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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
10A24
Bethesda, MD 20892
800-4-CANCER
CIS staff can
answer questions and mail free booklets about prostate cancer. The
prostate cancer “PDQ for Patients” contains detailed information on
diagnosis and treatment. Spanish speaking CIS staff are available
during daytime hours.
National Kidney and Urologic
Diseases Information Clearinghouse
Box
NKUDIC
Bethesda, MD 20892
301-468-6345
Ask for free
materials on BPH.
American Cancer
Society
1599 Clifton Road, NE
Atlanta, GA
30329
800-227-2345
Ask about their materials on prostate
cancer.
Prostate Health Council
The
American Foundation for Urologic Disease, Inc.
300 West Pratt
Street
Suite 401
Baltimore, MD
21201
800-242-2383
Ask for free brochures in English and
Spanish on prostate disease and prostate cancer.
The NIA
distributes free Age Pages on a number of topics, including
Cancer Facts for People Over 50, Urinary
Incontinence, and Considering Surgery.
National Institute on Aging
U. S. Department
of Health and Human Services
Public Health Service
National
Institutes of Health
1994
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