An enlarged prostate or “adenoma” is a common problem in men over 50. It sometimes requires surgery.
The diagnosis of a prostate adenoma also called “benign prostatic hyperplasia” or “benign hypertrophy of the prostate” is rather common in men after 50 years. Depending on the symptoms, the doctor may advise surgical treatment.
Definition: what is a prostate adenoma?
“It’s about a benign increase in volume of this gland exclusively male. This does not necessarily cause symptoms, but the most common are urination problems. explains Adam Vardi, urologist in Neuilly-sur-Seine. All men can be affected, “but the risk increases with age“, specifies the doctor. As a reminder, the prostate is a gland located under the bladder and whose main function is to secrete a liquid contributing to the fluidity of semen.
Is prostate adenoma linked to cancer?
No, a prostate adenoma is not cancer or pre-cancerous condition and does not increase the risk of cancer. “It’s a progressive and benign phenomenon” reassures Dr Natacha Naoun, oncologist specializing in Genito-Urinary oncology at Gustave Roussy. On the other hand “a man can discover his cancer because he is being assessed for urinary problems most often linked to the adenoma which is bothersome. Doctors can then accidentally discover cancer during these examinations.”
What are the causes of prostate adenoma?
“We do not know the causes of this disease” replies the urologist. There could be a genetic predisposition, because some families are more affected than others, but nothing is certain. In addition, testosterone would play an important role, but we still do not know what mechanisms come into play. It is possible that with age, the prostate becomes more sensitive to hormones.
What are the symptoms of prostate adenoma?
When the prostate increases in volume, it will put pressure on the bladder and the urethra. This can lead to symptoms associated with urination:
- frequent urge to urinate,
- urgent needs with leaks sometimes,
- a delay in initiating urination,
- the need to push to start it,
- a weak and intermittent urinary stream,
- longer urination.
In some men, there may also be a decrease in ejaculatory force.
Prostate hypertrophy is diagnosed by rectal examination, which allows the doctor to evaluate the size and consistency of this gland, and thus detect an abnormal growth. In addition to the rectal examination, additional examinations may be added: a urinary cytobacteriological examination (ECBU) or a blood test with Prostate specific antigen (PSA) test. An ultrasound of the urinary tract can also be performed, in order to more precisely assess the volume of the prostate.
What are the treatments for prostate adenoma?
“The adenoma may simply be benign and not cause symptoms. When this is the case, we can offer simple monitoring.”
► When the patient experiences symptoms that are bothersome to his daily life, medications can help reduce them. Drug treatment – first line based on alpha-blockers – can reduce urinary difficultiesby tackling the muscular contractions mainly responsible for urinary problems.
► As a second line, drugs called “5-alpha-reductase inhibitors” have the effect of deflating the gland, and therefore reducing the symptoms related to prostate compression. However, they only work on one in two patients and the reduction in prostate volume is not always significant. In addition, side effects may appear regarding sexuality.
“We operate if the symptoms are too severe”
Surgery: when to operate on a prostate adenoma?
For Doctor Adam Vardi, surgical treatments may be indicated “in special cases: for example, when symptoms are too severe or there are complications“. Surgery may also be requested by the patient if drug treatments have failed. Two types of intervention exist :
- open surgery (enucleation), “which consists in remove the main part of the prostate“
- there transurethral resection of the prostate which consists in curettage of hyperplased parts of the prostate without making an incision, but by introducing an instrument endoscopic through the urethra to the bladder.
What are the complications of adenoma?
“The most common complications are urinary infections“, explains the urologist. This can cause damage to the kidneys, so this is one of the situations in which it is necessary to operate. “Urinary blockage is also a complication, but more rare“, reassures the specialist.
Can we prevent prostate adenoma?
Although it is impossible to prevent prostate hypertrophy, there are nevertheless ways to prevent its worsening and impact: reduce drinks in the evening and avoid anything that congests the small pelvis: alcohol, spices, white wines, sedentary lifestyle, long car trips. Maintaining good physical activity is also essential.
Thanks to Dr Adam Vardi, urologist in Neuilly-sur-Seine and Dr Natacha Naoun, oncologist specializing in Genito-Urinary oncology at Gustave Roussy.