Introduction
The prostate is a small organ about the size of a walnut. It is found below
the bladder (where urine is stored) and surrounds the tube that carries urine
away from the bladder (urethra). The prostate makes a fluid that becomes part of
semen. Semen is the white fluid that contains sperm.
Prostate problems are common in men age 50 and older. Sometimes men feel
symptoms themselves, or sometimes their doctors find prostate problems during
routine exams. Doctors who are experts in diseases of the urinary tract (urologists)
diagnose and treat prostate problems.
There are many different kinds of prostate problems. Many don’t involve
cancer, but some do. Treatments vary but prostate problems can often be treated
without affecting sexual function.
Common Problems
There are several common prostate problems including:
Acute prostatitis
Acute prostatitis is an infection of the prostate caused by bacteria. It
usually starts fast and can cause fever, chills, or pain in the lower back and
between the legs. It also can cause pain when you urinate. If you have these
symptoms, see your doctor right away. Antibiotic drugs usually help heal the
infection and relieve the symptoms. Your doctor also may suggest that you drink
more liquids.
Chronic prostatitis
Chronic prostatitis is a prostate infection that keeps coming back time after
time. Symptoms may be milder than in acute prostatitis, but they can last
longer. Chronic prostatitis can be hard to treat. Antibiotics may work if
bacteria are causing the infection. But if bacteria are not the cause,
antibiotics won’t work. Massaging the prostate sometimes helps to release
fluids. Warm baths also may bring relief. Often chronic prostatitis clears up by
itself.
Benign prostatic hyperplasia
Benign prostatic hyperplasia (BPH) is the term used to describe an enlarged
prostate. BPH is common in older men. Over time, an enlarged prostate may block
the urethra, making it hard to urinate. It may cause dribbling after you urinate
or a frequent urge to urinate, especially at night. Your doctor will conduct a
rectal exam to diagnose BPH. The doctor also may look at your urethra, prostate,
and bladder.
Treatment choices for BPH include:
- Watchful waiting. If your symptoms are not troubling, your doctor
may suggest that you
wait before starting any treatment. In that case, you will need regular
checkups to make sure the condition does not get worse.
- Alpha-blockers (some generic names are doxasozin, terazosin) are
medicines that can relax muscles near the prostate and ease symptoms. Side
effects may include headaches, dizziness, or feeling lightheaded or tired.
- Finasteride (Proscar) acts on the male hormone (testosterone) to
shrink the prostate. Side effects of this medication can include less
interest in sex and problems with erection or ejaculation.
- Surgery also can relieve symptoms. But surgery can cause
complications. Also, it does not protect against prostate cancer.
Talk with your doctor about this treatment choice. Regular checkups are
important even for men who have had BPH surgery.
There are three kinds of surgery:
- Transurethral resection of the prostate (TURP) is the most common
type of surgery. While the patient is under anesthesia, the doctor uses a
special device to take out part of the prostate and remove the blockage.
- Transurethral incision of the prostate (TUIP) may be used when
the prostate is not too enlarged. The doctor makes a few small cuts in the
prostate near the opening of the bladder. This relaxes the bladder muscles
and improves the flow of urine.
- Open surgery is used when the prostate is very enlarged. In this
process, prostate tissue is removed directly rather than through the
urethra.
Prostate Cancer
Prostate cancer is one of the most common types of cancer among American men.
It is more common among African American men than white men. Treatment for
prostate cancer works best when the disease is found early.
Diagnosing Prostate Cancer
Doctors will ask questions about your medical history and perform a physical
exam to find the cause of prostate problems. In the exam, the doctor feels the
prostate through the rectal wall. Hard or lumpy areas may mean that cancer is
present.
Your doctor also may suggest a blood test to check your prostate specific
antigen (PSA) level. PSA levels may be high in men who have an enlarged prostate
gland or prostate cancer. PSA tests are very useful for early cancer diagnosis.
But PSA test results alone do not always tell whether or not cancer is present.
When doctors suspect cancer, they also may perform a biopsy. Using this
simple method, doctors can take out a small piece of the prostate and look at it
under a microscope.
Prostate Cancer Treatment
There are many options for treating prostate cancer. Each treatment plan is
based on details, such as whether or not the cancer has spread beyond the
prostate (stage of cancer), your age and general health, and how you feel about
the treatment options and side effects. Some of the treatment choices include:
- Watchful waiting, as with BPH, if the cancer is slow growing and
not causing problems, you may decide not to have treatment right away.
Instead, your doctor will watch closely for changes in your condition. Men
who are older or have another serious illness often choose this option.
- Surgery is used to take out the cancer. Among the different types
of surgery for prostate cancer are:
- Radical prostatectomy. This surgery takes out the entire
prostate and nearby tissues. Side effects may include lack of sexual
function (impotence) or problems holding urine (incontinence).
Improvements in surgery now make it possible for some men to keep their
sexual function. Some men with trouble holding urine may regain control
within several weeks of surgery. Others continue to have problems that
require them to wear a pad.
- Cryosurgery kills the cancer by freezing it.
- Radiation therapy uses high-energy X-rays to kill cancer cells
and shrink tumors. Radiation therapy sometimes is beamed into the prostate
from outside the body. It can cause problems with impotence and bowel
function.
- Brachytherapy is a type of radiation therapy often used when
the cancer is found only in the prostate gland. It also is sometimes
called internal radiation, implant radiation, or interstitial radiation
therapy. In this treatment, the doctor places radioactive “seeds”
directly into the prostate. This focuses the radiation directly on the
cancer and lowers the chance of affecting other, healthy areas around
the prostate.
- Hormone therapy stops cancer cells from growing. The growth of
prostate cancer often depends on testosterone. Drug treatment is one
effective way to block testosterone. This treatment is often used for
prostate cancer that has spread to other parts of the body.
You can get more detailed information on the pros and cons of these treatment
choices by calling the National Cancer Institute’s Cancer Information Service at
1-800-422-6237. Ask for prostate cancer information in “PDQ for Patients.”
Protecting Yourself
These are the signs of prostate problems:
- Frequent urge to urinate
- Blood in urine or semen
- Painful or burning urination
- Difficulty in urinating
- Difficulty in having an erection
- Painful ejaculation
- Frequent pain or stiffness in lower back, hips or upper thighs
- Inability to urinate
- Dribbling of urine
If you have any of these symptoms, see your doctor right away to find out if
you need treatment.
