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The mysteries of the prostate gland

Dr. Vladislav Mladenov, MD


Dr. Vladislav Mladenov graduated from Medical Faculty of the Westphalia-Wilhelm University in Münster, Germany in 2005. In the same university he completed a thesis on prostate cancer. He began his specialization in the Urology Clinic of UMBAL "Alexandrovska" in 2006, and in 2013 he became a specialist - urologist. He has been chief administrative physician of the Urology Clinic at Aleksandrovska UMBAL since 2016.


Dr. Mladenov specializes in laparoscopic urology in Germany. He is interested in oncourology, urolithiasis, lower urinary tract symptoms, andrology, etc.

What is the function of the prostate gland?

The prostate gland is a man's "second heart", his "biography" or "Achilles heel". It produces a secretion that is a component of sperm and creates a favorable environment for sperm. In some cases, inflammatory changes in the prostate can lead to serious disturbances in the sexual sphere in men - impaired erection, disturbances in the time of ejaculation, etc.


What are the main types of prostate gland diseases?

The prostate gland suffers from three main types of diseases.

In the first group are the inflammatory diseases typical for men at a younger age. The reasons for them are the more frequent promiscuous and accidental sexual contacts without the use of condoms.

The second group includes the so-called benign prostatic hyperplasia (BPH). It occurs in middle-aged men, with the incidence gradually increasing from about 50% in men in their 50s to about 80% in those in their 90s.

Prostate cancer is the third disease that affects the gland. The incidence of the disease has great geographic variability. It affects about 21% of elderly men. In Bulgaria, it ranks second in terms of mortality among men with 8.5%, which makes prostate cancer one of the most important and current problems in medical and social aspects for modern urology in our country.


What is benign prostatic hyperplasia (BPH)?

By clinical definition, BPH is a chronic, gradually progressive condition, not a disease, that is characterized by moderate to severe urinary symptoms, increased International Prostate Symptom Index (IPSI), enlarged prostate volume, and decreased peak urine output (MPU).

Until recently, the anatomy, physiology, diagnosis and treatment of BPH seemed clear. Nowadays we can admit that the more we get into the essence of the problem, the more circumstances related to the origin, development and treatment of this condition turn out to be completely unclear.

In the last two decades, the real "rejuvenation" of BPH also began. The reasons are due to an increase in the average life expectancy, which led to an aging population and an increase in men in absolute numbers.


What are the symptoms of BPH?

The clinical picture of BPH is determined by the patient's functional status, his anatomical features and the interactions between the prostate gland and the bladder. This leads to the formation of two groups of complaints characteristic for patients with BPH.

  • Obstructive symptoms (of voiding) - difficult initiation of urination, thinning, weakening and interruption of the stream, leakage of drops, feeling of incomplete emptying of the bladder
  • Irritative symptoms (of filling) - frequent urination, urgent urge to urinate, nocturnal urination, incontinence.

The growth of the prostate gland leads to an increased pressure in the bladder when miction starts. The muscules of the bladder thicken, become unstable and the irritative symptoms appear. The progression of the condition leads to an increase in obstructive symptoms. Complaints are also affected by bladder stones, neurological diseases, etc.

What does BPH diagnosis involve?

The accumulated scientific and practical knowledge about BPH in recent years has significantly changed the appearance of this pathological condition for men. We advise our students to remember that when a man stops enjoying urination it is time to see his urologist.

Today, we have a large number of clinical, laboratory, instrumental and imaging methods for early and on time diagnosis of BPH. After collecting the history of the patient, he should fill in the MPSI - a questionnaire about his complaints. Further, the diagnostic process includes prostate specific antigen (PSA) testing and rectal examination - mandatory before PSA. These tests are sufficient for a planned preventive examination.

An ultrasound examination of the prostate gland, uroflowmetry to determine the stream flow during urination, prostate biopsy, urethrocystoscopy and other highly specialized examinations may be made in case there are indications for them.


Why should the treatment be individualized?

BPH is a socially significant condition in men over the age of 50, which requires early diagnosis and adequate treatment having in mind the guidelines for good medical practice. The therapeutic plan is individual and is supervised by a urologist depending on the complaints of every patient. He must be precisely informed about his condition and actively participate in  making decisions on the type of treatment. The main goal of conservative treatment is:

  • To relieve complaints
  • To slow down the progression of the condition
  • To eliminate the danger of acute retention of urine
  • To reduce the need for surgical treatment


Why is self-medication dangerous for the patient?

Unfortunately, only 5.6% of men between the age of 40-70 consult a doctor about urinaty disorders. Some medications reduce the level of PSA in the serum and conceal the early diagnosis of prostate cancer. In medicine "two plus two is not four". It is good to know that BPH is a slowly progressing condition, not a disease. This is a condition that is also important for the partner. PSA must be checked at least once a year. Treatment is strictly individual after consultation with a urologist. Conservative treatment is symptomatic and self-medication is unacceptable and dangerous.


What is important to know about prostate carcinoma?

Cancer of the prostate gland is multifocal, it is common and it is hidden. Unfortunately, it was rarely recognized on time in the past. It ranks first among the tumors of the urogenital system and second as a cause of death  in men after lung cancer.


At what age should men see urologist annually?

Considering the variety of prostate gland diseases, a man can always find a reason to consult a urologist - from the youngest to the oldest age. Having in mind benign prostatic hyperplasia or the early diagnosis of prostate cancer, the consultation with a urologist should take place at least once a year after the age of 45. Even earlier in case of genetic predisposition.


The patient has to share his complaints and concerns with the doctor, the prostate specific antigen will be checked and if needed a rectal examination of the prostate gland will be made.