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What causes prostate pain

How does the prostate hurt in men? Signs, symptoms and treatment

Prostate diseases in men are associated with physical and psychological discomfort. The quality of life decreases and medical attention is required. A man does not always know how the prostate hurts and what to do about it.

Causes of pain

In some male diseases, the prostate is involved in the pathological process. The main causes of pain:

• inflammation in the prostate gland caused by urogenital infection;
• a tumor of the gland, which usually appears after 40 years;
• presence of stones;
• prostate cyst;
• Pain that originates in the rectum and radiates to the prostate.

The prostate is an important male organ responsible for the quality of the fertilizing fluid. The diameter of the prostate gland is 3 cm, it is difficult to diagnose due to inaccessibility.

It is impossible to make a diagnosis on your own. If you experience pain, you need to visit a doctor for examination and diagnosis.

The main symptoms of prostate disease are pain. To determine the cause of the ailment, the doctor will specify how the prostate hurts in a man, what precedes the pain, duration, whether unpleasant symptoms occur during sex.

There are symptoms that indicate prostate disease:

• frequent visits to the toilet, especially at night;
• an involuntary interruption of the jet occurs during urination;
• droplet urination;
• pain during urination;
• burning, discomfort or severe pain during intercourse or after orgasm;
• the presence of foreign fluids in semen;
• periodic pain in the pelvic region, in the perineum.

The listed symptoms may indicate another disease of the male reproductive system, it is impossible to make a diagnosis on your own. If you suspect a disease, you should contact a specialist.

Acute prostatitis

Acute prostatitis is the most common disease in men. Men under the age of 50 are at greater risk. How does the prostate hurt in the acute course of pathology?

There are unpleasant sensations in the perineum, fever and general intoxication of the body are possible. To determine the disease, the doctor performs palpation of the prostate and ultrasound, tests are also required.

Acute infectious prostatitis is caused by bacteria penetrating the gonad. Often, this disease is preceded by a sexually transmitted urogenital infection.

If a non-infectious form occurs, the cause may be stagnation of blood in the veins of the small pelvis. This is facilitated by interrupted sexual intercourse, lack of sexual life, its irregularity or excess.

If the prostate hurts a lot, how to treat the disease? Therapy for chronic prostatitis can only be prescribed by a doctor. A course of antibiotics is prescribed to kill the bacteria. To reduce pain, the doctor prescribes painkillers that relieve spasms in the groin.

After the acute stage has been stopped, auxiliary means are prescribed: physiotherapy and Prostate massage. This technique is necessary to relieve pain, swelling, improve local immunity.

In case of an acute illness, bed rest, diet and sexual abstinence are recommended until complete recovery.

Chronic prostatitis

Chronic prostatitis is a continuation of undertreated acute prostatitis. How does the prostate hurt with this disease?

The difficulty of diagnosing Chronic prostatitis lies in the blurring of symptoms. There is pain in urination and during sexual intercourse. There is a decrease in sexual desire. But sometimes these sensations are so imperceptible that the patient refuses to go to the doctor.

If chronic prostatitis is not treated, then it progresses. At the next stage, the pain becomes constant, there are changes in the tissues, problems with urination. In the absence of adequate treatment, the prostate enlarges, the pain becomes unbearable, the man gets up to go to the toilet several times a night. Sexual desire is absent, infertility and impotence are possible.

Any man can detect the first signs of the disease, if in doubt, you should consult a doctor to determine the stage of the disease and prescribe a treatment regimen.

Neoplasms

After 50 years, men are most susceptible to the occurrence of diseases of the genitourinary system associated with a neoplasm in the prostate gland. With tumors at the initial stage, the prostate hurts a little. What to do to determine this disease?

When a tumor grows, there is pressure on neighboring tissues.Pay attention to your health is necessary if the sexual attraction has decreased or the number of visits to the toilet has increased. In this case, even in the absence of other symptoms, a doctor's consultation is needed.

To determine the neoplasm in the body, the Diagnostics of the PSA is carried out, according to the results of which it can be said than caused by discomfort in a man.

If the doctor suspected the development of the tumor, then the following method of diagnosis is ultrasound. When a benign tumor is detected, treatment is aimed at reducing the neoplasm, removal of pain symptoms and improved quality of life. Treatment is necessary for a benign tumor not turned into malignant.

When determining the malignant tumor, the doctor may be selected expectant tactics or chemotherapy course. In some cases, an operation to remove the prostate gland is necessary.

Stones in the prostate gland

Stones in the prostate gland arise from men over 55 years old, up to 80% pass through this disease. Factors increasing the risk of calculous prostatitis:

• sharp or chronic prostatitis in history;
• Lifelong lifestyle, sitting, which leads to a violation of the blood circulation of the organs of a small pelvic;
• Harvest injury;
• infections of the genitourinary system, including sexually transmitted;
• rare or absence of sex acts;
• unbalanced food;
• Eating alcoholic beverages, smoking

Where the prostate hurts in men with calculous prostatitis, depends on the number of stones, their shape and duration of the disease.

The main signs are weakness, painful pain at the bottom of the abdomen, in the groin area, increasing when going to the toilet. It is possible to increase the temperature, a decrease in sexual entry, pain after orgasm.

In the treatment, antibacterial therapy is used, urinating improvement agents, anti-inflammatory drugs. Recommended diet excluding fried, oily, flour, sharp.

Small stones are removed using a laser. Operation takes 20 minutes, during this period, the stones are crushed into the sand and extend naturally.

Prostate cysts

The prostate cyst occurs in 20% of men and is not always detected in a timely manner. How is the prostate hurt when suspected of a cyst?

It all depends on the size of the cyst, because sometimes there are no symptoms. The cyst may occur due to various factors, but most often arises due to the transferred prostatitis.

Patients arises a few questions: What is the disease, what are the symptoms and how is the prostate hurt with a vyster?. Painful sensations of a rather strong character, because the cyst increases in size and presses on neighboring tissues, as with other diseases of the prostate gland. As for the accompanying symptoms, it is pain in the groin region, problems with urination, frequent urge to the toilet, a decrease in libido. With any symptoms, a specialist consultation is required.

To determine the diagnosis, the doctor conducts standard diagnostics: palpation, ultrasound, tests and tomography. Based on the size of the cyst, the doctor determines further action. If a cyst is less than 5 mm, then, as a rule, treatment is not required, only observation. With a larger cyst, it may be necessary to receive painkillers and antibiotics. In difficult situations, surgical intervention is possible.

Pathology of the rectum

Pain arising from the diseases of the rectum can occur in the same place where the prostate hurts. The fact is that these organs are near, and the pressure of the rectum on the urinary system can be confused. In the pathology of the rectum, pain occurs in the perineum and scrotum, which forces it initially turn to the urologist. There are several symptoms that do not arise with prostate disease:

• constipation;
• pain under the act of defecation;
• impurities in feces that should not be there.

Pain Treatment

Regardless of how the prostate hurts, the symptoms in men are similar for different diseases. For treatment and diagnostics apply the same techniques.

Depending on the intensity of pain, the doctor will write analgesics. They remove pain, reduce spasms, remove the swelling. Preparations contain analgin, novocaine and other substances.

Prostate adenoma recommended rectal candles, they reduce pain, render anti-inflammatory actions.

Antimicrobial drugs are discharged in suspected that the disease is caused by the infection of the urogenital system.

Folk remedies can be used after consulting the attending physician. Grand decorations reduce the intensity of pain, have an anti-inflammatory effect.

The prostate gland massage is carried out by a specialist, helps to relieve pain and improve potency.

Disease prevention

The main method for the prevention of inflammation of the prostate gland is the timely detection of the disease. For this, it is necessary to consult a doctor at the first signs, and after 40 years of age, regularly undergo a medical examination.

It is necessary to adhere to a healthy lifestyle, exclude alcohol, smoking. An active lifestyle, going to the gym will help prevent prostate pathology. You should give up promiscuity, adhere to the principles of proper nutrition, have a regular sex life.

Strengthening the immune system and avoiding hypothermia helps to maintain the male reproductive function.

Pain with prostatitis in men

Medical statistics show that a third of men of reproductive age suffer from prostatitis. And pain invariably accompanies the course of the disease. Pain with prostatitis in men is of a different nature. Deliver slight discomfort or cause acute pain attacks. Manifestations are aching, acute or dull.

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Any kind of pain manifestations negatively affects the psychological state, changes the usual routine, disrupts a man’s sleep. The prostate gland is an endocrine male organ involved in the synthesis of sperm components. The prostate is located below the bladder and blocks the urinary canal during an erection. Inflammation causes sloughing of cells. When combined with leukocytes, clots appear that clog the excretory channels. Blood clots squeeze the vessels with blood and lymph flow, disrupting the proper nutrition of the prostate.

The disease is difficult to diagnose in the first stage. Only analyzes can reveal it. Pain begins in the groin area, spreading to the abdomen, scrotum and lower back. What kind of pain occurs with prostatitis? There are dull and aching pains that come in waves. With sudden onset and fading, radiating to other organs. A sharp pain indicates the neglect of prostatitis, its exacerbation. In the absence of timely treatment, the disease flows into a chronic condition. Then the pains weaken and repeat cyclically.

Painful manifestations in chronic prostatitis

The painful phase can be of infectious and non-infectious origin. Young men are susceptible to the infectious form after infection with sexually transmitted diseases. Symptoms are burning and cutting in the urethra, accompanying urination, aching pain in the testicles and perineum, radiating to the lower abdomen and lumbar region. In some patients, the joints ache, they feel a dull, pulling pain. Rectal examination is painful.

The non-infectious form affects older men, which is associated with low activity, hypothermia, prolonged sexual abstinence and stagnant processes. Characterizes non-infectious prostatitis lumbar pain in the perineum, as well as in the pelvis and scrotum. The pain of an erased, aching character arises suddenly and also passes. Pain in chronic prostatitis is characterized by periodic manifestations without any apparent reason. The process of ejaculation is accompanied by pain.

At what point do pains appear

The appearance of pain in prostatitis is spontaneous. Pain discomfort manifests itself at any time of the day or night and also disappears suddenly.

Unfortunately, pain is chronic and aggravated in the following cases:

• Urine.
• Genital contact.
• Defecate.
• An erection.
• Sexual abstinence.
• Physical overload from work.
• Stress conditions.
• Contrast change in body temperature during hardening.
• After sexual contact.
• Smoking and drinking.

Regular and periodic pain causes anxiety and wears out a man. Some try to relieve the pain syndrome, which leads to a deterioration in the condition, because the inflammation persists and progresses. A comprehensive systemic treatment of prostatitis is needed, which will eliminate the causes of pain.

Causes of pain in prostatitis

Some diseases are associated with pain:

Pathologies of the rectum

Diseases of the rectum are associated with the appearance of pain that has the same manifestation and location, as with prostatitis. They are often confused due to their close anatomical position.

Prostate cysts

Failures in the secretory function of the prostate gland or obstruction of the excretory ducts cause the development of abnormalities.

Neoplasm growth

The appearance of tumors in the gland, which often affects men over 45-50 years old. Neoplasms are benign or malignant, which is reflected in the overall clinical picture of the patient.

Inflammation in the parenchyma

Prostatitis is considered one of the forms of complications after infection of the urethra. Acute or chronic inflammation of the prostate parenchyma has negative consequences for men's health.

Stones in excretory ducts

In a chronic relapsing disease, stone formation and blockage of the excretory ducts are possible. Pain in the prostate at the time of arousal is considered a characteristic sign of pathology.

Pain localization

Pain has not only a different origin, but also a different location. It is not so difficult to determine where it hurts with prostatitis. Inflammation in the prostate gland responds with pain in other organs. Unpleasant sensations in the lower abdomen, perineum, scrotum, kidneys indicate prostatitis. Lower back pain is a frequent comorbidity of the disease. The three lobes of the prostate gland have a connection with the seminal vesicles and ducts that discharge the seed, the rectum, bladder and urethra. A wide area of coverage is associated with the reaction of nerve fibers passing through the prostate from the genitourinary system to other organs.

The prostate cannot hurt because it has no nerve endings.

The spread of the pain syndrome indicates that the entire male genitourinary system is covered by inflammation. This nature of the manifestation of pain makes it difficult to diagnose. It is important for a doctor to distinguish pain caused by prostatitis from pain of a different origin. A similar location has a pain syndrome in pathologies of the rectum, malignant neoplasms of the pelvic organs.

Pain in the lower back

The long-term chronic form gives pain in the lower back with prostatitis. Appears from the 3rd stage of prostatitis, when other organs of the genitourinary system, such as the kidneys or ureters, are also covered by inflammation. This type of pain indicates a complication. Pain has a different manifestation and intensity. With prostatitis, the lower back hurts constantly or periodically, but with an acute manifestation. Aching or shooting pain in the sacrum is simultaneously accompanied by urination deviations, a burning sensation, abdominal pain, erectile pathologies and discomfort that occurs during intercourse.

Pain in the groin

Acute pain reactions in the inguinal zone are less common. Pain in this location has a sudden, paroxysmal manifestation. Attacks are most often intensified against the background of a viral infection or hypothermia. In case of complications, the disease is accompanied by fever, burning and dysuria.

Pain in the abdomen

Pain in the lower abdomen are the main symptoms of prostatitis, because this is the level of the prostate gland. The focus of inflammation covers the bladder and rectum due to its proximity. Consequently, the symptoms are aggravated by additional manifestations in the form of constipation, urination failures, and sharp pains accompanying defecation. Painful manifestations in men are caused by an increase in the size of the prostate, stretching of its flat capsule. Changes in shape cause squeezing of the vessels that feed the adjacent organs. The blood flow in this area is disturbed. The progression of the disease leads to ischemia. The inflammatory process in the male prostate is always associated with painful manifestations in the lower abdomen. The therapeutic course of treatment relieves swelling, resulting in a decrease in the gland. The state of the organ is normalized and pain manifestations no longer bother.

Pain in the scrotum

You can often hear the question: does the scrotum hurt in patients with prostatitis? It is known that the pain covers a fairly large area. Therefore, soreness is present in the pubis, testicles and penis. The nature of the pain is intense. With the development of the disease, seminal vesicles are affected and then it can also hurt in the anus and in the inguinal folds. Such a symptomatic picture is observed in men with a chronic form. Purulent formations in the prostate cause intense, unbearable pain in the scrotum.

Pain in the kidneys

Narrowing the passage of the urinary canal due to enlargement of the gland leads to difficulty in the removal of urine. With retention, residual fluid accumulates in the bladder and causes inflammation. Excesses turn into poisons and lead to intoxication, poison the body. Prostatitis is often associated with painful manifestations in the kidneys, working with overload and under toxic influence.

Deviations in the work of the urinary organs provokes kidney failure.

Pain in the legs

In some cases, there is a migratory pain in the legs, which manifests itself on the thigh inside or behind.Soreness of the lower extremities indicates an increase in inflammation. It spreads so actively that it covers the lymphatic system and muscles. Observe swelling and pain in the testicles and penis, radiating to the legs. Aching and pulling on the inner surface of the thigh. Chronic prostatitis sometimes starts a chain reaction when the organs are affected one by one. Delayed urination negatively affects the kidneys with the bladder. Deviation in the work of the kidneys is reflected in the heart. Evidence of the development of reactive arthritis in prostatitis of the bacterial type is pain in the leg. It's not the muscles that bother me, but the joint and bone pain. Reactive arthritis is considered one of the complications.

How to feel better

The urologist will tell you how to relieve an attack of prostatitis during a personal appointment.

For this purpose, analgesic drugs, local and general use are used. Analgesic and anti-inflammatory rectal suppositories are effective as topical preparations.

A warm bath and physical exercises aimed at activating blood flow in the genitourinary organs help to temporarily relieve the pain of prostatitis at home in combination with painkillers.

Pain is a reaction to the accumulation of excess secretion in the gland, which cannot be released due to blockage of the ducts. In the middle of the prostate increases pressure, there is a slight discomfort. When the state is running, the pain becomes severe.

Analgesic drugs will relieve the pain, but will not relieve the inflammation that caused it. It is pointless to use them for a long time, because they only relieve pain for a short time.

Unpleasant sensations signal a disease that requires complex treatment. If only the pain syndrome is removed, then this is not effective and leads to an increase in inflammation, a complication of which will be a purulent process.

It is necessary to contact a specialist who will advise how to relieve pain in any form of prostatitis. A therapeutic course of antibacterial and anti-inflammatory drugs is prescribed, physiotherapy is also recommended.

In the acute form of prostatitis, antibiotics can alleviate the condition for 2-4 days.

The treatment of prostatitis with the use of antispasmodics and non-steroidal anti-inflammatory drugs that relieve pain is effective. They are prescribed intravenously, orally and in the form of suppositories. Physiotherapy includes hirudotherapy, acupuncture, laser treatment, magnetotherapy. prostate massage promotes the outflow of pus and the elimination of congestion. Stimulation through massage increases the effectiveness of the use of medications for an attack of prostatitis and speeds up the process of treatment at home.

Folk remedies

In addition to the main complex of therapy, the urologist may recommend home remedies as an additional treatment course. Pumpkin seeds help relieve pain. They are consumed before meals for six months.

Here are some ways to relieve prostatitis pain at home:

Decoction of Burdock Root

Burdock Root must be crushed. Pour 1 liter of cold water 1 tbsp. l. crushed root. Put on fire and boil for 20 minutes. The broth should be insisted for 4-5 hours and filtered. Take half a glass twice a day before meals. The course of admission is 1 month.

Hazel Bark

Chop hazel bark in a coffee grinder. Take 1 tbsp. l. powder and pour a glass of boiling water. Wrap the container and leave for 4 hours in a dark place. Take a quarter cup 4 times a day.

Asparagus Root

Pour a glass of cold water over 1 tbsp. l. crushed root. Boil and keep at a low boil for 15 minutes. Infusion take 2 tbsp. l. in 4 hours.

Birch collection with medicinal herbs

Combine the same amount of birch buds, St. John's wort, Chamomile and immortelle flowers. Pour boiling water over a tablespoon of the crushed collection (2 tablespoons) and leave for 15 minutes. Strained broth to drink in the evening. After that, you can not eat or drink. In the morning, take a glass of infusion with a spoonful of honey half an hour before meals.

With a painful attack of prostatitis, the body reports the development of the inflammatory process, something needs to be done. Timely treatment, started in the early stages, completely eliminates the disease, its manifestations and severe consequences in the form of impotence.

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Why the prostate can hurt

The prostate is quite rightly called the second male heart.Outwardly, it resembles a walnut about 4 cm in diameter, however, its small size does not detract from its importance for the male body. When the prostate hurts, a man experiences a lot of uncomfortable sensations. There are many reasons for such pains, but almost all of them are associated with pathological processes, so the prostate requires more attention.

Even a slight disturbance in prostatic activity is fraught with sexual failure, a malignant tumor, adenoma and other intractable pathologies, which, in turn, drive a man into a state of deep depression and deprive him of life's optimism.

Prostate functions

The prostate refers to the glandular organs of the reproductive system, it grows to an anatomically natural size by about the age of 20, however, after the age of 45, it again tends to grow, provoking the occurrence of benign hyperplastic changes in the glandular tissues. A similar phenomenon is so common in urological practice that it is often referred to as a typical sign of old age like gray hair or wrinkles.

The prostate gland performs many functions, it is responsible for the fertilizing ability of sperm and the stability of sexual abilities, does not allow sperm to be thrown into the bladder cavity, and controls urinary processes. In other words, the performance of the urogenital area as a whole depends on the quality of prostatic activity. The prostate performs a secretory and barrier function. The secretory function consists in the synthesis of androgens, the production of bioactive elements and prostatic secretion, which is necessary for the highest quality of sperm. In the process of sexual intimacy, pleasant sensations are created due to the highly developed innervation system of the gland.

The barrier function of the prostate is to separate the processes of ejaculation and urination. The muscle tissues of the prostate act as a sphincter for the bladder, preventing the penetration of sperm into it. In addition, the prostate gland controls urination, if necessary, retains urine or releases it outside. Therefore, with violations of prostatic activity, a man can have many problems with the health of the urogenital area.

Probable prostatic pathologies

When the prostate hurts, it may indicate the presence of serious pathologies. One of the reasons for such manifestations may be an adenoma, which consists in an increase in the size of the gland due to the pathological growth of its tissues. According to statistics, prostatic adenoma is found in half of 50-60-year-old men, in 9% of 40-year-olds and almost every 80-year-old.

Sometimes prostatic pain is caused by a malignant tumor process. A similar pathology is usually found in patients over 65, however, there are cases when it is found in younger men. Such a disease is characterized by slow and latent development, therefore it is often found already at advanced stages. Also, pain can be associated with prostatitis, which occurs mainly in relatively young men.

Other causes of pain

The factors that provoke the appearance of pain in the prostate are conditions like:

• Chronic or acute form of prostatitis;
• Calculation in the prostate;
• Cystic processes;
• Malignant tumor process;
• Rectal pathologies;
• Stagnation of the prostatic secretion;
• Hormonal imbalance;
• Inflammation of the paraurethral gland;
• Pathologically low immune status;
• Hormonal disruption, etc.

Sometimes, this soreness is due to an unhealthy diet, leading to constipation and digestive disorders.

Dangerous clinical manifestations

If, along with prostatic pain, a man has other characteristic symptoms, then you should consult a urologist, because they can indicate dangerous health problems. Particularly alarming signs are problems with urination - difficulty, increased urge, weakening or interruption of the stream, a feeling of incomplete emptying, etc. In addition, the occurrence of testicular edema, pain in the sacral or inguinal region, and painful urination cannot be ignored.

Prostatic pain is characterized by irradiation to the anus, perineum, scrotum or lower back. Often, painful symptoms worsen after sexual intercourse, increased physical or psychological stress, alcohol abuse, physical inactivity, abstinence or excessive sexual activity.

Classification of painful manifestations

Pain in the prostate gland is classified according to the etiological nature.It may vary slightly depending on the underlying cause, so it is necessary to consider separately the various options for pain.

Pain symptoms in adenoma

Pain symptoms in the prostate begin to appear at later stages of adenoma development. Often, pain is accompanied by secondary cystitis or prostatitis. Usually, prostatic adenoma is accompanied by an increase in urination, weakening of the jet, lengthening of the urination process, a feeling of incomplete emptying, etc. Some cases of benign hyperplasia lead to urinary retention, which requires the mandatory intervention of specialists. Pain in the prostate with adenoma is usually associated with urinary retention.

Cancer pain

Prostatic cancer is usually found in patients 50-60 years old, develops due to benign hyperplasia, carcinogenic effects or heredity. Typically, prostate cancer is characterized by the symptomatic triad of pain, bloody urine, and urinary problems. First, pain symptoms are localized in the perineum and are aching in nature. With the progression of the pathology, the pain becomes constant, debilitating and painful, it cannot be stopped with painkillers, so the patient is prescribed narcotic drugs.

After the massage

If a man is undergoing treatment for prostatitis through massage procedures, then after the sessions he may be disturbed by painful symptoms. Prostate massage should only be performed by a highly specialized medical specialist, because the wrong technique is fraught with unpredictable health consequences.

If after a prostate massage a man feels a burning pain, then it is necessary to inform the doctor about this so that he changes the tactics of influencing the gland. To avoid post-massage burning sensation, a man is advised to refrain from urinating for half an hour after the procedure.

If the prostate hurts after sex

If the prostate begins to bother with soreness after lovemaking, then this may indicate the development of chronic prostatitis. Usually, pain symptoms are concentrated in the perineum, however, it can radiate to the area of the anus, groin and pubis, genitals and thighs. Typically, prostatitis pain is characterized by persistence and pulling character, it can occur during urination, ejaculation, or after defecation.

Usually, pain of this origin is accompanied by itching sensations in the intimate area, weakness, insomnia and decreased performance.

Pain after defecation

The appearance of pain after defecation indicates the development of malignant oncology, abscess processes or prostatitis. With prostatitis, the patient additionally feels weakness and lack of appetite, chills and dysuria, frequent constipation, throbbing pain in the anus.

If an abscess formed against the background of prostatitis, then in the process of emptying the intestines and after it, the patient notes symptoms of pronounced intoxication and severe weakness. If an independent opening of the abscess occurs, then purulent masses will be found in the patient's urine or feces.

Therapeutic measures

Treatment of pain syndrome in the prostate involves the elimination of the etiological factor that led to the occurrence of such a syndrome.

• With adenoma, drugs are prescribed that help eliminate pronounced symptoms. If a conservative approach is ineffective, then surgical practice is used.
• If the causes of pain are caused by infectious prostatitis, then antibiotic therapy is indicated.
• In case of prostate cancer, the treatment process consists of several methods, depending on the age of the patient, the degree of cancer development, the progression of the oncological process, etc. Radiation therapy, chemotherapy, etc. are used.

In inflammatory processes in prostatic tissues, rectal suppositories are often used, which greatly alleviate the patient's condition. If there are pain manifestations in the prostate, then it is necessary to immediately undergo a urological examination under the guidance of a qualified specialist.