We met with MD, professor, urologist Pavel Ilyich Rasner to talk about important urological topics.
Is prostate adenoma a sentence? Treatment, observation or surgery?
Not a verdict in any way! Adenoma of the prostate is a benign process that is perfectly controlled and responds perfectly to both medical and surgical treatment. The only intrigue of prostate adenoma is that the prevalence of this disease is approaching 100 percent for older men. At the age of 80, about 80-90% of men have this diagnosis, and almost everyone needs the help of a specialist.
Can an adenoma turn into cancer?
No never. There are three very well-known prostate diseases: prostate cancer, prostate adenoma, and prostatitis (inflammation of the prostate gland). All three diseases do not flow into each other, but they can simultaneously affect the same organ. However, no one has proven that they are somehow causally related.
It is believed that cancer develops slowly in old age and sometimes it is better to leave it as it is. Do you think it is better to cut or leave?
Just the other day we had just such a case: an elderly patient with a neglected oncological process applied. At the medical consultation, my colleagues and I formulated the main task: "To try to prolong a person's life as much as possible." Therefore, speaking about the possibility of an operation, we must always assess the ratio of risk and effectiveness. If the effectiveness exceeds the risk, then we can recommend the operation, but the final decision is necessarily made together with the patient. Our task as doctors is to explain in detail what the consequences of a surgical intervention can be. If the risk is too high, we can find alternative solutions and prescribe radiation, hormonal or chemotherapy. In each case, this decision is made individually based on the stage of the disease, the general state of health and, of course, the patient's wishes.
Pavel Ilyich, does everyone need circumcision? Does it really reduce the risk of contracting STDs and penile cancer?
This is a myth that is more than one hundred years old. There was a time when virtually all boys were circumcised in the United States, but the overall incidence profile has not changed significantly. If circumcision did significantly reduce the risk of getting sick, in some countries many common STDs simply would not exist, or they would be much less common. Unfortunately, no such pattern has been identified. From a medical point of view, as "prevention of STDs" this procedure does not make much sense. True, there is a relationship between the risk of cervical cancer and male circumcision. In this matter, circumcision is really a blessing.
Are there mythical diagnoses in urology?
Of course have. The most common mythical disease is chronic prostatitis. The diagnosis is very fond of outpatient urologists, but only in 5% of cases it is really justified. In 95% of cases, this diagnosis has no sufficient basis. There are a number of objective signs on the basis of which, after an appropriate examination, chronic prostatitis can be diagnosed. Unpleasant sensations in the perineum or above the bosom and nonspecific urination disorders are inconclusive evidence of the disease!
