The prostate is a small organ about the size
of a walnut. It lies below the bladder (where urine is stored) and
surrounds the urethra (the tube that carries urine from the bladder). The
prostate makes a fluid that becomes part of semen. Semen is the white
fluid that contains sperm.
Prostate problems are common in men 50 and older. Most can be treated
successfully without harming sexual function. A urologist (a specialist in
diseases of the urinary system) is the kind of doctor most qualified to
diagnose and treat many prostate problems.
Noncancerous Prostate Problems
Acute prostatitis is a bacterial
infection of the prostate. It can occur in men at any age. Symptoms
include fever, chills, and pain in the lower back and between the legs.
This problem also can make it hard or painful to urinate. Doctors
prescribe antibiotics for acute prostatitis and recommend that the patient
drink more liquids. Treatment is usually successful.
Chronic prostatitis is a prostate infection that comes
back again and again. The symptoms are similar to those of acute
prostatitis except that there is usually no fever. Also, the symptoms are
usually milder in chronic prostatitis. However, they can last a long time.
Chronic prostatitis is hard to treat. Antibiotics often work when the
infection is caused by bacteria. But sometimes no disease causing bacteria
can be found. In some cases, it helps to massage the prostate to release
fluids. Warm baths also may bring relief. Chronic prostatitis clears up by
itself in many cases.
Benign prostatic hypertrophy (BPH)
is enlargement of the prostate. This condition is common in older men.
More than half of men in their 60’s have BPH. Among men in their 70’s
and 80’s, the figure may go as high as 90 percent.
An enlarged prostate may eventually block the urethra and make it hard to
urinate. Other common symptoms are dribbling after urination and the urge
to urinate often, especially at night. In rare cases, the patient is
unable to urinate.
A doctor usually can detect an enlarged prostate by rectal exam. The
doctor also may examine the urethra, prostate, and bladder using a
cytoscope, an instrument that is inserted through the penis.
BPH Treatment Choices
There are several different ways to treat BPH:
Watchful Waiting is often chosen by men who are not bothered by
symptoms of BPH. They have no treatment but get regular checkups and wait
to see whether or not the condition gets worse.
Alpha blockers are drugs that help relax muscles near the
prostate and may relieve symptoms. Side effects can include headaches.
Also, these medicines sometimes make people feel dizzy, lightheaded, or
tired. Alpha blockers are new drugs, so doctors do not know their long
term effects. Some common alpha blockers are doxazosin (Cardura), prazosin
(Minipress), and terazosin (Hytrin).
Finasteride (Proscar) is a drug that inhibits the action of the
male hormone testosterone. It can shrink the prostate. Side effects of
finasteride include declining interest in sex, problems getting an
erection, and problems with ejaculation. Again, because it is new, doctors
do not know its long-term effects.
Surgery is the treatment most likely to relieve BPH symptoms.
However, it also has the most complications. Doctors use three kinds of
surgery for BPH:
- Transurethral resection of the prostate (TURP) is the
most common. After the patient is given anesthesia, the doctor inserts
a special instrument into the urethra through the penis. With the
instrument, the doctor then removes part of the prostate to lessen its
obstruction.
- Transurethral incision of the prostate (TUIP) may be
used when the prostate is not too enlarged. In this procedure, the
doctor passes an instrument through the urethra to make one or two
small cuts in the prostate.
- Open surgery is used when the prostate is very
enlarged. In open surgery, the surgeon makes an incision in the
abdomen or between the scrotum and the anus to remove prostate tissue.
Men should carefully weigh the risks and benefits of
each of these options. The Agency for Health Care Policy and Research has
designed a booklet to help in choosing a treatment; call 800-358-9295 and
ask for their free patient guide on prostate enlargement.
Prostate Cancer
Prostate cancer is one of the most common forms of
cancer among American men. About 80 percent of all cases occur in men over
65. For unknown reasons, prostate cancer is more common among African
American men than white men.
In the early stages of prostate cancer, the disease stays in the prostate
and is not life threatening. But without treatment, cancer can spread to
other parts of the body and eventually cause death. Some 40,000 men die
every year from prostate cancer that has spread.
Diagnosis. To find the cause of prostate symptoms, the
doctor takes a careful medical history and performs a physical exam. The
physical includes a digital rectal exam, in which the doctor feels the
prostate through the rectum. Hard or lumpy areas may mean that cancer is
present.
Some doctors also recommend a blood test for a substance called prostate
specific antigen (PSA). PSA levels may be high in men who have prostate
cancer or BPH. However, the test is not always accurate. Researchers are
studying changes in PSA levels over time to learn whether the test may
someday be useful for early diagnosis of prostate cancer.
If a doctor suspects prostate cancer, he or she may
recommend a biopsy. This is a simple surgical procedure in which a small
piece of prostate tissue is removed with a needle and examined under a
microscope. If the biopsy shows prostate cancer, other tests are done to
determine the type of treatment needed.
Prostate Cancer Treatment. Doctors have several ways to
treat prostate cancer. The choice depends on many factors, such as whether
or not the cancer has spread beyond the prostate, the patient’s age and
general health, and how the patient feels about the treatment options and
their side effects. Approaches to treatment include:
Watchful waiting. Some men decide not to have treatment
immediately if the cancer is growing slowly and not causing symptoms.
Instead, they have regular checkups so they can be closely monitored by
their doctor. Men who are older or have another serious illness may choose
this option.
Surgery usually removes the entire prostate and surrounding
tissues. This operation is called a radical prostatectomy. In the past,
impotence was a side effect for nearly all men undergoing radical
prostatectomy. But now, doctors can preserve the nerves going to the penis
so that men can have erections after prostate removal.
Incontinence, the inability to hold urine, is common for a time after
radical surgery for cancer. Most men regain urinary control within several
weeks. A few continue to have problems that require them to wear a device
to collect urine.
Another kind of surgery is a transurethral resection, which cuts
cancer from the prostate but does not take out the entire prostate. This
operation is sometimes done to relieve symptoms caused by the tumor before
other treatment or in men who cannot have a radical prostatectomy.
Radiation therapy uses high energy rays to kill cancer cells and
shrink tumors. It is often used when cancer cells are found in more than
one area. Impotence may occur in men treated with radiation therapy.
Hormone therapy uses various hormones to stop cancer cells from
growing. It is used for prostate cancer that has spread to distant parts
of the body. Growth of breast tissue is a common side effect of hormone
therapy.
More detailed information on the pros and cons of these treatment options
is available from the Cancer Information Service at 800-422-6237; ask for
the prostate cancer “PDQ for Patients.”
Protecting Yourself
The best protection against prostate problems is to have
regular medical checkups that include a careful prostate exam. See a
doctor promptly if symptoms occur such as:
- a frequent urge to urinate,
- difficulty in urinating, or
- dribbling of urine.
Regular checkups are important even for men who have had
surgery for BPH. BPH surgery does not protect against prostate cancer
because only part of the prostate is removed. In all cases, the sooner a
doctor finds a problem, the better the chances that treatment will work. |