The prostate gland, a key part of the male reproductive system, is linked closely with the urinary system. It is a small gland that secretes much of the liquid portion of semen, the milky fluid that transports sperm through the penis when a man ejaculates.
The prostate is located just beneath the bladder, where urine is stored, and in front of the rectum. It encircles, like a donut, a section of the urethra. The male urethra is the tube that carries urine from the bladder out through the penis. During ejaculation, semen is secreted by the prostate through small pores in the urethra's walls.
The prostate is made up of three lobes encased in an outer covering, or capsule. It is flanked on either side by the seminal vesicles, a pair of pouch-like glands that contribute secretions to the semen. Next to the seminal vesicles run the two vas deferens, tubes that carry sperm from the testicles. The testicles, in addition to manufacturing sperm, also produce testosterone, a male sex hormone that controls the prostate's growth and function.
Prostate problems are very common after age 50. And the older men get, the more likely they are to have such problems. Most prostate problems are not cancer.
When a man is young, the prostate is about the size of a walnut. It slowly grows larger as him get older. If the prostate gets too large, it can cause urinary problems. Infection or cancer in the prostate can also cause urinary and other problems. Often, men notice symptoms themselves, and sometimes their doctor finds something during a routine check-up.
There are several different kinds of prostate problems. Only a doctor can tell one from another. That’s why is a wise decision to see a doctor if something doesn’t seem right.
Common Problems (not Cancer)
Acute prostatitis is an infection of the prostate caused by bacteria. It usually starts all of a sudden. It can cause fever, chills, or pain in the lower back and between the legs. It can cause pain when urinating. Antibiotic drugs can kill the bacteria and help to feel better.
Chronic prostatitis is an infection of the prostate that keeps coming back time after time. This problem can be hard to treat. Sometimes, taking antibiotics for a long time may work.
Benign prostatic hyperplasia, or BPH, is very common in older men. The prostate is enlarged, but it is not cancerous. Over time, an enlarged prostate may press against the urethra, making it hard to urinate. It may cause dribbling after urinating or a need to urinate often, especially at night. A doctor will do a rectal exam to check for BPH. And he may suggest having special x-rays or scans to check the urethra, prostate, and bladder.
✦ Watchful waiting. If the symptoms are not too bad, the doctor may suggest waiting before starting any treatment. It will need regular checkups. Treatment can start later on if symptoms get worse.
✦ Alpha-blockers. These medicines can ease the symptoms. Side effects may include headaches, dizziness, or feeling lightheaded or tired.
✦ Finasteride (Proscar®). This medicine lowers the amount of the male hormone (testosterone) in the body. The result is that the prostate shrinks and urinary problems get better. Side effects can include less interest in sex and problems with erection or ejaculation.
✦ Surgery. An operation can improve the flow of urine but it can also cause other problems. Usually, men have surgery only if medicine hasn’t worked. This surgery does not protect against prostate cancer. Regular check-ups are important after BPH surgery. There are three kinds of surgery:
■ Transurethral resection of the prostate (TURP) is the most common type of surgery. The surgeon takes out part of the prostate through the urethra.
■ Transurethral incision of the prostate (TUIP) may be used when the prostate is not too large. The doctor makes a few small cuts in the prostate near the opening of the bladder.
■ Open surgery is used only when the prostate is very large. The doctor removes the prostate through a cut in the belly or behind the scrotum.
Prostate cancer is a common type of cancer among men. Treatment for prostate cancer works best when the disease is found early.
Diagnosing Prostate Cancer. Early prostate cancer does not usually cause symptoms. As the cancer grows, it may cause trouble urinating, and the need to urinate often, especially at night. Other symptoms can be pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.
To figure out if these symptoms are caused by prostate cancer, the doctor will ask the patient questions about past medical problems, and will perform a physical exam, putting a gloved finger into the rectum to feel the prostate through the wall. Hard or lumpy areas may be a sign of cancer.
The doctor may also do a test to check the prostate-specific antigen (PSA) level in the blood. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer.
It may also need to have an ultrasound exam. In this procedure, a probe that produces sound waves is put into the rectum. Sound waves bounce off the tissues, and a computer uses the echoes to make a picture of the prostate.
A biopsy is almost always needed to diagnose prostate cancer for sure. This exam takes out tiny pieces of the prostate and sends them to a laboratory to be checked for cancer cells under a microscope.
Prostate Cancer Treatment. The choice of treatment depends on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other parts of the body). It also depends on the patient age and general health. The following are three standard treatment choices for cancer that has not spread beyond the prostate:
Watchful waiting. If the cancer is growing slowly and not causing problems, is possible to decide not to have treatment right away. Instead, the doctor will check regularly for changes in the patient condition. Older men with other medical problems often choose this option.
Surgery. The most common type of surgery is a radical prostatectomy. The surgeon takes out the whole prostate and some nearby tissues. Side effects may include loss of sexual function (impotence) or problems holding urine (incontinence), which can go away within a year of surgery. But some men continue to have problems and have to wear a pad. An operation called nerve-sparing surgery gives some men a better chance of keeping their sexual function.
Radiation therapy. This treatment uses high-energy x-rays to kill cancer cells and shrink tumors. There are two kinds of radiation therapy. External radiation therapy is beamed into the prostate from a machine outside the body. Internal radiation therapy uses radioactive “seeds” that are placed in the prostate, into or near the tumor itself. Like surgery, radiation therapy can cause problems with impotence, not as likely to cause urinary incontinence as surgery. But it can cause rectal problems such as pain and soreness, rectal urgency, and trouble controlling bowel movements.
In addition, after radiation therapy, some men are treated with hormone therapy. This is used when chances are high that the cancer will come back. Hormone therapy is also used for prostate cancer that has spread beyond the prostate. Side effects of hormone treatments include hot flashes, loss of sexual function, and loss of desire for sex.
On PSA Testing:
Some doctors think that men should have regular PSA tests, and others do not. The reason is even knowing that this test can catch a cancer before it causes symptoms, it is not sure that PSA tests save lives. Also, PSA tests find small cancers that would never grow or spread. When that happens, a man may have surgery or other heavy treatments that are not needed. Researchers are studying ways to improve the PSA test so that it catches only cancers that need treatment.