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Prostate
Problems
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.
Noncancerous
Prostate Problems
Acute prostatitis 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 hard 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 long time.
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 70’s and 80’s, the figure may go
as high as 90 percent.
An 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 the penis.
BPH Treatment
Choices
There are several different 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
obstruction.
- 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 the prostate.
- 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. The Agency
for Health Care Policy and Research has designed a booklet to
help in choosing a treatment; call 800-358-9295 and ask for
their free patient guide on prostate enlargement.
Prostate Cancer
Prostate cancer is one of the most common forms of cancer among
American men. About 80 percent 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 from prostate cancer that has spread.
Diagnosis.
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 present.
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
cancer.
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.
Surgery
usually 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 prostatectomy.
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.
Hormone 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.
More detailed information
on the pros and cons of these treatment options is available
from the Cancer Information Service at 800-422-6237; ask for
the prostate cancer “PDQ for Patients.”
Protecting Yourself
The best protection against prostate problems is to have regular
medical checkups that include a careful prostate exam. See a
doctor promptly if symptoms occur such as:
- 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 work.
Resources
Agency for Health
Care Policy and Research (AHCPR) Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
800-358-9295
Ask for the free
booklet called Treating Your Enlarged Prostate . It
contains detailed information on the pros and cons of different
treatments for BPH.
Cancer Information
Service (CIS)
National Cancer Institute
Building 31, Room 10A24
Bethesda, MD 20892
800-4-CANCER
CIS staff can answer
questions and mail free booklets about prostate cancer. The
prostate cancer “PDQ for Patients” contains detailed information
on diagnosis and treatment. Spanish speaking CIS staff are available
during daytime hours.
National Kidney
and Urologic Diseases Information Clearinghouse
Box NKUDIC
Bethesda, MD 20892
301-468-6345
Ask for free materials
on BPH.
American Cancer
Society
1599 Clifton Road, NE
Atlanta, GA 30329
800-227-2345
Ask about their
materials on prostate cancer.
Prostate Health
Council
The American Foundation for Urologic Disease, Inc.
300 West Pratt Street
Suite 401
Baltimore, MD 21201
800-242-2383
Ask for free brochures
in English and Spanish on prostate disease and prostate cancer.
The NIA distributes
free Age Pages on a number of topics, including Cancer Facts
for People Over 50, Urinary Incontinence, and
Considering Surgery.
The National Institute
on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
National Institute
on Aging
U. S. Department of Health and Human Services
Public Health Service
National Institutes of Health
1994
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