoma treatment:
- estimation of volume flow of urine;
- detection of potential tumor risks;
- detection of concrements;
- detection of other disorders
- urethrocystoscopic research, minimal invasive methods
- cytoscopic research
Pharmacological therapy of prostate hyperplasie(adenoma) in Germany
Treatment methods in Germany are indicated according to symptoms and concomitant disorder signs. Therapy of adenoma, includes conservative methods (above all, phytotherapeutic drugs). In case the symptoms have not diminished, it is advisable to use medicines, which are aimed at down-regulation of hormone generation, etc.
Surgeries. Operations (Diagnosis: prostate adenoma in Germany)
Surgical treatment of benign adenoma hyperplasia in Germany can be performed by means of different surgical operations. Among them is prostate extraction via urethra or open surgeries.
Doctors of German clinics have different surgical techniques at their disposal, which allow conducting transurethral surgical operations. Open surgery is recommended in case of large tumors or various complications. Among the most common operations are:
- TUR-operation, vaporization of enlarged prostate tissues, the scope of laser methods (above all: Green laser);
- open surgery;
- da Vinci method (in those cases when there is cancer risk).
There are new methods being investigated and implemented in Germany. One of the is water stream therapy (WIT), an experimental method which helps to destroy adenoma tissue with the use of water-air-filled balloon. This procedure minimizes the risk of damage of healthy prostate tissue.
To secure our patients’ safety and health we use only reliable and established methods and help to find best clinical centers.
In terms of relative frequency prostate cancer yields only to lungs and stomach cancer. Pathology characterizes malignant lesion of organ tissues. Long asymptomatic development leads to late diagnosis - at 3-4 stages. Despite the gradual rejuvenation of the disease, the risk group is headed by men over 60 years old. There are 4 histological forms: adenocarcinoma - 90% of all cases, squamous, transitional-cell, undifferentiated cancer.
The first 2 stages symptoms are similar to signs of adenoma, prostatitis. The occurrence of dull pain in the ribs or spine indicates the lesion metastasis.
At the last stage, anemia, weight loss, cachexia, and swelling of the lower limbs are noted. Treatment involves surgery, chemotherapy, radiation therapy.
During the first two stages, it is advisable to conduct a radical treatment - prostatectomy, means the removal of the gland, seminal vesicles, part of the urethra, and bladder neck. Subsequently, impotence and urinary incontinence are possible. Radiation and chemotherapy are used in the later stages in order to prolong the patient's life.
Prostate treatment with the use of Green Light laser is effective for fighting benign prostatic hyperplasia (BPH) with minimal traumatization of healthy tissues. Photoselective vaporization provides instant relief of the disease symptoms, improves urine outflow significantly, as opposite to the standard transurethral prostatic resection (TURP). This type of laser prostate surgery requires less time and provides quicker recovery. There are minimal side effects. Compared to other minimally invasive methods, this technology doesn’t require catheter installation during recovery period. A special light source that emits green laser impulses is used for the photoselective gland cell vaporization. As a rule this prostate laser surgery in Germany is made in the outpatient settings, surgical centers or polyclinics.
The cost of such treatment in Germany starts from 6.000 Euro.
The treatment approach
Green Light laser acts on the growing prostate tissues by vaporizing the targeted cells. The laser impulses for the surgery are generated by a special fiber-optic lightguide inserted into an ordinary cystoscope. The impulses of green laser are directed on hyperplastic prostate tissues.
Green Light laser removes prostatic obstruction quickly and precisely, removing the hyperplastic prostate tissue almost unbloodily. The average duration of such surgery is less than 60 minutes.
Photoselective vaporization by a green laser (PVP) in Germany: major advantages:
- BPH is diagnosed in 40% men above 50 and 90% men above 80.
- Patients usually get back to work that doesn’t require serious physical efforts in 2-3 days after PVP treatment.
- Patients return to their physical activities in 4-6 weeks.
- Complications after PVP surgery are met rarely, and usually they are not serious.
- 30% patients who underwent PVP treatment don’t need catheter installation after surgery.
- PVP doesn’t lead to impotence development.
- PVP lowers the frequency of retrograde ejaculation development in patients.
- The need in repeated PVP surgery usually occurs in 5 years and more. It is much rarer compared to other treatment methods.
- GreenLight therapy PVP is an outpatient operation that is a great alternative for traditional methods of surgery BPH therapy.
Clinic of prostate treatment in Heidelberg
Heidelberg clinic is a specialized center, which uses attenuated methods of prostate diseases treatment. It provides such mild treatment methods as prostate non-bioptic diagnostic to determine the risk of prostate cancer, synchronous elastography to study tumor changes in tissues, choline PET, high-intensity focused ultrasound ablation in case of prostate cancer, Greenlight-laser ( TCR-laser), as well as diode laser Evolve by Biolitec for gentle treatment of benign prostatic hyperplasia, thermotherapy using microwaves, transurethral needle ablation and prostatitis treatment by magneto therapy, using therapeutic device NeoControl.
Surgical prostate treatment methods are:
- Treatment with the help of Greenlight-laser (laser TCR) – a minimally invasive procedure to remove benign prostatic tissue
- Removal of prostate by transurethral resection or laparotomy
The center of prostate treatment in Frankfurt-am-Main
The center of prostate treatment offers medical and surgical treatment of prostate diseases. The surgical methods, used for prostate treatment in the center in Frankfurt-am-Main, include thermotherapy (hyperthermia, thermotherapy or thermoablation and other laser methods), transurethral resection of prostate (as an alternative to removal of prostate through laparoscopy). The clinic also uses an endoscopic method of treatment by means of laser system Greenlight.
An important aspect of work of the center is carrying out preventive studies aimed at early diagnosis of prostate cancer. Such studies include ultrasound, analysis of the urine for signs of inflammation and blood in it, a test for diagnosis of bladder cancer and others. The highest diagnostic accuracy of prostate cancer is observed, when using a comprehensive study, which consists of a digital rectal examination and test for prostate-specific antigen (PSA).
Prostate treatment center “Nymphenburg” in Munich
The center offers the latest diagnostic and therapeutic possibilities. The range of services of prostate treatment, provided by “Nymphenburg” in Munich, includes diagnostic and treatment of all prostate diseases:
- Diagnostic and treatment of benign prostate enlargement and prostate chronic syndrome (drug treatment, transurethral resection of prostate, open removal of adenoma (subcapsular enucleation by Millin), and bipolar plasma vaporization)
- Diagnostic and treatment of malignant changes of prostate (prostate cancer) – a study on early diagnosis of prostate cancer, follow-up study, prostate biopsy, active observation, radical surgery, external irradiation (percutaneous radiotherapy), internal irradiation (brachytherapy), drug treatment (hormone and chemotherapy)
- Diagnostic and treatment of prostate inflammatory diseases and pelvic chronical pain syndrome
- Brachytherapy in case of prostate cancer
Prostate treatment center in Berlin
The main aspects of prostate treatment center Berlin-Mitte are diagnostic and treatment of prostate cancer. The range of services in this area includes:
- Diagnostic: determination of PSA and its coefficient, uroflowmetry and measurement of urine residue by sonographic studies, cystomanometry, transrectal ultrasound, prostate trepanobiopsy by sonography, histologic and immunohistologic study of tissue samples, bone scintigraphy, MRI, CT, PET-CT
- Therapy (in case of prostate cancer): surgery (removal of prostate, but preserving nerves and potency, radical prostatectomy with or without regional lymph nodes removal, laparoscopic removal of lymph nodes – before radiation therapy, transurethral resection of prostate); radiotherapy (external and internal irradiation, radiation therapy with modulated intensity); brachytherapy (permanent implantation of radioactive seeds, internal short-term irradiation); at advanced stages (chemotherapy, antihormonal therapy, pain-relieving therapy)
- Follow-up study
- Treatment in case of incontinence, when radical surgical removal of prostate (radical prostatectomy) takes place, implantation of an artificial sphincter
- Treatment (benign prostate enlargement): transurethral resection of prostate, transurethral incision of prostate, open surgical removal of prostate.