Benign Prostatic Hyperplasia and Prostate Cancer - Expert Interview with Dr. Talal Ebash

Dr. Talal Ebash is a highly qualified specialist in urology and pediatric urology who practices 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 benign prostatic hyperplasia and prostate cancer, utilizing 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 range of treatments extends 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 also has extensive experience in treating sexual and erectile dysfunction as well as pediatric urology. His exceptional skills in urological oncology and reconstructive surgery set him apart and make him a key point of contact for patients who value the highest medical standards and precise, minimally invasive surgical techniques.

After successfully completing his medical studies at the University of Aleppo in Syria and receiving thorough surgical training, Dr. Ebash decided to pursue further specialization in Germany. For several years, he headed the urology department at Idar-Oberstein Hospital in Rhineland-Palatinate, most recently as chief of staff. Since moving to Dubai in late 2023, he has been applying his expertise with full dedication at the Saudi German Hospital. Particularly noteworthy is his use of state-of-the-art technology for minimally invasive procedures in oncological surgery, kidney stone removal, and andrology. His passion for technical precision and modern medicine enables him to achieve excellent results even in complex cases.

In addition to his clinical 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 remains at the cutting edge of urological research and technology. Dr. Talal Ebash thus combines the highest level of medical expertise, innovative thinking, and a personalized approach to patient care, setting new standards for urology in the United Arab Emirates.

The editorial team of the Leading Medicine Guide spoke with Dr. Ebash, focusing on prostate diseases, specifically benign prostatic hyperplasia and prostate cancer.

Prostate conditions are among the most common health challenges men may face over 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 significantly affect not only well-being but also quality of life. Early signs often go unnoticed, and many men are reluctant to discuss symptoms such as frequent urination or a weak urine stream. 

The early signs and symptoms of prostate 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 impact the urinary tract. 

“The most important thing to know is that prostate cancer does not cause symptoms, at least not in the early stages. For this reason, we strongly recommend getting regular screenings. By the time prostate cancer becomes symptomatic, it is usually too late for successful treatment. The initial symptoms of an enlarged prostate vary widely—they can include incontinence, strong bladder pressure, a weak urine stream, and an increased need to get up multiple times at night to urinate. It primarily affects older men; young men under 40 are rarely affected. The older a man gets, the higher the likelihood of an enlarged prostate. People with a family history of benign prostatic hyperplasia often have a genetic predisposition,” explains Dr. Ebash at the beginning of our conversation.

In the case of prostate cancer, additional symptoms such as blood in the urine or semen may occur, indicating a more serious condition. In advanced stages, pain or stiffness in the lower back, hips, or thighs, as well as unintentional weight loss or general malaise, may also occur. Benign prostatic hyperplasia, on the other hand, usually affects only the urinary tract and is easily treatable, even though it can significantly impair quality of life. 

The risk of developing benign prostatic hyperplasia (BPH) or prostate cancer is influenced by a variety of factors. These risk factors can be categorized as genetic, hormonal, age-related, and lifestyle-related.

“Age is one of the most significant risk factors for both conditions, but especially for prostate cancer. Genetic factors also play an important role if there is a family history of prostate cancer—for example, in the father or an uncle. In such cases, the risk of developing prostate cancer is twice as high. Other risk factors include smoking, poor dietary habits, and a lack of physical activity. In the case of benign prostatic hyperplasia (BPH), the primary cause is age,” said Dr. Ebash.

Early detection of benign prostatic hyperplasia (BPH) and prostate cancer is crucial for effective treatment and improving the prognosis. 

Modern diagnostic methods have advanced significantly and offer a wide range of options for accurately assessing the prostate and its conditions. “The initial examination of a patient with benign prostatic hyperplasia depends on the patient’s age. As a rule, however, an ultrasound examination is performed first to determine the size of the prostate. It is also important to assess how well the bladder empties. To this end, a urine flow rate measurement is routinely performed, and a urinalysis is conducted to rule out a possible infection. If prostate cancer is suspected, the PSA (prostate-specific antigen) level in the blood should also be tested. A digital rectal exam must also be performed, during which the surface of the prostate is palpated to rule out any abnormal lumps or to plan further diagnostic tests. If the PSA level is elevated, a prostate biopsy must be considered. In cases of a slight increase in PSA, an MRI of the prostate is the preferred option,” explains Dr. Ebash regarding the diagnostic process.

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The PSA level (prostate-specific antigen) is a protein produced by the prostate that can be detected in the blood. It serves as an important marker for the early detection and diagnosis of prostate diseases such as benign prostatic hyperplasia (BPH), inflammation, or prostate cancer. A level below 4 ng/ml is generally considered normal, while levels above 10 ng/ml increase the risk of a serious disease. However, PSA levels can also rise temporarily due to factors such as a digital rectal exam, ejaculation, or riding a bicycle. Since the test is not always conclusive, an elevated PSA level should always be evaluated in conjunction with further tests such as an MRI or biopsy.

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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 treatment—the gold standard—is drug therapy with alpha-blockers. Alpha-blockers such as tamsulosin and alfuzosin relax the muscles around the prostate and the bladder neck, thereby facilitating urine flow and improving the urine stream. Sometimes other medications (5-alpha-reductase inhibitors) are added, which cause a slight reduction in prostate size over the long term. They inhibit the conversion of testosterone into dihydrotestosterone (DHT), a hormone that promotes prostate growth. However, these medications often take several months to produce a significant effect. “In certain cases, combination therapy—using both alpha-blockers and 5-alpha-reductase inhibitors—may also be beneficial to improve symptom control,” explains Dr. Ebash.

In the early stages—typically in cases of localized prostate cancer (Stages I and II)—treatment options are often curative in nature.

If conservative measures are insufficient or the patient suffers from severe symptoms that significantly impair quality of life, surgical treatment may be considered. “There is a wide range of surgical treatment options, particularly for prostate cancer. Patients with localized, non-advanced prostate cancer can be offered curative therapy through surgical removal of the prostate and regional lymph nodes. This leads to complete remission of the prostate cancer. Alternatively, the prostate can be treated with radiation therapy, which leads to the same outcome. Both options have their respective advantages and disadvantages. Potential side effects or complications must be discussed with the patient. Surgery can lead to bleeding or infections and may result in incontinence or impotence. “Radiation therapy can lead to long-term effects such as chronic cystitis,” Dr. Ebash explains.

Regarding surgical options for benign prostatic hyperplasia, Dr. Ebash explains: “If medication-based therapies are ineffective 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 using a minimally invasive technique. Holmium laser enucleation of the prostate (HoLEP) is also very successful and allows for a virtually bloodless procedure. Vaporization of prostate tissue (Rezum™ treatment) is another option that can be performed minimally invasively in just about 10 minutes and yields excellent results in select patients. Under local anesthesia, a fine needle is inserted into the prostate through the urethra. Steam is then precisely directed into the tissue, causing the affected cells to die and be gradually broken down by the body. This causes the prostate to shrink and improves urine flow. “All of these surgical procedures are, of course, offered and performed here at the Saudi German Hospital in Dubai.”

In cases of very large prostate enlargement, an open prostatectomy may be necessary. For patients who are not candidates for surgery, stents or active surveillance are available. In advanced stages (III & IV), hormone therapy and radiation therapy are combined. For metastatic prostate cancer, chemotherapy, targeted therapies (e.g., PARP inhibitors), or immunotherapies are also used.

“Surgical techniques have improved dramatically. The introduction of robotic surgery has further significantly optimized the precise removal of the tumor while preserving the nerves that are important for sexual function. For the patient, the outcome is significantly better, with fewer side effects and a lower rate of complications,” emphasizes Dr. Ebash, adding: “After surgery, the patient remains in the hospital for about 5–7 days because they are fitted with a urinary catheter, and the wound between the bladder and the urethra must heal during this time before the catheter can be removed. Once the catheter is removed, the patient can leave the hospital the same day. The patient then needs a recovery period of about 2–3 weeks, depending on the surgical technique used. With laparoscopic or robot-assisted surgery, the recovery time is generally shorter.”

Men can reduce their risk of prostate diseases—particularly benign prostatic hyperplasia and prostate cancer—through a combination of regular preventive measures and a healthy lifestyle. 

Key preventive measures include regular medical checkups, especially starting at age 45 or earlier if there is an increased risk, such as due to a family history of the condition. An annual examination by a urologist, which often includes a digital rectal exam (DRE) and a prostate-specific antigen (PSA) test. Men should also be aware of 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 fluids to prevent possible urinary tract infections. Regular exercise is also important! Early screening should take place once a year. And if there is a family history of prostate disease, you can start as early as age 40,” recommends Dr. Ebash, and with that, we conclude our conversation.

Thank you very much, Dr. Ebash!