The prostate is a small gland in men. It is part of the male reproductive system. The prostate is about the size and shape of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum. The prostate helps make semen, the milky fluid that carries sperm from the testicles through the penis when a man ejaculates. The prostate surrounds part of the urethra, a tube that carries urine out of the bladder and through the penis.

 

How the Prostate Changes As You Age

Because the prostate gland tends to grow larger with age, it may squeeze the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms aren't noticed until much later in life. An infection or a tumor can also make the prostate larger.

Any of the following symptoms can occur in prostate problems: passing urine more during the day, urgent need to pass urine, have less urine flow, feel burning when you pass urine and need to get up many times during the night to pass urine. 

Growing older raises your risk of prostate problems. The three most common prostate problems are inflammation (prostatitis), enlarged prostate (BPH, or benign prostatic hyperplasia), and prostate cancer. One change does not lead to another.

For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible for you to have more than one condition at the same time.

 

Prostatitis: This is an inflammation of the prostate gland that may result from a bacterial infection. It affects at least half of all men at some time during their lives. Having this condition does not increase your risk of any other prostate disease.

Symptoms includes: Trouble passing urine, a burning or stinging feeling or pain when passing urine, strong, frequent urge to pass urine, even when there is only a small amount of urine, chills and high fever. Others are Low back pain or body aches, pain low in the belly, groin, or behind the scrotum, urethral discharge, genital and rectal throbbing, sexual problems, loss of sex drive and painful ejaculation (sexual climax). Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. 

 

Types of Prostatitis and Treatments

Acute bacterial prostatitis: This type is caused by a bacterial infection and comes on suddenly (acute). There is often blood in the urine. Your PSA level may be higher than normal. It's the least common of the four types, yet it's the easiest to diagnose and treat.

Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort. If your PSA level was high, it will likely return to normal once the infection is cleared up.

Chronic bacterial prostatitis: Also caused by bacteria, this type of prostatitis doesn't come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.

Antibiotic treatment over a longer period of time is best for this type. Treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that won't clear up.

Chronic prostatitis or chronic pelvic pain syndrome: This disorder is the most common but least understood type of prostatitis. Found in men of any age from late teens to the elderly, its symptoms can come and go without warning. There can be pain or discomfort in the groin or bladder area. Infection-fighting cells are often present, even though no bacteria can be found.

There are several different treatments for this problem, based on your symptoms. These include anti-inflammatory medications and other pain control treatments, such as warm baths. Other medicines, such as alpha-blockers, may also be given. Alpha-blockers relax muscle tissue in the prostate to make passing urine easier. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.

Asymptomatic inflammatory prostatitis: You don't have symptoms with this condition. It is often found when you are undergoing tests for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this form of prostatitis, your PSA test may show a higher number than normal.

Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.

 

Enlarged Prostate (BPH)

BPH stands for benign prostatic hyperplasia. Benign means "not cancer," and hyperplasia means abnormal cell growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer—yet the symptoms for BPH and prostate cancer can be similar.

 

ENLARGE

Symptoms of BPH. Trouble starting a urine stream or making more than a dribble, passing urine often, especially at night, feeling that the bladder has not fully emptied, strong or sudden urge to pass urine, weak or slow urine stream, stopping and starting again several times while passing urine and pushing or straining to begin passing urine. At its worst, BPH can lead to: a weak bladder, backflow of urine causing bladder or kidney infections, complete block in the flow of urine and kidney failure.

The prostate gland is about the size of a walnut when a man is in his 20s. By the time he is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon. The enlarged prostate can press against the bladder and the urethra. Early BPH symptoms take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor.

 

Treatments for BPH

Some men with BPH eventually find their symptoms to be bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms.

 

Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach. Watchful waiting means getting annual checkups. 

If you choose watchful waiting, these simple steps may help lessen your symptoms:

Limit drinking in the evening, especially drinks with alcohol or caffeine. Empty your bladder all the way when you pass urine. Use the restroom often. Don't wait for long periods without passing urine.

Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:

Over-the-counter cold and cough medicines (especially antihistamines), tranquilizers, antidepressants and blood pressure medicine.

 

Drug Therapy

Two main types of drugs are used. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

Alpha-blockers are drugs that help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days.  

5 alpha-reductase inhibitors are drugs that help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase.  

Taking these drugs can help increase urine flow and reduce your symptoms. You must continue to take these drugs to prevent symptoms from coming back.

Surgery is used when symptoms are severe or drug therapy has not worked well. Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure. 

 

Prostate Cancer

Prostate cancer means that cancer cells form in the tissues of the prostate. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or even 30 years before a tumor gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize). By the time symptoms appear, the cancer may already be advanced.

By age 50, very few men have symptoms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. Most of these cancers never pose a problem. They may never cause symptoms or become a serious threat to health.

Symptoms of Prostate Cancer may be similar to that of benign prostate hyperplasia or prostatitis. Prostate cancer can spread to the lymph nodes of the pelvis. Or it may spread throughout the body. It tends to spread to the bones. So bone pain, especially in the back, can be a symptom of advanced prostate cancer.

 

Risk Factors For Prostate Cancer

Some risk factors have been linked to prostate cancer. Having one or more risk factors doesn't mean that you will get prostate cancer. It just means that your risk of the disease is greater. Age. Men who are 50 or older have a higher risk of prostate cancer.

Race: African-American men have the highest risk of prostate cancer—the disease tends to start at younger ages and grows faster than in men of other races.

Family history: Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.

Diet: The risk of prostate cancer may be higher for men who eat high-fat diets.

Prostate Cancer Screening: A screening test may help find cancer at an early stage, when it is less likely to have spread and may be easier to treat. By the time symptoms appear, the cancer may have started to spread. The most useful screening tests are those that have been proven to lower a person's risk of dying from cancer.

Although some people feel it is best to treat any cancer that is found, including cancers found through screening, prostate cancer treatment can cause serious and sometimes permanent side effects.. 

 

Digital Rectal Exam (DRE)

DRE is a standard way to check the prostate. With a gloved and lubricated finger, your doctor feels the prostate from the rectum. The test lasts about 10-15 seconds.

The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check the health of your prostate.

 

PSA (Prostate-Specific Antigen) Test. PSA is a protein made by prostate cells. It is normally secreted into ducts in the prostate, where it helps make semen, but sometimes it leaks into the blood. When PSA is in the blood, it can be measured with a blood test called the PSA test.

In prostate cancer, more PSA gets into the blood than is normal. However, a high PSA blood level is not proof of cancer, and many other things can cause a false-positive test result.

For example, blood PSA levels are often increased in men with prostatitis or BPH. Even things that disturb the prostate gland--such as riding a bicycle or motorcycle, or having a DRE, an orgasm within the past 24 hours, a prostate biopsy, or prostate surgery--may increase PSA levels. 

There is no magic PSA level below which a man can be assured of having no risk of prostate cancer nor above which a biopsy should automatically be performed. A man's decision to have a prostate biopsy requires a thoughtful discussion with his physician, considering not only the PSA level, but also his other risk factors, his overall health status, and how he perceives the risks and benefits of early detection.

Prostate Biopsy

If your symptoms or test results suggest prostate cancer, you will need a prostate biopsy. For a biopsy, small tissue samples are taken directly from the prostate. Your doctor will take samples from several areas of the prostate gland. This can help lower the chance of missing any areas of the gland that may have cancer cells.

A positive test result after a biopsy means prostate cancer is present. Reaching a decision about treatment of your prostate cancer is a complex process. Many men find it helpful to talk with their doctors, family, friends, and other men who have faced similar decisions.

 

Written by: Dr. Sanwo