At Aare Urocare, we provide discreet environment and specialised treatments tailored to your bladder, kidney and prostate conditions. We offer a range of treatments — from minimally invasive methods to surgical intervention.
The prostate is a walnut-sized gland below the bladder. It produces semen and the development of the prostate is controlled by testosterone, the male sex hormone. The urethra runs from the bladder to the penis and through the centre of the prostate, and this is where urine flows out of the body.
As the prostate wraps around the urethra, prostate-related conditions often result in urinary issues such as the frequent urge to urinate or the inability to urinate. Some common prostate health conditions that cause voiding issues are benign prostatic hyperplasia (BPH), prostatitis and prostate cancer.
Benign Prostatic Hyperplasia
Benign Prostatic Hyperplasia (BPH) is a condition common in older men where the prostate gland becomes enlarged, leading to obstruction of the urinary tract. This condition is benign and is a non-cancerous enlargement of the prostate gland. It occurs in about 40% of men above 60 years old, and the incidence of BPH increases with age.
Symptoms of BPH include:
- Lower urinary tract symptoms (LUTS)
- Feeling a frequent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Dribbling of urine at the end of urination
- The sensation of incomplete bladder emptying
- Having a weak urine stream
- Having a urine stream starts and stops
- In advanced BPH
- Having frequent urinary tract infections (UTIs)
- Blood in the urine (haematuria)
- Bladder stones
- Inability to urinate (acute urinary retention)
Note that the size of the prostate does not determine the severity of symptoms, and that the symptoms of BPH differ among everyone.
Treatment of BPH ranges from medical to surgical. These are:
Alpha-blockers — these help relax the muscles in the prostate gland and base of the bladder, which can help relieve obstruction and symptoms.
5-alpha reductase inhibitors — these help shrink the prostate by controlling the action of testosterone which causes the growth of the prostate gland.
Transurethral resection of the prostate (TURP) remains the gold standard in managing BPH. It involves removing the obstructing part of the prostate gland with an instrument known as a resectoscope, and is inserted via the urinary passage in the penis. TURP is done under general anaesthesia, and it involves an inpatient stay of a few days.
Prostatitis
Prostatitis refers to inflammation (swelling) of the prostate gland. This condition can end up becoming very painful and distressing but will often get better with good medical treatment. Prostatitis usually occurs between 30 to 50 years old and can either be acute or chronic.
Acute prostatitis
Symptoms are usually severe and come on suddenly. It is rare, but when it happens, it requires immediate treatment.
- Causes: bacterial infection of the urinary tract (which consists of the kidneys, bladder, ureters, and urethra) that spreads upwards to the prostate.
Chronic prostatitis
When symptoms come and go over a number of months (≥3 months). This is the most common type of prostatitis.
- Causes of chronic prostatitis are often not clear, and infection in the prostate usually cannot be found.
Symptoms of prostatitis include:
- In acute prostatitis:
- Fever
- Chills
- General discomfort
- Severe pain around the penis, testicles, anus, lower back, or abdomen
- Painful urination (dysuria)
- LUTS symptoms
- Feeling a frequent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Dribbling of urine at the end of urination
- The sensation of incomplete bladder emptying
- Having a weak urine stream
- Having a urine stream starts and stops
- Acute urinary retention
- Pain on ejaculation
- In chronic prostatitis
- Pain around the penis, testicles, anus, lower back or abdomen
- Painful urination (dysuria)
- LUTS symptoms
- Erectile dysfunction, painful ejaculation, pelvic pain after sex
- Acute prostatitis is usually treated with antibiotics and painkillers. Antibiotics are usually over a 4-6 week course.
- Treatment for chronic prostatitis is more for the control of symptoms because the symptoms come and go over a number of months. Treatment options include painkillers, alpha-blockers and antibiotics.
Prostate Cancer
Prostate cancer is the 2nd most common cancer among Singaporean men and it develops when the cells in the prostate undergo uncontrolled growth and form abnormal cancer cells. Prostate cancer usually forms a lump which has the propensity to invade nearby structures to the prostate such as the bladder, urethra, and seminal vesicles, as well as spread to other areas of the body such as the lungs, back, and lymphatic glands in the pelvis and back, via a venous plexus located behind the prostate known as the Batson’s venous plexus.
Oftentimes, prostate cancer carries a long prognosis, and many elderly men have small prostate cancers that do not cause symptoms and are clinically insignificant.
Symptoms of prostate cancer include:
- Lower urinary tract symptoms (LUTS)
- Feeling a frequent need to urinate
- Increased frequency of urination at night (nocturia)
- Difficulty starting urination
- Dribbling of urine at the end of urination
- The sensation of incomplete bladder emptying
- Having a weak urine stream
- Having a urine stream starts and stops
- Weakness of the lower limbs
- Back pain
- Swelling in the lower limbs
- Lumps on the prostate gland detected on physical examination
Treatment options for prostate cancer vary and depend on the stage of cancer and the patient factors such as age, medical history, and fitness.
Surgery to remove the entire prostate and urologist may also remove the lymph nodes.
Prostate cancers can grow very slowly and may take many years to spread or even develop symptoms. Some men diagnosed with low-risk, localised prostate cancer may not need immediate treatment and may instead be recommended to have regular surveillance while keeping the option of treatment open.
Hormonal treatment is a common way to treat advanced or metastatic prostate cancer and it involves interfering with the effects of the male sex hormones that are responsible for the growth of the prostate. It can be used in combination with radiotherapy. Androgen deprivation therapy helps to slow/stop the growth of cancer cells and can halt the spread of prostate cancer.
Radiotherapy uses radiation/high-energy beams from outside the body to kill cancer cells or stop their growth. It treats the prostate gland specifically and/or metastatic lesions.
Chemotherapy does not cure prostate cancer per se as it does not work very well in helping to kill prostate cancer cells (radiotherapy is a better option). Chemotherapy is a systemic treatment (i.e. affects the whole body) and is generally given in patients with advanced or metastatic prostate cancer where the cancer has spread to other parts of the body. It can also be given when patients no longer respond to hormonal treatment.
Summary
The prostate plays an important role in producing the fluid that composes part of the semen. However, it also greatly affects urinary health because structurally, the prostate hugs the upper part of the urethra, which is responsible for transporting urine out of the bladder.
If you suffer from prostate-related urinary conditions such as difficulty urinating, blood in your urine or severe abdominal pain, please consult a urologist for proper diagnosis and a personalised treatment plan.
References
“Benign Prostate Hyperplasia – Singapore.” NUH, https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Benign-Prostate-Hyperplasia.aspx. Accessed 6 June 2022.
“Prostate Cancer.” Singapore Cancer Society, https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/prostate-cancer.html. Accessed 6 June 2022.
“Singapore Cancer Registry Annual Report 2018.” National Registry Of Diseases Office, 31 March 2021, https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-annual-report-2018.pdf. Accessed 6 June 2022.
