Prostate Diseases: Diagnosis and Treatments

Prostate diseases are common health issues that men face as they age, causing a wide range of complaints from difficulty urinating to pelvic pain. The most frequently encountered prostate conditions include benign prostatic hyperplasia (BPH), prostate infection (prostatitis), and prostate cancer. Thanks to early diagnosis, highly successful results are achieved in the treatment of these diseases today.

• The prostate is a part of the male reproductive system, located just below the bladder.
• Benign prostatic hyperplasia (BPH) is not cancer, but it can make urine flow difficult.
• Prostatitis is an infection or inflammation that can affect men of all age groups.
• Prostate cancer usually progresses slowly and may not show any symptoms in its early stages.
• An annual prostate exam is recommended after the age of 50 (or starting at 45 for those in higher risk groups).

What Are Prostate Diseases?

The prostate is a fundamental part of the male reproductive system. It is a walnut-sized gland weighing about 15-25 grams, located right below the bladder. It completely surrounds the urethra, the tube that carries urine out of the body. Its primary function is to produce the fluid portion of semen, which nourishes and protects sperm. The most common prostate diseases fall into three main categories: benign prostatic hyperplasia (BPH), prostate infection (prostatitis), and prostate cancer.

Each of these conditions occurs through different mechanisms and often affects different age groups. For instance, while prostatitis is frequently seen in young adults in their 20s or 30s, prostate enlargement and cancer typically affect men over 50. Detecting these diseases early is of great importance to preserve bladder and kidney functions. Although prostate problems often raise immediate fears of cancer in the general public, the vast majority of cases are actually caused by benign enlargement or infections.

Causes and Risk Factors

Many factors play a role in the development of prostate diseases, including age, genetic predisposition, hormonal changes, and lifestyle. Benign prostatic hyperplasia (BPH) is directly linked to changing levels of testosterone and dihydrotestosterone (DHT) hormones as men age. As men get older, the prostate gland tends to grow through a natural process of cellular multiplication.

Prostatitis, on the other hand, is usually caused by bacterial infections. Acute or chronic inflammation can occur when bacteria from the urinary tract reach the prostate gland. Sometimes, however, a non-bacterial condition known as chronic pelvic pain syndrome can develop due to stress, cold exposure, or spasms in the pelvic floor muscles. For prostate cancer, the most significant risk factor is age; the risk increases noticeably after 50. Men with a family history of prostate cancer (father, uncle, or brother) have a much higher likelihood of developing the disease. Additionally, a diet rich in animal fats and low in fibre is thought to increase the risk of prostate cancer.

Symptoms of Prostate Diseases

Because of the prostate's anatomical position surrounding the urinary tract, symptoms of these diseases usually present as urination problems. Symptoms of benign prostatic hyperplasia include frequent urination (especially waking up at night), a weak urine stream, difficulty starting urination, a stopping-and-starting flow, and a feeling that the bladder is not completely empty.

Prostatitis symptoms vary depending on the type of infection. Acute prostatitis starts suddenly, causing severe complaints such as high fever, chills, intense pain in the lower abdomen and perineum (the area between the testicles and the anus), and a burning sensation while urinating. Chronic prostatitis presents with milder but persistent pelvic pain that can last for months, along with recurrent urinary tract infections. Prostate cancer often has no symptoms in its early stages; the disease progresses silently. However, when the tumour grows and presses on the urethra, it can cause BPH-like urination issues, blood in the urine or semen, and in advanced stages, back, waist, or hip pain due to the cancer spreading to the bones.

Diagnosis: How Is It Diagnosed at the Hospital?

Accurate diagnosis of prostate diseases requires a detailed evaluation by a urology specialist. The first step is usually a digital rectal exam (DRE). This exam checks the size, consistency, and any hard spots (nodules) on the prostate. Next, the level of PSA (Prostate-Specific Antigen) in the blood is measured. PSA is a protein produced by prostate cells, and elevated levels can indicate prostate enlargement or infection, as well as prostate cancer.

To measure the speed and volume of urine flow, a uroflowmetry test is performed. During this test, you are asked to urinate into a special device, which calculates the degree of blockage in the urinary tract in millilitres per second. Ultrasonography is also used to examine the kidneys, bladder, and the volume of the prostate. If prostate cancer is suspected, a multiparametric prostate MRI (mp-MRI) is taken to map out suspicious areas. A definitive diagnosis is made by pathologically examining tissue samples obtained through an ultrasound- or MRI-guided prostate biopsy.

Treatment Methods

Your treatment plan is personalised based on the type and stage of the disease, as well as your general health condition. For benign prostatic hyperplasia, initial treatments often involve medications that relax the prostate muscles (alpha-blockers) or shrink the prostate (5-alpha reductase inhibitors). When medications are insufficient, surgical intervention comes into play. The traditional closed prostate surgery (TURP) is a common option. Moreover, innovative laser technologies like HoLEP (Holmium Laser Enucleation of the Prostate) and ThuFLEP (Thulium Laser Enucleation of the Prostate) allow the enlarged tissue to be completely separated from the capsule, reducing bleeding risks and offering faster recovery. For some eligible patients, minimally invasive methods such as water vapor therapy may also be preferred.

For prostatitis, strong antibiotics and painkillers are used in acute cases, whereas long-term medication, pelvic floor exercises, and lifestyle changes are recommended for chronic prostatitis. Prostate cancer treatment is planned according to the stage of the disease. Active surveillance may be chosen for very early stages. When surgery is required, a radical prostatectomy (using robotic or laparoscopic techniques) is performed to remove the prostate completely. If necessary, radiotherapy or hormone therapy to lower testosterone levels and stop tumour growth are also evaluated as options.

Complications and Risk Groups

If left untreated, prostate diseases can do more than just lower your quality of life; they can lead to severe kidney and bladder problems. Advanced benign prostatic hyperplasia can cause complete blockage of the bladder (urinary retention), making it impossible to urinate. This blockage increases pressure inside the bladder, paving the way for urine backing up into the kidneys, kidney failure, bladder stones, and severe, recurrent urinary tract infections.

Untreated acute prostatitis can turn into a prostate abscess or allow the infection to enter the bloodstream (sepsis), creating a life-threatening risk. Over time, prostate cancer can break through the prostate capsule and spread (metastasise) to surrounding lymph nodes and especially to bones like the spine and pelvis. Men over 50, those with a first-degree relative who had prostate cancer, and individuals with a genetic predisposition are in the highest risk group. It is critical for individuals in these risk groups to undergo regular screenings, even if they have no complaints, to prevent potential complications.

When to See a Doctor

Certain symptoms in prostate diseases require immediate medical attention. Early intervention prevents permanent organ damage. You should visit a healthcare facility without delay if you experience any of the following:

• A sudden inability to urinate even though your bladder is full (In this case, you should go to the nearest emergency room or call 112 immediately)
• Visible fresh blood in your urine or semen
• Severe burning during urination accompanied by high fever, chills, and nausea
• Sudden, unbearable pain in the lower abdomen, lower back, or perineal area
• Continuous urinary incontinence or a complete inability to hold your urine

Aside from emergencies, if you have chronic symptoms that reduce your quality of life—such as waking up frequently at night to urinate, a weakened urine stream, difficulty starting urination, or a constant feeling of pressure in the pelvic area—it is highly recommended to schedule an examination with a urologist.

The Process at BHT CLINIC

At the BHT CLINIC İstanbul Tema Hastanesi Urology department, the most up-to-date medical approaches and advanced technological equipment are used in the diagnosis and treatment of prostate diseases. When you visit our hospital, our specialist physicians will conduct a detailed physical examination, and your necessary blood (PSA), urine, and imaging tests (uroflowmetry, multiparametric MRI) will be swiftly planned in our modern laboratories.

If surgical intervention is required, modern methods such as HoLEP, ThuFLEP, or robotic surgery are safely performed by our experienced surgical team. In emergencies like sudden urinary blockage or severe infection, our 24/7 emergency department and on-call physicians are always by your side. To stop delaying your health and to create the most suitable treatment plan for you, you can book an appointment at our hospital.

Frequently Asked Questions

Does an enlarged prostate turn into cancer?

No, benign prostatic hyperplasia (BPH) does not turn into cancer. BPH and prostate cancer are completely different diseases. However, both conditions can exist at the same time in the same person; therefore, patients with an enlarged prostate must also undergo regular cancer screenings.

Is sexual life affected after prostate surgery?

This depends on the type of surgery performed. In surgeries for benign prostatic enlargement (TURP, HoLEP, etc.), the likelihood of experiencing erectile dysfunction is very low, but semen flowing backward into the bladder (retrograde ejaculation) is common. In radical surgeries for prostate cancer, nerve-sparing techniques are used to aim for the preservation of sexual functions.

Does a high PSA definitely mean cancer?

No, a high PSA level does not definitively mean cancer. Conditions such as benign prostatic hyperplasia, urinary tract infections, prostate inflammation (prostatitis), and even the insertion of a urinary catheter can elevate PSA levels in the blood. Advanced tests like a biopsy are required for a definitive diagnosis.

Can prostatitis be completely cured?

Acute prostatitis is usually completely cured with the correct antibiotic treatment. Chronic prostatitis, however, is more resistant; symptoms may flare up from time to time. Still, with appropriate medication, lifestyle changes, and pelvic floor exercises, complaints can be largely controlled.

How long does prostate enlargement surgery take?

Prostate enlargement surgery generally takes between 1 and 2 hours, depending on the size of the prostate and the chosen surgical method (TURP, HoLEP, ThuFLEP). Patients are usually kept under observation in the hospital for 1-2 days before being discharged.

This article is for informational purposes only; please be sure to consult your physician for diagnosis and treatment.