Prostate Problems     

The prostate is a gland the size of a walnut located between the pubic bone and the rectum in men. The prostate's main job is to make part of the fluid in which sperm travel. The urethra (the tube through which urine leaves the body) runs through the center of the prostate gland. There are many different kinds of prostate problems, and they are common in men age 50 and older.

Symptoms

Symptoms of prostate problems can include:

• Difficulty starting or stopping urination

• Frequent need to urinate

• Need to urinate in the middle of the night

• Pain with urination

• Weak or unsteady urine stream

• Urine leakage (incontinence)

• Feeling as if the bladder is not completely empty after urination

• Pain in and around the base of the penis or discomfort between the scrotum and rectum

• Pus, blood, or cloudiness in the urine

• Painful ejaculation

• Difficulty having an erection

• Pain in the lower back, hips, or upper thighs

If you have acute prostatitis, you may also have sudden fever, chills, and pain in the abdomen. Early prostate cancer often doesn't have any symptoms.

Types of Prostate Problems

Prostatitis is an inflammation of the prostate gland. There are three types of prostatitis: acute bacterial, chronic bacterial, and chronic nonbacterial. Acute prostatitis is often caused by a bacterial infection, but only about 5 percent of chronic prostatitis cases are caused by bacterial infection. Chronic prostatitis is often related to frequent urinary tract infections. Another possible cause of chronic prostatitis is an enlarged prostate.

Enlarged prostate, also called benign prostatic hypertrophy (BPH), is a noncancerous enlargement affected by the male hormone testosterone and by aging. Starting at about age 40, the prostate gland naturally begins to enlarge in most men. Almost 90 percent of men ages 80 and older have an enlarged prostate.

Some men have BPH but have no problems as a result. In others, however, the enlarged prostate may begin to press inward on the urethra, partially or completely blocking the flow of urine and causing symptoms. If the bladder never completely empties, a buildup of old urine can lead to bladder or urinary tract infection. In severe cases the enlarged prostate may stop the flow of urine so much that it causes kidney problems.

Prostate cancer is the most commonly diagnosed form of cancer, other than skin cancer, among men in the United States. It is second only to lung cancer as a cause of cancer-related death among men. Although the causes of prostate cancer are not well understood, there are certain factors that can increase your risk:

•  Age. Prostate cancer is found mainly in men over age 55.

• Family history. Your risk is higher if your father or brother has had the disease.

• Race. The disease is much more common in African American men than in Caucasian men and less common in Asian and Native American men.

• Diet. Some evidence suggests a diet high in animal fat may increase the risk of prostate cancer, whereas a diet high in fruits and vegetables may reduce the risk.

Treatment

If you have symptoms of prostate problems, there are several tests your doctor may perform to make a diagnosis. In a digital rectal examination (DRE), your doctor inserts a gloved finger into your rectum to feel your prostate gland and check for inflammation, enlargement, lumps, or tenderness.

In a prostate-specific antigen (PSA) test, your doctor measures the level of PSA in a blood sample. PSA is a substance that is produced by the prostate gland and circulated through your bloodstream. Higher than normal levels of PSA can indicate a prostate problem such as prostatitis, a greatly enlarged prostate or cancer.

Urine and semen may also be tested for bacteria and white blood cells. If your doctor suspects prostate cancer, you will need to have a biopsy, in which small tissue samples are taken from your prostate for testing.

After testing, the following treatment may be recommended.

Prostatitis

• If you have a bacterial infection, your doctor will prescribe antibiotics, which need to be taken for at least 4 to 6 weeks. Hospitalization is sometimes needed so antibiotics can be given intravenously (into your vein).

• If the infection is chronic, surgery may be needed to drain pus from the prostate or to remove chronically infected or inflamed tissue.

• Treatment for chronic prostatitis that is not caused by infection often involves an alpha-blocker medication, which relaxes the muscles of the prostate.

Enlarged Prostate

• The most commonly used medications for treating an enlarged prostate are alpha-blockers and finasteride. Alpha-blockers relax the muscles of the prostate and the opening of the bladder. Finasteride prevents the conversion of testosterone into Dihydrotestosterone (DHT).  It is DHT that causes enlargement of the prostate so blocking it can reduce the size of the prostate.

• In balloon dilation therapy, a small balloon is inserted into the urethra and then inflated to open the passageway.

• If your bladder is not emptying completely or if you are having frequent urinary tract infections or kidney problems, you may need surgery. There are several different procedures in which part or all of the prostate may be removed.

Prostate Cancer

• Watchful waiting may be suggested if prostate cancer has been found at an early stage and appears to be growing slowly. This is often advised for older men or men with other health problems, because the side effects of treatment may outweigh the benefits.

• Surgery is a common treatment for prostate cancer. Your doctor may remove all the prostate or just part of it. A procedure called cryosurgery is sometimes used to kill the cancer by freezing it. If cancer has spread to the lymph nodes or other parts of the body, your doctor will usually recommend a different type of treatment.

• Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation may be used instead of surgery, or it may be used after surgery to destroy any cancer cells left in the area.

• Hormone therapy temporarily stops cancer cells from growing. Because the growth of prostate cancer often depends on male hormones, hormone therapy uses drugs to stop your body from producing these hormones or to block them from getting into cancer cells. This treatment is often used for prostate cancer that has spread to other parts of the body.

Self-Care

Follow these self-care steps to help reduce everyday symptoms and prevent potential problems:

• Go to the bathroom as soon as you feel the urge to urinate. Don't "hold it."

• Drink plenty of fluids to help flush away possible bacteria and old urine in the bladder, but don't drink large quantities all at one time or just before bedtime. Try drinking an 8-ounce glass of water each hour during the day.

• Avoid caffeine (coffee, tea, colas) and alcohol, which will make you urinate more.

• Soak in a hot bath to help relieve discomfort and pain.

• Avoid cold and allergy medications that contain antihistamines or decongestants.

• If your doctor prescribes an antibiotic, take your medication exactly as it is prescribed.

• Call your doctor if you have symptoms that get worse or are not relieved with self-care.

Prevention

The three most important steps you can take to maintain prostate health are to eat well, keep physically active, and see your doctor regularly. Because prostate cancer is curable when caught early but often doesn't have symptoms, talk to your doctor about scheduling routine prostate exams.