The prostate is a doughnut-shaped gland that surrounds the bladder opening and urethra in males. It is located at the bottom of the bladder, about halfway between the rectum and the base of the penis.

Common prostate problems in older men include prostatitis or infection of the prostate, benign prostatic hypertrophy (BPH) or non-cancerous enlargement of the prostate gland, and prostate cancer. Enlargement of the prostate is a common condition in men over 60 years of age. Cancer of the prostate is as common as lung cancer among males. This disease claims about 42,000 lives a year. Less than one percent of men under age 50 have any detectable forms of prostate cancer, but after age 80, more than 50 percent of males have been shown to have some stage of prostate cancer.

Q. What causes these conditions?

A. Prostatitis, particularly chronic prostatitis, frequently accompanies a urinary tract infection. After age 40, the prostate enlarges. This condition is called benign prostatic hypertrophy, and it occurs to some degree in every man as he ages. The cause of prostate cancer, as with other cancers, is uncertain. However, risk factors for prostate cancer include family history of the disease, age, smoking, and a high-fat diet.

Q. What are the symptoms of these conditions?

A. Symptoms of prostatitis include pain and burning with urination and ejaculation, and frequent urges to urinate but only being able to pass a small amount of urine. Occasionally there may be blood in the urine.

Because in BPH the prostate expands and pinches the urethra, symptoms of this condition include decreased force of the stream of urine, difficulty starting and stopping urination, increased urinary frequency (especially at night), and incomplete emptying of the bladder.

Prostate cancer and BPH have similar symptoms, although most men who have prostate cancer may never know it unless they have regular prostate exams. It is a slow-growing cancer and many men die from other causes before prostate cancer advances to the stage where it causes noticeable symptoms. As in BPH, symptoms may include decreased force of the stream of urine, problems starting and stopping the stream, and frequent urination. Hip or lower back pain, blood or pus in the urine, and painful urination also may be noticed.

You should contact your doctor if any of these urinary symptoms occur for more than two weeks, or sooner if there is blood in the urine, pain, fever, chills, or abdominal pain.

Q. How are problems of the prostate diagnosed?

A. Diagnostic tests may include a complete history of symptoms, blood and
urine tests, a digital exam of the prostate in which the doctor inserts a finger into the rectum and feels the prostate for enlargement and abnormal growths, X-ray of the urinary tract system, and tissue biopsies.

The PSA (prostate-specific antigen) test is a screening test for prostatic abnormalities. It detects a protein in the blood when there is a tumor, infection, or non-cancerous enlargement of the prostate. If the PSA test detects elevated levels, your doctor can then use other exams to determine the specific problem. Because BPH and prostatitis can elevate PSA levels, this test is not a definitive indicator of the absence or presence of prostate cancer, but rather a method to assess the risk. For example, for men with slightly elevated PSA levels the chance of prostate cancer is 20 to 50 percent. Experts suggest that the PSA's cancer-predicting ability can be improved by taking into account the man's age, the PSA density, annual changes in PSA values, and whether or not the PSA is attached to proteins.

The American Cancer Society and the American Urological Association recommend an annual digital rectal exam and PSA test for all men over age 50; however, you should know that some groups do not recommend routine screening for men without risk factors. Ultimately, it's a decision that you need to make with your personal physician after you weigh the benefits, costs, and risks.

Q. What treatment options are available?

A. Prostatitis usually responds well to antibiotic therapy. Also, your doctor may advise you to avoid alcohol, coffee, tea, and spicy foods; increase your fluid intake; and control your stress level (high levels of stress are closely associated with these infections). Soaking in a warm bath also seems to help.

BPH usually is not a serious problem unless urination becomes extremely difficult or the incomplete emptying of the bladder causes bladder infections or kidney problems. Surgery is a common treatment for BPH. The most common procedure is transurethral prostatectomy (TURP). With this, the core portion of the prostate is removed to relieve the obstruction. In some cases, the best treatment is no treatment (watchful waiting). And, there also has been progress in finding medications (e.g., finasteride, alpha-adrenergic blockers) that can improve the symptoms of BPH. Currently, there are a number of other surgical options under investigation that include the use of ultrasound, vaporization, microwaves, lasers, and stents to treat BPH. Your doctor can discuss the various treatment options available for your particular situation.

Treatment options for cancer of the prostate are based primarily on how far the disease has spread. Radical prostatectomy, complete removal of the prostate, is effective for cancer contained within the gland. Radiation treatment, through external beam radiation or implanted seeds, is used when the cancer is contained or has spread only slightly.

Hormone therapy, stopping the supply of testosterone that the cancer needs to grow, is used when the cancer has spread widely. Removal of the testicles is another procedure used to stop testosterone production and is used in advanced cases of the disease. With these last two techniques, impotence is a side effect.

Cryotherapy, a method that freezes the prostate and kills the cancer cells, is currently being used and assessed. However, data on long-term effectiveness has not been demonstrated.

Finally, watchful waiting and monitoring a small tumor carefully through regular exams and screening is the option sometimes used with older patients.

When considering treatment options, men need to carefully assess the risks and benefits of each procedure and weigh them against other factors such as age, stage of disease, and quality of life. For instance, incontinence and/or impotence are two major risks associated with radical prostatectomy, radiation therapy, and hormone therapy. The good news is that new surgical techniques that spare delicate nerve connections are getting better at reducing these risks.

Note: While it may seem natural for a prostate cancer patient to have the blues and feel down, it's not healthy when depressive symptoms are more severe, longer lasting, and more disabling. Not only can cancer and its treatments be frightening, but prostate cancer can affect a man's body image and self-esteem, change his lifestyle, disrupt life's plans, and create significant financial concerns. As a result, prostate cancer patients may become depressed, an estimated 25 percent of cancer patients do, and feel isolated from family and friends. In turn, depression can make battling prostate cancer far more difficult, as it tends to sever a man's ties to the people and things he cares about. The good news is that depression can be successfully treated.

Questions to Keep in Mind:

• How often should I, given my age, family history, and any symptoms, get a PSA test and a digital exam to screen for prostate cancer?

• If I have a prostate infection (prostatitis), what antibiotics will be proscribed? How will they act? How should I take them? Do I need to keep taking them even if I feel better? What side effects can I expect? Is there anything else I can do to feel better?

• When should I be concerned about benign prostatic hypertrophy (BPH)? Is no treatment the best option for me? What should I do if the symptoms get better? Worse? What medication is available to treat the symptoms of BPH? Is it an option for me?

• When is surgery appropriate for BPH? What are the risks? Benefits? Could another treatment option be as effective? How successful is this procedure? How long is the recovery period?

• If I have been diagnosed with prostate cancer, what treatment options are recommended for my condition? Why? What are the risks and benefits of each? What is the success rate of each? What are the major side effects (e.g., impotence, incontinence)?

• When is "watchful waiting" appropriate? Is it the best option for me?

• What other factors do I need to think about when considering treatment options (e.g., stage of disease, age, other health problems)?

  

Copyright © 2001 DrRajMD.com Inc. All Rights Reserved.
Copyright © 2001 adam.com All rights reserved.
Important Disclaimers - Privacy Practices

The information contained above is intended for general reference purposes only. It is not a substitute for professional medical advice or a medical exam. Always seek the advice of your physician or other qualified health professional before starting any new treatment. Medical information changes rapidly and while DrRajMD.com  and its content providers make efforts to update the content on the site, some information may be out of date. No health information on DrRajMD.com , including information about herbal therapies and other dietary supplements, is regulated or evaluated by the Food and Drug Administration and therefore the information should not be used to diagnose, treat, cure or prevent any disease without the supervision of a medical doctor.