Dr. MJ Bazos MD,
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.
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 difficult 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
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 70s and 80s,
the figure may go as high as 90%.
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
BPH Treatment Choices
There are several 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
•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
•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.
Prostate cancer is one of the most
common forms of cancer among American men. About 80% 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 of prostate cancer
that has spread.
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
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
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.
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
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.
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.
The best protection against prostate
problems is to have regular medical checkups that include a careful prostate
exam. See a doctor promptly if you experience any of the following symptoms:
•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