November 3, 2021
The prostate is a gland. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body.
A young man’s prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is common after age 50. The older men get, the more likely they are to have prostate trouble, including:
- Prostatitis, an infection usually caused by bacteria.
- Benign prostatic hyperplasia, or BPH. BPH is an enlarged prostate, which may cause dribbling after urination or a need to go often, especially at night.
- Prostate cancer is a common cancer that responds best to treatment when detected early.
The Prostate Specific Antigen (PSA) blood test helps detect prostate cancer in its early stages. The prostate is a gland located in the pelvis at the neck of the bladder and is important in making semen. If the level of PSA is elevated, this could mean the prostate is infected, inflamed, enlarged, or has cancer. The normal PSA varies with age, and all men over the age of 45 should have a PSA exam once a year. Men who have a history of prostate cancer in their family or who are African-American should start having the PSA test at age 40. If your PSA result is abnormal or elevated, your doctor may recommend further testing to ensure the prostate is healthy.
Prostatectomy is a surgical procedure to remove the prostate gland and the cancer in it, The surrounding seminal vesicles are usually removed as well. Not every patient with prostate cancer can benefit from a prostatectomy. This procedure is used only if the cancer has not extended outside the prostate and into the pelvis or abdomen.
A prostatectomy is always done under general anesthesia, and may be performed by:
- A vertical incision in the lower abdomen
- An incision between the scrotum and the rectum
- Many small incisions in the abdomen to allow for a laparoscopic prostatectomy
- Many small incisions and then with the help of a robot known as the Da Vinci robotic system.
The prostatectomy can also be done in a manner that tries to save the nerves that surround the prostate. A variation of the operation involves nerve grafting. The surgeon reconnects the nerves that have been cut with a nerve taken either from the leg or from inside the pelvis. In all types of surgery, once the prostate is removed the surgeon reconnects the neck of the bladder to the urethra with very delicate sutures.
Transurethral Resection of Prostate (TURP) is a procedure to remove excess prostate growth. This is a common condition in older men, and it can result in pressure on the urethra and block the bladder outlet making it hard to start and maintain the urinary stream. This problem could become serious if the pressure makes urination very restricted or impossible. The pressure in the bladder may rise and damage the kidneys. In a TURP procedure, the excess prostatic tissue is removed using a special instrument called a resectoscope. Prostatic tissue removed will be examined by a pathologist to ensure that there are no abnormalities such as cancer. It is possible that the prostate may grow again and cause a return of symptoms, necessitating another TURP.