alta uro

The prostate

Detailed information on the prostate, common prostate diseases, treatment options, prevention and measures to promote prostate health.

Diseases

Symptoms

Investigation

Treatment options

Prevention

What you should know - Interesting facts about the prostate gland

Many men are affected by prostate disease as they age. Therefore, it is helpful to know signs and symptoms of diseases of the prostate. We will be happy to inform you about diagnosis and treatment options for prostate diseases. At our center, we specialize in the diagnosis and treatment of prostate disease. Together with our patients, we can identify ways to prevent potential problems related to prostate disease or improve existing symptoms.

Our experts on the prostate

Priv.-Doz. Dr. med. Malte Rieken

What is the prostate?

The prostate belongs to the male sexual organs. It is located below the urinary bladder. The prostate gland surrounds the urethra and plays an important role in the production of semen. With the help of special secretions, it supports the mobility and supply of sperm. Thanks to its muscular structure, the prostate helps to expel sperm during orgasm. Thus, the functions of the prostate are crucial to a man's ability to reproduce. Complaints related to the prostate are relatively common. It is estimated that nearly every man in the Western industrialized world will require medical treatment for prostate problems at least once during his lifetime.

Functions of the prostate

The prostate is an important gland in the male reproductive system and performs several important functions:

Prostate secretion production

The main function of the prostate is to produce a special secretion that is a part of the ejaculate. This secretion makes up a large part of the ejaculate and serves as a source of nutrients for the sperm to maintain their viability and motility.

Sperm transport support

Prostate secretion contains enzymes and other substances that help sperm improve their motility and move more easily through the female reproductive tract for successful fertilization.

pH regulation

The prostatic secretion helps regulate the pH of the ejaculate and create an optimal environment for the sperm in the female genital tract.

Muscle contraction during orgasm

The prostate has muscle cells that perform rhythmic contractions during orgasm. These contractions support the expulsion of ejaculate from the urethra.

The function of the prostate is essential for male reproductive ability. However, this function can be impaired by various diseases, such as benign prostatic hyperplasia (BPH), inflammation of the prostate (prostatitis) or prostate cancer (prostate carcinoma). These diseases can also affect the function of the prostate and lead, for example, to weak urine stream, frequent urination, pain or other discomfort. It is important to consult a specialist if prostate problems occur, in order to obtain an accurate diagnosis and appropriate treatment.

Anatomy of the prostate

The prostate is located in the pelvic area between the rectum and the symphysis. It is surrounded by several structures, including muscles, nerves and blood vessels. Its location can be described as follows based on the anatomical reference points:

Anterior (front): The front of the prostate is directed toward the pubic bone.

Posterior (back): The back of the prostate is oriented toward the rectum and can be palpated via digito rectal examination (palpation via the rectum).

Lateral (side): The prostate is bounded laterally by the levator and obturator muscles.

Apex (tip): The tip of the prostate is located towards the pelvic floor.

Base (Basis): The base of the prostate lies in the direction of the urinary bladder.

Common diseases of the prostate

With age, the prostate may increase in size. The exact causes of this benign prostate enlargement are unclear. Age-related hormone shifts or inflammation appear to play a role. Benign prostate enlargement can constrict the urinary tract and cause discomfort during urination. These symptoms usually develop gradually and become more severe over time. In addition to benign enlargement, tumors (prostate cancer, prostate carcinoma) can also develop in the prostate. Furthermore, inflammations (prostatitis) are possible.

Benign prostate enlargement

Weak urine stream, nocturnal urination or disturbing urge to urinate can be signs of benign prostate enlargement ... learn more

What is benign prostate enlargement?

Benign prostate enlargement, also known as benign prostatic hyperplasia (BPH), is a common condition that affects many men. It is a benign change in the prostate gland, the exact causes of which are not yet fully understood.

What symptoms does benign prostate enlargement cause?

The symptoms of benign prostate enlargement can be many and vary from patient to patient. The first signs often include a delayed onset of urination and a weak urinary stream. Frequent urination is another typical symptom of this condition. Affected men often feel the urge to go to the toilet more often, especially at night. Due to the weak urine stream, they often find it difficult to empty the bladder completely. It is not uncommon for residual urine to remain in the urinary tract after urination and to "dribble" later.

What treatments does alta uro offer for the treatment of BPH?

A variety of treatment approaches are available for the treatment of benign prostate enlargement. The selection of the optimal treatment option depends on individual factors and should be discussed with a specialist. The patient's individual symptoms are the primary consideration. In the case of mild symptoms, an adjustment of lifestyle such as drinking behavior is often sufficient. If the symptoms are not very pronounced, treatment with medication is possible. Various preparations are available here, which can also be combined individually depending on the size of the prostate and the symptoms. If medication does not respond satisfactorily or if there are repeated complications (e.g. urinary retention, bleeding or infections), surgical therapy should be considered. Here, alta uro offers a wide range of minimally invasive and innovative therapies. The choice of procedure is adapted to the individual circumstances and wishes of our patients.

Bipolar TUR pro state - the "classic" prostate resection, performed with modern technology.

Greenlight laser vaporization of the prostate - a particularly gentle and safe surgical procedure

Aquablation - the first robotic surgical procedure for benign prostate enlargement. Ideal for patients for whom sparing ejaculation is important

Rezum - a minimally invasive procedure for patients who do not want their sexuality to be affected

Adenoma enucleation with the Da Vinci surgical robot - especially for patients with very large prostates

Prostatitis

Inflammation of the prostate (prostatitis) is an unpleasant but usually harmless disease that can cause a variety of symptoms and discomfort.

What is prostatitis?

Prostatitis is an acute or chronic inflammation of the prostate. Different forms of prostatitis are distinguished:
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Acute bacterial prostatitis

Chronic bacterial prostatitis

Chronic pelvic pain syndrome in men (colloquially often called chronic prostatitis).

Prostatitis without symptoms

Acute bacterial prostatitis is a severe clinical picture that is accompanied by fever, chills, pain in the perineal area and difficulty urinating. It is caused by bacteria.
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Chronic prostatitis, on the other hand, is much more common. However, it is a chronic bacterial infection in only about 5% of cases. In the remaining 95% of patients, there is a non-bacterial inflammation or pain syndrome. The pain syndrome is called chronic pelvic floor pain syndrome in men and has nothing to do with bacterial inflammation of the prostate.
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The symptoms of pelvic floor pain syndrome often have an undulating course. Affected individuals complain of burning or pain in the pelvic or perineal area that may radiate to the penis, testicles, or thighs. Painful ejaculations and difficulty urinating, as well as burning in the urethra, are also common.

The exact causes of pelvic floor pain syndrome are still unclear. It is suspected that in some cases an infection with bacteria that are difficult to detect may be responsible. Often, however, all examinations show inconspicuous findings, leading to consideration of changes in the area of the bladder outlet or tension in the muscles of the pelvic floor.

How is prostatitis diagnosed?

In order to diagnose prostatitis, various examinations are performed. These include a palpation of the prostate, a urine examination, blood tests and an ultrasound examination of the bladder and prostate. If necessary, further clarifications such as a cystoscopy may be necessary.

What treatment options does alta uro offer?

In acute bacterial prostatitis, antibiotic therapy is necessary, in severe cases even as an inpatient. In addition, anti-inflammatory and pain-relieving drugs are administered. If the prostate swells so much in the course of acute prostatitis that spontaneous urination is no longer possible, the urinary bladder must be drained via a catheter.

The therapy of chronic prostatitis depends on the underlying cause. If chronic bacterial inflammation is present, antibiotic therapy for several weeks is required. If it is a non-bacterial inflammation or a pelvic pain syndrome, a therapy oriented to the symptoms is used. This may include anti-inflammatory and analgesic medications as well as medications to improve urination, medications to relieve the urge to urinate, warm sitz baths, relaxing physiotherapy, herbal preparations or psychotherapy.

Prostate Cancer

The diagnosis of prostate cancer is a drastic event for many affected men ... learn more

What is prostate cancer?

Prostate cancer is the most common cancer in men. Statistics show that about one in seven men will face this disease during his lifetime. However, there are different types of prostate cancer. Some tumors grow quickly and aggressively, while others progress slowly. Therefore, treatment options also vary.

How is prostate cancer diagnosed?

An elevated blood value, the so-called PSA (prostate specific antigen), is often the first sign of prostate cancer. A hardening of the prostate on palpation by the specialist can also indicate prostate cancer. Initial indications of cancer often cause uncertainty and anxiety among those affected. It is therefore particularly important to clarify any suspicion carefully.
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An abnormal PSA value should be checked within 4-6 weeks. If the elevation persists, further clarification is necessary. As a next step, alta uro organizes a multiparametric magnetic resonance imaging (short = mpMRI) of the prostate in cooperation with a radiology center. This modern MRI technology enables high-resolution images of the prostate and thus an early and more precise detection of areas suspected of cancer.
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If the suspected diagnosis of "prostate cancer" is confirmed by the mpMRI, a tissue removal from the prostate, a so-called prostate biopsy, is necessary. The alta uro team performs this biopsy gently and precisely as a perineal fusion and mapping biopsy.

Treatment options for prostate cancer at alta uro

Our alta uro center offers a wide range of therapies for the treatment of prostate cancer. The choice of procedure is largely based on the stage of the tumor disease (localized, locally advanced or metastatic prostate cancer).
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Localized prostate cancer:

Active surveillance: if the cancer is not very aggressive, regular surveillance is performed using PSA determination, imaging (mpMRI of the prostate) and perinaela fusion and mapping biopsy.
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Focal therapy: in focal therapy, only the part of the prostate affected by the cancer is treated. At alta uro, we perform this therapy using irreversible electroporation (IRE, NanoKnife).
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Radical prostatectomy: The complete removal of the prostate and the end pieces of the vas deferens and seminal vesicles is routinely performed by the doctors at alta uro using the Da Vinci robotic system. For this purpose, we have the world's most modern surgical robot at the Merian Iselin Clinic in Basel.
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Radiotherapy: Preciseradiotherapy of the localized area (prostate and, if necessary, lymph node stations) is an alternative to surgery.
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Locally advanced prostate cancer:
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‍Surgerymayalsobe required for locally advanced tumors, but with extended removal of lymph nodes or removal of lymph node metastases. In most cases, this operation can also be performed using the Da Vinci robotic system.
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Metastatic prostate cancer:
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‍Ifprostate cancer with metastases is already more advanced, drug therapy is necessary. In this situation, radiation therapy can also be of great benefit. Treatment for advanced prostate cancer is carried out in close coordination and cooperation with local tumor centers.
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At alta uro, we stand by you in this challenging situation and offer you comprehensive care and individually tailored treatment options to regain your health.

Symptoms of prostate disease

The symptoms of prostate diseases can be varied. While benign prostate enlargement (BPH) or prostatitis are often noticeable, early-stage prostate cancer is often asymptomatic, i.e. affected men feel nothing.
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The first signs of benign prostate enlargement (BPH) often include a delayed onset of urination with a weak urinary stream. A frequent urge to urinate is another typical symptom of this condition. Affected men often feel the urge to go to the bathroom more often, especially at night. Due to the weak urine stream, they often find it difficult to empty the bladder completely. It is not uncommon for residual urine to remain after urination and to "dribble" later.

Frequent urination

An enlarged prostate can lead to frequent urination. Urinary tract infections can also be a reason. Medications such as alpha blockers or 5-alpha reductase inhibitors can help.
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Our tips:

Limit consumption of caffeinated beverages and alcohol.

Be sure to stay hydrated, but don't drink too much before bedtime.

Take a short walk in the evening and go to the toilet again consciously to urinate before going to bed.

Strong urge to urinate

An enlarged prostate is often the trigger. However, other causes can also underlie a strong urge to urinate. Therefore, a professional clarification is very important. Once serious diseases have been ruled out, many different options are available.
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Our tips:

In case of a strong urge to urinate, it is generally recommended to avoid triggering factors. Thus, it often already helps to avoid the consumption of alcoholic beverages, caffeinated drinks and other substances.

Make sure you drink enough fluids. However, avoid drinking large amounts of liquid shortly before going to bed. Important. Stress can also increase the urge to urinate. Relaxation techniques such as yoga, meditation or breathing exercises can help relieve stress and reduce the urge to urinate.

Nocturnal urination

Nocturia is also known as nocturnal urination and is a common problem that can affect both men and women. It refers to the need to go to the bathroom several times during the night to empty the bladder. Nocturia can have various causes (e.g., prostate, bladder problems, diabetes, heart failure, and the use of various medications). Therefore, specialist clarification is important.
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Our tips:

If nighttime urination becomes bothersome or you are concerned about it, you should see a doctor to determine the underlying cause.

As a general rule, do not drink too much before going to bed. Take a short walk in the evening and consciously go to the toilet once more to urinate before going to bed.

Weak urine stream

A weak urinary stream in men can have various causes. Here it is important to think of the following things:
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Benign prostate enlargement:
A benign enlargement of the prostate, colloquially often called BPH (benign prostatic hyperplasia), can obstruct the flow of urine and cause a weak urinary stream.

Prostatitis:
Inflammation of the prostate gland (prostatitis) can cause swelling and thus narrowing of the urethra, which can weaken the urinary stream.

Urethral stricture:
Scarring of the urethra (stricture) can restrict urinary flow and cause a weak urinary stream.

Neurological problems:
Damage or disorders in the nervous system that control bladder function can affect the bladder muscles, leading to a weak urine stream.

Bladder stones:
Stones that form in the bladder can obstruct the flow of urine and also lead to a weak stream.

Bladder emptying disorder:
Impaired bladder emptying can lead to a weak urine stream. There are many causes of bladder emptying dysfunction.

Medications:
Certain medications can affect bladder function and urine flow as a side effect, leading to a weak urinary stream.

Aging:
As we age, the bladder muscles and urethra can weaken, resulting in a weaker urinary stream.
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Our tips:

If you suffer from a weak urinary stream, it is important to consult a specialist to determine the exact cause. The doctor will ask about your medical history and perform diagnostic tests and examinations to determine the exact cause of the weak urinary stream. Treatment depends on the underlying cause and may include medications, bladder retraining, lifestyle changes or, in some cases, surgery.

Pain in the pelvic area

Pain in the pelvic area can have various causes, such as cystitis, urinary tract infections or problems with the prostate. Therefore, pelvic pain should always be clarified by a specialist.
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Our tips:

To relieve the discomfort, warm baths, relaxation exercises or pain medication can be helpful.

Stress can increase the urge to urinate. Relaxation techniques such as yoga, meditation or breathing exercises can help to reduce stress and thus also reduce the urge to urinate.

Urine dribbling

Urinary dribbling in men is also called postmicturition dribbling and refers to the uncontrolled dribbling of urine from the urethra after urination is already complete. It is a common problem that can occur in men and can have several causes, including:
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Prostate problems:
An enlarged prostate (benign prostatic hyperplasia, or BPH) or inflammation of the prostate (prostatitis) can affect urine flow and cause residual urine to accumulate in the bladder and dribble later after urination.

Weak pelvic floor muscles:
The pelvic floor muscles play an important role in controlling the flow of urine. When these muscles are weakened, incomplete emptying of the bladder can occur, leading to urine dribbling.

Urethral problems:
A narrowing or blockage of the urethra can interfere with the normal flow of urine and cause residual urine to accumulate in the bladder and dribble later after urination.
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Aging:
As we age, the bladder muscles may become weaker, resulting in decreased bladder emptying and urinary dribbling.

Nerve damage:
Injury or disease to the nerves that empty the bladder can cause urinary dribbling.

Medications:
Certain medications can cause urinary dribbling as a side effect.
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Our tips:

Treatment for urinary dribbling depends on the underlying cause. In some cases, medication, bladder training, or physical therapy to strengthen the pelvic floor muscles may help. Urinary re-dripping due to prostate disease may require treatment of the underlying condition. It is advisable to see a specialist if recurrent urinary dribbling occurs to determine the cause and receive appropriate treatment.

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The specialists for urology in Basel

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Prostate examinations and diagnostic procedures

There are various examination and diagnostic procedures for the prostate. These are performed depending on the suspected diagnosis. The digito rectal examination allows the specialist to detect irregularities in the prostate. The PSA test can indicate possible problems such as inflammation or tumors in the prostate. An imaging procedure (mpMRI of the prostate) is often performed if prostate cancer is suspected. A biopsy of the prostate is ultimately necessary to definitively diagnose or rule out prostate cancer. To do this, tissue samples are taken and analyzed. It is important to note that all these procedures have advantages and disadvantages and that they can be used in combination.

Digito rectal examination (DRU)

The digito rectal examination (DRU) is a prostate examination procedure in which the specialist gently inserts the index finger into the rectum to assess the prostate. The palpation examination makes it possible to detect possible irregularities or enlargements of the prostate and thus to be able to find initial indications of a disease.

Preparation for DRU:
Prior to the digito rectal examination, you should perform a complete bowel cleansing and inform your physician of any medications that may affect the results.

Performing the DRU:
During the digito rectal exam, your specialist will wear a glove and gently insert your index finger into your rectum to check the size, shape, and consistency of your prostate.

Interpretation of results:
After completion of the digito rectal examination, your doctor will tell you whether or not abnormalities have been detected in your prostate. Further tests, such as a PSA test or biopsy, may be needed to make an accurate diagnosis.

Prostate Specific Antigen (PSA) Test

The prostate specific antigen (PSA) test measures the level of PSA in the blood. An elevated PSA level may indicate an inflamed or enlarged prostate, but may also be a sign of prostate cancer. Age, family history, and ethnicity affect results. Higher values may indicate possible disease and require further investigation. However, it is important to note that not all men with a high PSA level have prostate cancer.

Preparation for the PSA test:
We recommend avoiding cycling and sexual intercourse two to three days before the blood sample is taken for PSA measurement. Palpation of the prostate can also increase the PSA level in the short term and should always be performed after the blood sample for PSA determination.

Performing the PSA test:
To determine the PSA level, a blood sample is taken from a vein in the arm at the doctor's office and sent to a laboratory.

Interpretation of PSA test results:
Low or stable values are usually safe. Changes over time should be monitored.

Biopsy

A biopsy, i.e. a tissue sample taken from the prostate, may be necessary if prostate cancer is suspected. In this procedure, tissue samples are taken from the prostate and subsequently examined in the laboratory. Although a biopsy can help detect prostate cancer early and make an accurate diagnosis, it also carries certain risks. Possible complications include bleeding, infection, or pain in the rectum or bladder. The decision to perform a biopsy should be carefully considered. At our center, we perform a prostate biopsy exclusively under anesthesia as a gentle and precise perineal fusion and mapping biopsy.

Evaluation of tissue samples:
The tissue samples taken are processed and examined by a pathologist using a microscope to obtain fine tissue (histological) information. If cancer is diagnosed (positive biopsy), it is possible to further determine the nature of the cell changes and thus better classify the tumor. In addition, conclusions can be drawn about the local extent of the disease.

Microphotography of prostate hyperplasia

Treatment options for prostate disease

Treatment options for prostate disease depend on the specific diagnosis and severity of the disease. There are several prostate diseases, the most common of which are benign prostatic enlargement or benign prostatic hyperplasia (BPH), prostatitis and prostate cancer. Here are some of the common treatment options for these conditions:

Benign Prostate Hyperplasia (BPH):

Drug therapy:
Alpha-blockers and 5-alpha-reductase inhibitors can be used to relieve symptoms and improve urinary flow.

Minimally invasive procedures:
Transurethral resection of the prostate (TURP), recum, aquablation, or laser ablation may be used to remove the excess tissue to eliminate the narrowing of the urethra.

Prostate cancer:

Active monitoring:
At low risk, the physician may recommend close monitoring without active treatment.

Surgery:
A prostatectomy may be performed to remove the prostate and cancer.

Radiation Therapy:
External beam radiation therapy can be used to destroy cancer cells.

Hormone therapy:
Blocking or reducing male hormones can slow or stop the growth of prostate cancer.

Chemotherapy:
Chemotherapy drugs are used when cancer has spread to other organs.

The choice of appropriate treatment depends on factors such as the patient's age, the stage and aggressiveness of the disease, and individual health conditions. It is important to discuss the findings of a cancer with a specialist in order to find the best individual treatment for you.

Prostatitis:

Antibiotics:
Antibiotics are prescribed for bacterial prostatitis to treat the infection.

Anti-inflammatory medications:
Anti-inflammatory medications may be used to relieve symptoms of non-bacterial prostatitis.

Warm sitz baths:
To relieve pain and relax pelvic muscles.

Lifestyle changes to support prostate health.

Summary

The prostate performs important functions in the male body. Among other things, it produces the prostate-specific antigen (PSA). The PSA is important for sperm activity and helps regulate the pH of the ejaculate. The prostate also plays a role in urination, as it surrounds the urethra and controls the flow of urine.

Common diseases of the prostate include benign prostatic enlargement, prostatitis or prostate cancer. Benign prostate enlargement can cause discomfort when urinating, while a malignant tumor can cause symptoms such as pain in the pelvic area or blood in the urine.

To prevent prostate problems, it is advisable to see a specialist regularly after a certain age and to reduce risk factors such as obesity or lack of exercise. Treatment options for prostate problems vary depending on the type of underlying condition and range from taking medication to conservative therapies (e.g. physiotherapy) and surgical treatment.

alta uro
The specialists for urology in Basel

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FAQs

How is prostate disease diagnosed?

Prostate disease can be diagnosed in several ways. The process usually involves several steps to make an accurate diagnosis. Here are the most common methods used to diagnose prostate disease:

Medical history and physical examination:
The specialist will first take a detailed medical history and ask questions about the symptoms. He or she will then perform a physical examination, during which he or she may palpate the prostate by means of a rectal examination.

Blood test:
A blood test can help identify certain markers in the blood that may indicate prostate disease. These include, for example, prostate specific antigen (PSA) and other blood levels.

Urinalysis:
A urinalysis may be performed to identify infections or other diseases of the urinary tract (kidney, ureter, bladder, and urethra).

Imaging procedures:
Imaging procedures (sonography, X-ray, CT, MRI, etc.) may be used for further diagnosis.

What are the symptoms of prostate disease?

Prostate disease can cause several symptoms that may vary depending on the type and severity of the disease. Here are some common symptoms that can occur with prostate disease:

Problems urinating:
An enlarged prostate can press on the urethra and block the flow of urine. This can cause difficulty urinating, such as frequent urges to urinate, difficulty starting and stopping the flow of urine, weak urine stream, or a feeling that the bladder is not emptying completely.

Decline in sexual function:
Prostate disease can affect sexual function. Some men report erection problems, problems with ejaculation, or decreased sexual drive.

Pelvic pain or discomfort:
Some men with prostate disease may experience pain or discomfort in the pelvic area. This may manifest as pain in the prostate, scrotum, perineum, or lower back.

What treatments are available for prostate disease?

Treatment options for prostate disease depend on the specific diagnosis and severity of the disease. There are several prostate diseases, the most common of which are benign prostatic hyperplasia(BPH), inflammation of the prostate (prostatitis) and prostate cancer (prostate carcinoma).

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