Editing Prostate (section)

==Clinical significance==

===Inflammation===
{{Main|Prostatitis}}

<!--Introduction, symptoms and investigations-->
[[File:Inflammation of prostate.jpg|thumb|[[Micrograph]] showing [[inflammation|inflamed]] prostate ([[H&E stain]]) with large amount of darker cells ([[leukocyte]]s); area without inflammation seen on the left]]

Prostatitis is [[inflammation]] of the prostate gland. It can be caused by infection with bacteria, or other noninfective causes. Inflammation of the prostate can cause [[painful urination]] or ejaculation, groin pain, difficulty passing urine, or [[constitutional symptoms]] such as [[fever]] or [[malaise|tiredness]].{{sfn|Davidson's|2018|pp=437–9}} When inflamed, the prostate becomes enlarged and is tender when touched during [[digital rectal examination]].  The bacteria responsible for the infection may be detected by a [[urine culture]].{{sfn|Davidson's|2018|pp=437–9}}

<!--Treatment-->
Acute prostatitis and chronic bacterial prostatitis are treated with [[antibiotic]]s.{{sfn|Davidson's|2018|pp=437–9}} [[chronic prostatitis/chronic pelvic pain syndrome|Chronic non-bacterial prostatitis, or male chronic pelvic pain syndrome]] is treated by a large variety of modalities including the medications [[alpha blockers]], [[non-steroidal anti-inflammatories]] and [[amitriptyline]],{{sfn|Davidson's|2018|pp=437–9}} [[antihistamine]]s, and other [[anxiolytic]]s.<ref name="Anderson-2006" /> Other treatments that are not medications may include [[physical therapy]],<ref>{{Cite web |year=2014 |title=Physical Therapy Treatment for Prostatitis/chronic pelvic pain syndrome |url=http://www.chronicprostatitis.com/the-wise-anderson-protocol/ |access-date=2014-10-22}}</ref> [[psychotherapy]], [[neuromodulation|nerve modulator]]s, and [[surgery]]. More recently, a combination of [[trigger point]] and psychological therapy has proved effective for category III prostatitis as well.<ref name="Anderson-2006">{{Cite journal |vauthors=Anderson RU, Wise D, Sawyer T, Chan CA |year=2006 |title=Sexual dysfunction in men with chronic prostatitis/chronic pelvic pain syndrome: improvement after trigger point release and paradoxical relaxation training |journal=J. Urol. |volume=176 |issue=4 Pt 1 |pages=1534–8; discussion 1538–9 |citeseerx=10.1.1.383.7495 |doi=10.1016/j.juro.2006.06.010 |pmid=16952676}}</ref>

===Prostate enlargement===
{{Main|Benign prostatic hyperplasia}}

<!--Intro and symptoms-->
An enlarged prostate is called prostatomegaly, with benign prostatic hyperplasia (BPH) being the most common cause. BPH refers to an enlargement of the prostate due to an increase in the number of cells that make up the prostate ({{wt|en|hyperplasia}}) from a cause that is not a malignancy. It is very common in older men.{{sfn|Davidson's|2018|pp=437–9}} It is often diagnosed when the prostate has enlarged to the point where urination becomes difficult. Symptoms include needing to urinate often ([[urinary frequency]]) or taking a while to get started ([[urinary hesitancy]]). If the prostate grows too large, it may constrict the urethra and impede the flow of urine, making urination painful and difficult, or in extreme cases completely impossible, causing [[urinary retention]].{{sfn|Davidson's|2018|pp=437–9}} Over time, chronic retention may cause the bladder to become larger and cause a backflow of urine into the kidneys ([[hydronephrosis]]).{{sfn|Davidson's|2018|pp=437–9}}

<!--Management-->
BPH can be treated with medication, a [[minimally invasive procedure]] or, in extreme cases, surgery that removes the prostate. In general, treatment often begins with an [[alpha-1 adrenergic receptor]] [[receptor antagonist|antagonist]] medication such as [[tamsulosin]], which reduces the tone of the [[smooth muscle]] found in the [[urethra]] that passes through the prostate, making it easier for urine to pass through.{{sfn|Davidson's|2018|pp=437–9}} For people with persistent symptoms, procedures may be considered. The surgery most often used in such cases is [[transurethral resection of the prostate]],{{sfn|Davidson's|2018|pp=437–9}} in which an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of [[urine]]. Minimally invasive procedures include [[transurethral needle ablation of the prostate]] and [[transurethral microwave thermotherapy]].<ref>{{Cite journal |last1=Christensen |first1=TL |last2=Andriole |first2=GL |date=February 2009 |title=Benign Prostatic Hyperplasia: Current Treatment Strategies |url=http://www.consultantlive.com/display/article/10162/1376744 |journal=Consultant |volume=49 |issue=2}}</ref> These outpatient procedures may be followed by the insertion of a temporary [[prostatic stent|stent]], to allow normal voluntary urination, without exacerbating irritative symptoms.<ref>{{Cite journal |vauthors=Dineen MK, Shore ND, Lumerman JH, Saslawsky MJ, Corica AP |year=2008 |title=Use of a Temporary Prostatic Stent After Transurethral Microwave Thermotherapy Reduced Voiding Symptoms and Bother Without Exacerbating Irritative Symptoms |journal=J. Urol. |volume=71 |issue=5 |pages=873–877 |doi=10.1016/j.urology.2007.12.015 |pmid=18374395}}</ref>

===Cancer===
{{Main|Prostate cancer}}
{{Multiple image
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 | width     = 220
 | image2    = Diagram showing prostate cancer pressing on the urethra CRUK 182.svg
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 | caption2  = A diagram of prostate cancer pressing on the urethra, which can cause symptoms
 | image4    = Prostate adenocarcinoma 2 high mag hps.jpg
 | alt4      =
 | caption4  = [[Micrograph]] showing normal prostate cancer in the right upper aspect of image. [[HPS stain]]. [[Prostate biopsy]].
}}

Prostate cancer is one of the most common [[cancer]]s affecting older men in the UK, US, Northern Europe and Australia, and a significant [[cause of death]] for elderly men worldwide.<ref>{{Cite journal |vauthors=Rawla P |date=April 2019 |title=Epidemiology of Prostate Cancer |journal=World J Oncol |type=Review |volume=10 |issue=2 |pages=63–89 |doi=10.14740/wjon1191 |pmc=6497009 |pmid=31068988}}</ref> Often, a person does not have symptoms; when they do occur, symptoms may include urinary frequency, urgency, hesitation and other symptoms associated with BPH. Uncommonly, such cancers may cause weight loss, retention of urine, or symptoms such as [[back pain]] due to {{wt|en|metastatic}} lesions that have spread outside of the prostate.{{sfn|Davidson's|2018|pp=437–9}}

<!--Investigations-->
A [[digital rectal examination]] and the measurement of a [[prostate-specific antigen]] (PSA) level are usually the first investigations done to check for prostate cancer. PSA values are difficult to interpret, because a high value might be present in a person without cancer, and a low value can be present in someone with cancer.{{sfn|Davidson's|2018|pp=437–9}} The next form of testing is often the taking of a [[prostate biopsy]] to assess for [[tumour grade|tumour activity]] and invasiveness.{{sfn|Davidson's|2018|pp=437–9}} Because of the significant risk of [[overdiagnosis]] with widespread screening in the general population, [[prostate cancer screening]] is controversial.<ref>{{Cite journal |last1=Sandhu |first1=Gurdarshan S. |last2=Andriole |first2=Gerald L. |date=September 2012 |title=Overdiagnosis of Prostate Cancer |journal=Journal of the National Cancer Institute. Monographs |volume=2012 |issue=45 |pages=146–151 |doi=10.1093/jncimonographs/lgs031 |issn=1052-6773 |pmc=3540879 |pmid=23271765}}</ref> If a tumour is confirmed, [[medical imaging]] such as an [[MRI]] or [[bone scan]] may be done to check for the presence of tumour {{wt|en|metastases}} in other parts of the body.{{sfn|Davidson's|2018|pp=437–9}}

<!--Management-->
Prostate cancer that is only present in the prostate is often treated with either surgical [[prostatectomy|removal of the prostate]] or with [[radiotherapy]] or by the insertion of small radioactive particles of [[iodine-125]] or [[palladium-103]], called [[brachytherapy]].<ref>{{Cite web |title=What is Brachytherapy? |url=https://www.americanbrachytherapy.org/resources/for-patients/what-is-brachytherapy/ |access-date=8 August 2020 |website=American Brachytherapy Society |language=en}}</ref>{{sfn|Davidson's|2018|pp=437–9}} Cancer that has spread to other parts of the body is usually treated also with hormone therapy, to deprive a tumour of sex hormones (androgens) that stimulate proliferation. This is often done through the use of [[GnRH analogues]] or agents (such as [[bicalutamide]]) that block the receptors that androgens act on; occasionally, [[orchidectomy|surgical removal of the testes]] may be done instead.{{sfn|Davidson's|2018|pp=437–9}} Cancer that does not respond to hormonal treatment, or that progresses after treatment, might be treated with [[chemotherapy]] such as [[docetaxel]]. [[Radiotherapy]] may also be used to help with pain associated with bony lesions.{{sfn|Davidson's|2018|pp=437–9}}

Sometimes, the decision may be made not to treat prostate cancer. If a cancer is small and localised, the decision may be made to monitor for cancer activity at intervals ("active surveillance") and defer treatment.{{sfn|Davidson's|2018|pp=437–9}} If a person, because of [[Frailty syndrome|frailty]] or other medical conditions or reasons, has a [[life expectancy]] less than ten years, then the impacts of treatment may outweigh any perceived benefits.{{sfn|Davidson's|2018|pp=437–9}}

===Surgery===
{{Main|Prostatectomy}}

<!--Introduction-->
Surgery to remove the prostate is called prostatectomy, and is usually done as a treatment for cancer limited to the prostate, or prostatic enlargement.<ref name="Cancer=2019">{{Cite web |date=1 August 2019 |title=Surgery for Prostate Cancer |url=https://www.cancer.org/cancer/prostate-cancer/treating/surgery.html |access-date=8 August 2020 |website=www.cancer.org |publisher=The American Cancer Society medical and editorial content team |language=en}}</ref> When it is done, it may be done as [[open surgery]] or as [[laparoscopic surgery|laparoscopic (keyhole) surgery]].<ref name="Cancer=2019" /> These are done under [[general anaesthetic]].<ref name="CRUK-2019">{{Cite web |date=18 Jun 2019 |title=Surgery to remove your prostate gland {{!}} Prostate cancer {{!}} Cancer Research UK |url=https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/surgery/surgery-remove-your-prostate-gland |access-date=8 August 2020 |website=www.cancerresearchuk.org |publisher=Cancer Research UK}}</ref> Usually the procedure for cancer is a [[radical prostatectomy]], which means that the seminal vesicles are removed and the vasa deferentia are also tied off.<ref name="Cancer=2019" /> Part of the prostate can also be removed from within the urethra, called [[transurethral resection of the prostate]] (TURP).<ref name="Cancer=2019" /> Open surgery may involve a cut that is made in the [[perineum]], or via an approach that involves a cut down the midline from the belly button to the [[pubic bone]].<ref name="Cancer=2019" /> Open surgery may be preferred if there is a suspicion that lymph nodes are involved and they need to be removed or biopsied during a procedure.<ref name="Cancer=2019" /> A perineal approach will not involve lymph node removal and may result in less pain and a faster recovery following an operation.<ref name="Cancer=2019" /> A TURP procedure uses a tube inserted into the urethra via the penis and some form of heat, electricity or laser to remove prostate tissue.<ref name="Cancer=2019" />

<!--Complications-->
The whole prostate can be removed. Complications that might develop because of surgery include [[urinary incontinence]] and [[erectile dysfunction]] because of damage to nerves during the operation, particularly if a cancer is very close to nerves.<ref name="Cancer=2019" /><ref name="CRUK-2019" /> [[Ejaculation]] of [[semen]] will not occur during [[orgasm]] if the vasa deferentia are tied off and seminal vesicles removed, such as during a radical prosatectomy.<ref name="Cancer=2019" /> This will mean a man becomes [[infertile]].<ref name="Cancer=2019" /> Sometimes, orgasm may not be able to occur or may be painful. The penis length may shorten slightly if the part of the urethra within the prostate is also removed.<ref name="Cancer=2019" /> General complications due to surgery can also develop, such as [[infection]]s, [[bleeding]], inadvertent damage to nearby organs or within the abdomen, and the formation of [[blood clot]]s.<ref name="Cancer=2019" />