Prostate Problems

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.

Resources

Agency for Health Care Policy and Research (AHCPR) Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295

Ask for the free booklet called Treating Your Enlarged Prostate . It contains detailed information on the pros and cons of different treatments for BPH.

Cancer Information Service (CIS)
National Cancer Institute
Building 31, Room

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