Yeditepe University Koşuyolu Hospital Chief Physician and Head of the Department of Urology Prof. Dr. Faruk Yencilek, explains what prostate is. Does every enlarged prostate turn into cancer? He gave information about prostate enlargement and HoLEP Surgery used in the treatment of benign prostate enlargement.

What is the Prostate?

The prostate is a gland located just in front of the bladder and through which the lower urinary tract passes. The prostate, which is part of the male reproductive system, whose main task is to produce the fluid that protects the sperm and to store the sperm in this fluid in a healthy way, also prevents urinary incontinence by squeezing the mouth of the bladder. 

Does Every Man Have Prostate Enlargement?

The prostate is a tissue weighing between 18-20 grams and as time passes, it starts to grow. Growth cannot be expected before the age of 30. However, after the age of 30, the prostate starts to grow slowly. While this rate is around 8% in the 40s, it can grow up to 40% between the ages of 50 and 60, up to 60% over the age of 60, and then up to 70-80%.

Is Benign Prostate Enlargement Genetic?

Although the cause and mechanism of prostate enlargement are not fully understood, it is thought that hormonal factors that occur in men of advanced ages have an effect. It is thought that the decrease in testosterone hormone with age and the increase in estrogen levels are the main causes of prostate enlargement.
Increasing age is the most important risk factor for prostate enlargement. Both benign and cancerous prostate enlargement increase with age. After the age of 40, the risk increases. Genetic factors and family history are also important. If there are three or more enlarged prostates in the family, if prostate problems started at an early age, or if the prostate is over 80 grams, there are data that the prostate is hereditary in these people.

Does Malignant Prostate Enlargement Mean Cancer?

Prostate cancer usually develops from the membrane called the capsule, which is located on the outside of the prostate, while benign enlargement develops from the prostate tissue surrounding the urethra. The site of origin is different. Special tests in imaging such as MRI, multiparametric MRI, and diffusion MRI show different variables for prostate cancer. The definitive diagnosis can only be made by biopsy. Cancer can develop in the prostate tissue in all men, whether the prostate enlargement is benign or not. Therefore, it should not be inferred that men who develop benign enlargement once will not develop prostate cancer. Even if a patient has had BPH before, cancer should be checked with annual controls.

Does Benign Prostate Enlargement Require Surgical Treatment?

In mild and moderate benign prostate enlargement, drug treatment can be applied in the first stage. However, patients with advanced problems often do not benefit sufficiently from drug treatment. In these patients, surgical treatment should come to mind first. In addition, if the function of the kidneys has started to deteriorate, there is a potential for prostate-induced kidney disease, recurrent infections, bleeding in the urinary tract, stones in the bladder, or small pockets called diverticulum have formed, direct surgical intervention should be performed instead of drug treatment.

What is HoLEP Treatment?

HoLEP is a closed prostate surgery method. HoLEP stands for "Holmium Laser Enucleation of Prostate" and means the removal of the enlarged prostate inner tissue (adenoma) by separating it from its capsule with the help of a laser. Benign Prostate Enlargement (BPH) is a condition in which the prostate, which grows with age, blocks the outlet of the bladder (urinary bladder) and prevents urine flow.

What Differentiates HoLEP from Other Closed Surgeries?

There are many different closed surgery methods for benign prostate enlargement. However, since the entire part of the prostate tissue outside the capsule is removed, the risk of recurrence of the disease after HoLEP surgery is almost negligible compared to surgeries performed with other closed methods.

Is There a Risk of Recurrence after HoLEP Surgery?

In HoLEP surgery, there is no risk of recurrence of the disease since the entire part of the prostate tissue outside the capsule is removed.

Is There an Age Limit for HoLEP Surgery?

There is no age limit for HoLEP used in patients with benign prostate enlargement. However, drug treatment is the primary choice for young patients in their 40s and 50s. Difficulty in urination may worsen as age increases. For this reason, drug treatment may not be beneficial in older age groups. Since the inability to urinate well due to the prostate can also impair the kidneys and lead to kidney failure, this should be prevented. Therefore, surgical treatment should be performed immediately.