What is the prostate and what does it do?

What is the prostate and what does it do?

The organ we call the prostate is located below the bladder in men and surrounds the urethra, which carries urine out of the bladder. Its main function is to produce the fluid part of semen and to help expel this fluid during sexual intercourse. As age advances, for various reasons the prostate can block the urethra, causing difficulty urinating and sometimes an inability to urinate at all. The prostate gland, which is normally the size of a chestnut (and also resembles a chestnut in appearance), begins to grow from the age of 40, and excessive growth of its inner part leads to symptoms of obstruction.

Why does the prostate grow?

Although the cause and mechanism of prostate enlargement are not fully understood, hormonal factors that arise in men at older ages are thought to play a role. Just as testosterone, the male hormone, is produced in men's bodies, a small amount of estrogen, the female hormone, is also present. The decrease in testosterone with age and the resulting increase in estrogen level are thought to be among the leading causes of prostate enlargement.

What happens when the prostate grows?

We can list the complaints that appear in patients with an enlarged prostate as follows;

1. Difficulty starting to urinate
2. Frequent urination
3. Split, slow-flowing urination
4. Feeling of incomplete emptying after urinating
5. Waking at night to urinate
6. Intermittent urination (stop-and-start stream)
7. Dribbling after urination has finished
8. Leaking before reaching the toilet
9. Burning on urination, sometimes bleeding
10. Inability to urinate (sudden blockage)

When the above symptoms appear, the enlarged prostate needs to be treated. If it is not treated and delays occur, undesirable side effects may develop, such as urinary tract infection, stone formation and dysfunction in the bladder, sudden inability to urinate, and kidney dysfunction and failure following the pressure on the kidneys from a bladder that cannot be adequately emptied.

How is it diagnosed?

First, the patient's complaints need to be evaluated. Some conditions and some medications being used can change patients' urination habits. Therefore, after thoroughly questioning the patient's complaints and history, the necessary examinations and tests should be performed.

The basic examinations that need to be performed to make a diagnosis are;

1. Digital rectal prostate examination
2. Prostate-specific antigen (PSA) test
3. Measurement of urine flow rate and post-void residual urine volume
4. Ultrasonography of the urinary system (prostate size and structure are evaluated)
5. Urinalysis
6. Symptom scoring that evaluates the patient's complaints.

How is it treated?

There are two types of treatment for benign prostate enlargement.

Follow-up or medication: Not every patient with an enlarged prostate may need treatment. If, after evaluation of patients who have no difficulty in urine flow and related findings, it is determined that the bladder and kidneys are not damaged, the patient can be kept under follow-up at regular intervals. If there are symptoms that affect the person's daily life and impair comfort, treatment with various medications is started and the patient is again kept under follow-up and control.

Surgical treatment: If medication does not help, or if the patient's prostate is causing obstruction symptoms, then surgical intervention on the prostate is necessary.

Is early diagnosis possible?

The PSA test is done after discussing its benefits and harms with a doctor; it is generally started from the age of 50, and from 45 in high-risk groups (from 40 in BRCA2 carriers).