Dr. Talal Ebash is a highly qualified specialist in urology and paediatric urology who works at the renowned Saudi German Hospital in Dubai. With extensive medical training and many years of international experience in Germany and the United Arab Emirates, he is one of the leading specialists in his field. Dr. Ebash is known for his expertise in the treatment of prostate hyperplasia and prostate cancer, using minimally invasive techniques such as laparoscopy and innovative laser therapies. These modern procedures enable him to offer patients particularly gentle and effective treatments aimed at maintaining and improving their quality of life.
His treatment spectrum ranges from highly specialized therapies for prostate enlargement, including holmium laser enucleation (HoLEP) and transurethral resection (TURP), to advanced urinary stone therapy and the diagnosis and treatment of incontinence in men and women. Dr. Ebash is also experienced in the treatment of sexual and erectile dysfunction as well as pediatric urology. His special skills in urological oncology and reconstructive surgery set him apart and make him an important point of contact for patients who value the highest medical standards and precise, gentle surgical methods.
After successfully completing his medical studies at the University of Aleppo in Syria and receiving in-depth surgical training, Dr Ebash decided to specialize further in Germany. For several years, he headed the urology department at the Idar-Oberstein Clinic in Rhineland-Palatinate, most recently as Chief Physician. Since moving to Dubai at the end of 2023, he has been putting his experience to full use at the Saudi German Hospital. His use of state-of-the-art technology, which he uses for minimally invasive procedures in oncological surgery, kidney stone removal and andrology, is particularly outstanding. His passion for technical precision and modern medicine enables him to achieve excellent results even in complex cases.
In addition to his practical skills, Dr. Ebash is actively involved in professional development. As a member of leading professional societies such as the German Society of Urology (DGU), the European Association of Urology (EAU) and the German Continence Society, he always keeps abreast of the latest urological research and technology. Dr. Talal Ebash thus combines the highest level of medical expertise, innovative thinking and a personal patient focus and sets new standards for urology in the United Arab Emirates.
The editors of the Leading Medicine Guide were able to speak with Dr. Ebash and focused on prostate diseases, in particular prostate hyperplasia and prostate cancer.
Prostate diseases are among the most common health challenges that men can face in the course of their lives. From benign prostatic hyperplasia (BPH), a benign enlargement of the prostate, to prostate cancer, one of the most commonly diagnosed cancers in men worldwide, these conditions have a significant impact not only on well-being but also on quality of life. Early signs often go unnoticed and many men are reluctant to talk about symptoms such as frequent urge to urinate or a weak urinary stream.
The first signs and symptoms of prostatic hyperplasia, also known as benign prostatic hyperplasia (BPH), and the symptoms of prostate cancer can be similar, as both conditions affect the prostate and can affect the urinary tract.
“The most important information is that prostate cancer shows no symptoms, at least not in the first stage of prostate cancer. For this reason, we strongly recommend regular screening. When prostate cancer becomes symptomatic, it is usually too late for successful treatment. The first symptoms of prostate enlargement are very different - incontinence can occur, strong bladder pressure, the urine stream can become weak, the need to get up several times at night to void increases. It mainly affects older men; young men under 40 are rarely affected. The older you get, the higher the likelihood of prostate enlargement. People with a family history of prostatic hyperplasia often have a genetic predisposition,” explains Dr. Ebash at the beginning of our conversation.
With prostate cancer, symptoms such as blood in the urine or semen may also occur, indicating a more serious problem. In advanced stages, pain or stiffness in the lower back, hips or thighs as well as unwanted weight loss or general malaise may also occur. Prostatic hyperplasia, on the other hand, usually only affects the urinary tract and is easily treatable, even if it can severely impair quality of life.
The risk of developing prostatic hyperplasia (BPH) or prostate cancer is influenced by a variety of factors. These risk factors can be divided into genetic, hormonal, age-related and lifestyle-related categories.
“Age is one of the most important risk factors for both diseases, but especially for prostate cancer. Genetic factors also play an important role if prostate cancer runs in the family, for example in the father or uncle. In this case, the risk of developing prostate cancer is twice as high. Other risk factors include smoking, poor eating habits and lack of activity. In the case of prostate hyperplasia, the main cause is age,” says Dr. Ebash.
Early detection of prostatic hyperplasia (BPH) and prostate cancer is crucial for effective treatment and improving the prognosis.
Modern diagnostic methods have developed considerably and offer a wide range of options for accurately assessing the prostate and its diseases. “The initial examination of the patient for prostatic hyperplasia depends on the age of the patient. As a rule, however, an ultrasound examination is performed first to see how large the prostate is. It is also important to determine how well the bladder is emptied. For this purpose, a urine stream measurement is routinely carried out and a urine test is performed to rule out a possible infection. If prostate cancer is suspected, the PSA value (prostate-specific antigen) in the blood should also be examined. A rectal examination must also be carried out, in which the surface of the prostate is palpated to rule out any abnormal lumps or to plan further diagnostics. If the PSA value is abnormal, a prostate biopsy must be considered. If there is a slight increase in PSA, an MRI of the prostate is preferred,” explains Dr. Ebash on diagnostics.
The PSA value (prostate-specific antigen) is a protein that is produced by the prostate and can be detected in the blood. It is an important marker for the early detection and diagnosis of prostate diseases such as benign prostatic hyperplasia (BPH), inflammation or prostate cancer. A value below 4 ng/ml is usually considered normal, while values above 10 ng/ml increase the risk of a serious illness. However, the PSA value can also rise briefly due to factors such as a palpation, ejaculation or cycling. As the test is not always conclusive, an elevated PSA value should always be evaluated in conjunction with further examinations such as an MRI or biopsy.
The treatment of prostatic hyperplasia (BPH), also known as benign prostatic hyperplasia, can include both conservative and surgical approaches, with the choice of therapy depending on various factors.
“The most important conservative therapy, the gold standard, is drug therapy with alpha blockers. Alpha-blockers such as tamsulosin and alfuzosin relax the muscles in the area of the prostate and bladder neck, which facilitates the flow of urine and improves the urine stream. Sometimes other drugs (5-alpha-reductase inhibitors) are added, which cause a slight reduction in the size of the prostate in the long term. They inhibit the conversion of testosterone into dihydrotestosterone (DHT), a hormone that promotes the growth of the prostate. However, these drugs often take several months to show a significant effect. In certain cases, a combination therapy can also be useful, in which both alpha-blockers and 5-alpha-reductase inhibitors are used to improve symptom control,” explains Dr. Ebash.
In the early stages, i.e. usually in localized prostate cancer (stages I and II), the treatment options are often curative.
If conservative measures are not sufficient or the patient suffers from severe symptoms that significantly impair their quality of life, surgical treatment may be considered. “There are a variety of surgical treatment options for prostate cancer in particular. Patients with localized and non-advanced prostate cancer can be offered curative treatment by surgically removing the prostate and regional lymph nodes. This leads to a complete remission of the prostate cancer. Alternatively, the prostate can be irradiated, which leads to the same result. Both options have advantages and disadvantages. Possible side effects or complications must be discussed with the patient. Surgery can lead to bleeding or infections and can cause incontinence or impotence. Radiotherapy can have long-term consequences such as chronic bladder inflammation,” Dr. Ebash explains.
Dr. Ebash describes the surgical measures for prostate hyperplasia: “If the drug therapies do not help or a complication arises, surgery must be performed. Alternatively, laser therapies such as ThuLEP (thulium laser enucleation of the prostate) can be used, in which excess tissue is removed via the urethra in a minimally invasive procedure. Holmium laser enucleation of the prostate (HoLEP) is also very successful and enables an operation with virtually no bleeding. The vaporization of prostate tissue (RezumTM treatment) is another option that can be performed in a minimally invasive procedure in just 10 minutes and leads to excellent results in selective patients. Under local anesthesia, a fine needle is inserted into the prostate via the urethra. Steam is then directed into the tissue, causing the affected cells to die and gradually be broken down by the body. This shrinks the prostate and improves the flow of urine. All these surgical procedures are offered and performed here at the Saudi German Hospital in Dubai as a matter of course."
An open prostatectomy may be necessary for very large prostate enlargements. Stents or active monitoring are available for patients who cannot undergo surgery. In advanced stages (III & IV), hormone therapy and radiotherapy are combined. Chemotherapy, targeted therapies (e.g. PARP inhibitors) or immunotherapies are also used for metastatic prostate cancer.
“In surgery, the technology has improved massively. The addition of robotics has also significantly optimized precise removal while preserving the nerves that are important for potency. The outcome for the patient is significantly better, with fewer side effects and complication rates,” emphasizes Dr. Ebash and adds: ”Once the patient has undergone surgery, they remain in hospital for around 5-7 days as they receive a bladder catheter, during which time the wound between the bladder and urethra must heal before the catheter can be removed. Once the catheter is removed, the patient can leave the hospital on the same day. The patient then requires a recovery period of approx. 2-3 weeks, depending on the surgical technique used. With laparoscopic surgery or robot-assisted surgery, the recovery time is usually shorter”.
Men have the opportunity to reduce the risk of prostate diseases, especially prostate hyperplasia and prostate cancer, through a combination of regular preventive measures and a healthy lifestyle.
The main preventive measures include regular medical examinations, especially from the age of 45 or earlier if there is an increased risk, for example due to a family history. An annual examination by a urologist, which often includes a digital rectal examination (DRU) and determination of the prostate-specific antigen (PSA). Men should also look out for symptoms such as frequent urination, difficulty urinating or blood in the urine and discuss these with a doctor immediately.
“A healthy lifestyle also plays a key role. This includes a balanced diet and, above all, drinking enough to avoid possible urinary infections. Regular exercise is also important! Early preventive measures should take place once a year. And if you have a family history of prostate disease, you can start at the age of 40,” recommends Dr. Ebash, and with that we end our conversation.
Thank you very much, Dr. Ebash!
