Prostate The prostate is a gland only men have. It is a gland producing most of the fluid which is ejaculated (the semen and some of the fluid are produced by the testis, the epididymis and the seminal vesicles).

The prostatic fluid contains some sugars and proteins (such as prostate-specific-antigen) that are necessary for the fertility of the ejaculate.
In most men the prostate will have the size (20 cc) and feel of a small plum, it can be reached in a rectal examination.
The prostate is located near the urethra just below the urinary bladder and consists of glandular tissue and some smooth muscles.
The develoment of the prostate is dependent on the male hormone testosterone (produced in the testis). It grows during puberty and will not grow or shrink in castrates.

Due to its location and function prostate disorders can result in severe problems.

Prostatitis:
An inflammation of the prostate
is called prostatitis.

The experts know different types of inflammatory disorders, whose symptoms and therapy are different.

Bacterial inflammations (acute or chronic) are treated with antibiotic medication.
In many cases the prostate inflammation will be non-bacterial.

Many treatment options are used to cure the inflammatory reaction and reduce the symptoms.
Prostatitis is a disease common in the daily urologic practice and a severe problem for the patients. Although it is a very frequent disease therapy concepts are still very controversial.

The experienced urologist will combine medical scientific results and therapy strategies as well as personal experience and expertise to select the individual therapy concept for his patient.

Benign Prostate Enlargement:
In many men the prostate will enlarge in his 50’s and 60’s – a very common finding. As the prostate is locateted at the outlet of the bladder an enlargement of the prostate will often result in difficulties while urinating – the bladder does not empty completely any more: getting up at night for urinating, dripping, weak flow and eventually urinary infections can be the result.
Modern oral medications will widen the bladder outlet (such as alpha-blockers) or reduce the size of the prostate (e.g. finasteride), but in many cases the outlet obstruction will remain and can often only by cured by urosurgical therapy.
Within the last two decades many scientist have tried to invent new techniques for the urosurgical treatment of prostate enlargement – e.g. laser prostate therapy, green-light-laser, thermo therapy and many others. Many centers and companies are trying to promote their instruments and systems to participate in this multi-million-dollar market, and especially laser therapy seems to attract many patients.
 
However, today the transurethral resection of the prostate (TUR-P), improved with new energy applications systems, remains one of the safest and most effective therapy options for bladder outlet obstruction.
For patients with a smaller prostate Dr. Petsch would recommend this well established method. In the hand of an experienced surgeon the TUR-P is the method that Dr. Petsch would select for himself and his father.
For patients with a larger prostate (more than 80-100 gram) an open surgery might be the best choice. Always try to find an urologist who does a lot of prostate surgeries and TUR-P.

Prostate cancer:
Prostate cancer is one of the most frequent forms of cancer in men. Regular rectal examinations and a PSA (prostate-specific-antigen)testing can help to detect a prostate cancer at an early stage – prostate cancer can be cured.
Prostate cancer has the potential to spread within the body – mostly into the bones and the lymph nodes. Symptoms of a prostate cancer can be pain, erectile dysfunction, difficulty in urinating and other symptoms.

The prevalence of prostate cancer varies around the world – it is a common disease in the US and Europe and less frequent in Asian countries.
However the differences can also be a result of different detection rates. Many factors (e.g. diet, genetics or sexual behaviour) are subjects of an ongoing debate.

In the US prostate cancer is responsible for more deaths than any other cancer except lung cancer.
Most of the prostate cancer patients will be older than 50 years.
Prostate cancer therapy can be surgery, radiation therapy, hormonal therapy, (chemotherapy – less effective) or a combination of these.
Detection and diagnosis
The traditional screening procedure for detecting prostate cancer is by DRE (digital rectal exam). The doctor inserts a gloved lubricated finger into the rectum to check the prostate size and feel the back wall and sides of the prostate for bumps or other abnormalities. The exam is quick and generally painless and can be a good indicator that further tests are necessary.
An additional screening method that has revolutionized prostate cancer detection is a simple blood test to check PSA (Prostate Specific Antigen) level. PSA is an enzyme produced by prostate cells, whether normal or cancerous. An abnormal prostate, including one with cancer, will secrete more PSA. Since the normal range of PSA is 0.0 - 4.0 ng/ml, a level between 4 and 10 may raise suspicion that a patient has prostate cancer. However, an elevated level of PSA does not necessarily mean that you have prostate cancer. Other factors that can raise the PSA level are: inflammation or infection of the prostate, non-cancerous prostate growth (BPH), recent urinary catheterization or procedure, recent prostate biopsy or surgery, stones in the prostate or bladder surgery.
If the DRE or PSA level indicates that cancer may be present, your doctor will perform an ultrasound and biopsy of the prostate. A lubricated ultrasound probe is inserted in the rectum and sound waves emitted by the probe provide images of the entire prostate. Biopsies of the prostate are taken with tiny hollow needles inserted through the thin rectal wall. Biopsy is the only definitive way to diagnose the presence of prostate cancer.
The following criteria are used to characterize prostate cancer: grade of the tumor (Gleason score, where the higher the number the more aggressive the cancer), stage of the tumor (T1-T4, where the higher the number the more the cancer has spread) and volume of the prostate.

An important diagnostic step is the Prostate biopsy – in most of the cases done as a transrectal, ultrasound-guided multifocal needle-biopsy. The procedure can be done with local anaesthesia as an outpatient procedure.

Prostate cancer prevention
Screen for prostate cancer by having an annual digital rectal exam and PSA blood test from age 50. If you are African American or have a family history of prostate cancer you should have these annual tests from age 40.

Brachytherapy for prostate cancer:
Seed implantation with iodine-125 seeds (brachytherapy) is a highly effective treatment for men with prostate cancer. In a 10-year survivability study, the success rate was demonstrated to be better than external beam radiation and equal to that of surgery. Brachytherapy requires no surgical incision, offers men a shorter recovery time, and has less chance of troubling side effects such as impotence and incontinence.

Brachytherapy is an outpatient procedure and most men go home the same day as their treatment. Seed implantation takes only 45 minutes to 1 hour. External beam radiation requires 5 hospital visits each week for about 7 to 8 weeks. With brachytherapy, most men can return to their normal activities a few days after treatment. Surgery requires hospitalization and takes many weeks to heal.

Seed implantation with iodine-125 seeds gives a lower dose rate of radiation than palladium-103, and as the seeds work in your body longer than palladium-103, it is ideal for treating slow growing tumors such as most prostate cancers. When prostate cancer spreads to the tissue that immediately surrounds the prostate, many doctors choose RAPID Strand. The unique way the seeds are linked together in RAPID Strand™ allows doctors to securely place seeds directly in and adjacent to the surrounding tissue, to treat cancer that has extended outside of the prostate.

Implantation of the seeds
Before an implantation, an ultrasound volume study to see the size and location of the prostate as well as the surrounding organs.
 
During the pre-plan a predetermination is made of how many seeds a patient will need and exactly where they should be placed based on the size and shape of the prostate. At the beginning of the implantation, the patient will be administered anesthesia.
 
To guide the precise placement of the seeds, an ultrasound probe is placed in the rectum so that an image of the prostate appears. Usually 80 to 100 seeds are placed inside needles that are inserted in to the prostate. The ultrasound probe ensures that the needles are guided with maximum accuracy based on the plan.

The entire implantation procedure usually takes only 45 minutes to 1 hour. After the seeds are implanted, the patient will stay in a recovery room. Since seed implantation is an outpatient procedure, the patient can usually go home after the anesthesia wears off.

Are there any side effects?
There is little discomfort after the implantation.

As might be expected, there may be some mild soreness, some blood in the urine, and/or bruising or swelling between the legs.
 
These symptoms usually go away in a few days. Some men may experience discomfort while urinating, or the need to urinate more frequently. These symptoms usually begin 1 to 2 weeks after implantation and gradually decrease over time as the seeds lose their strength.
 
Drinking lots of fluids and avoiding caffeine and alcohol may help relieve these symptoms. A small percentage of men, particularly those who have had previous prostate surgery, may experience incontinence. Impotence may also occur in some men, particularly those over the age of 70. However, the rates of impotence and incontinence are lower with Seed Brachytherapy than with other treatments.
 
Does the patient need to take
special precautions after the implantation?
Although seeds contains radioactive material, the patient is not radioactive.
 
One of the benefits of seeds is that almost all radiation stays within the prostate. After implantation, the patient can continue to enjoy physical contact with other adults.
 
As a precaution, the physician may suggest using a condom during sex for a few days after the procedure. A physician may also recommend that patients avoid close contact with small children and pregnant women for the first 2 months after treatment.