The Prostate

The prostate is basically a male sex gland, about the size of a walnut, located beneath the bladder. (Read about "The Urinary System") It makes some of the fluid that carries sperm. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

Prostate problems are not unusual for men over age 50. As men age, the likelihood of problems increases. In fact, according to the National Institute on Aging, as many as 90 percent of American men in their 70's and 80's experience prostate problems.

The American Foundation for Urologic Disease says there are three main types of prostate problems - prostatitis or infections and inflammation, enlargement (also known as benign prostatic hypertrophy or benign prostatic hyperplasia), and cancer. Prostatic Intraepithelial Neoplasia (PIN) is another concern. Below find information on these four prostate concerns.

Prostatitis

Prostatitis means that the prostate is inflamed. If you have prostatitis, you may have a burning feeling when you urinate, or you may have to urinate more often. (Read about "The Urinary System") You may also have a fever or just feel tired.

Prostatitis may be responsible for a quarter of all office visits by young and middle-age men for complaints involving the genital and urinary systems, according to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). NKUDIC says prostatitis can fall into one of several different categories:

• Acute bacterial prostatitis is the least common of the categories but also the easiest to diagnose and treat. This form of prostatitis leads to a range of very uncomfortable and painful symptoms, including chills, fever, pain in the lower back and genital area, urinary frequency and urgency often at night, burning or painful urination, and body aches. There is also a clear infection of the urinary tract, with white blood cells and bacteria in the urine. It is treated with antibiotics. (Read about "Microorganisms" "Antibiotics")
• Chronic bacterial prostatitis is another category. This form of prostatitis is associated with an underlying defect in the prostate. Symptoms can be similar to those of acute bacterial prostatitis, and there are also signs of infection. Effective treatment usually requires identifying and correcting the defect and then treating the infection with antibiotics. However, antibiotics often do not cure it.
• Chronic prostatitis/chronic pelvic pain syndrome is the most common but least understood form of prostatitis. It is found in men of any age; symptoms go away and then return without warning. Chronic prostatitis/chronic pelvic pain syndrome may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism, but they do contain cells the body usually produces to fight infection. In the noninflammatory form, there is no evidence of inflammation or infection-fighting cells, but there are symptoms.
• Asymptomatic inflammatory prostatitis is the diagnosis when the patient does not complain of pain or discomfort but has infection-fighting cells in his semen. Doctors usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer. (Read about "Infertility")

If you are having suspicious problems, you should consult with your doctor. If you have bacterial prostatitis, your doctor will be able to find bacteria in a sample of your urine. Your doctor can then give you an antibiotic medicine to fight the bacteria. (Read about "Antibiotics") If you keep getting infections, you may have a defect in your prostate that allows bacteria to grow. This defect can usually be corrected by surgery. If no bacteria is found, antibiotics will not help. You may have to work with your doctor to find a treatment that does work. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says changing your diet or taking warm baths may help. Your doctor may also give you medication to relax the muscle tissue in the prostate. Your doctor will also try to rule out other possible causes, if you are having urinary problems, such as a urinary tract infection (Read about "Urinary Tract Infections"), a kidney stone (Read about "Kidney Stones") or cancer (see below).

Prostate Enlargement (Hypertrophy/Hyperplasia)

Benign prostatic hypertrophy or BPH is an enlargement of the prostate. The National Institute on Aging (NIA) says that more then half of men in their 60's have BPH. An enlarged prostate can block the urethra. That can make it hard to urinate and create other issues. (Read about "The Urinary System")

If you have BPH, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says you may have one or more of these problems:

• a frequent and urgent need to urinate, even getting up several times a night to go to the bathroom
• trouble starting a urine stream, even when you feel you have to rush to get to the bathroom
• a weak stream of urine
• a small amount of urine each time you go
• the feeling that you still have to go, even when you have just finished urinating
• leaking or dribbling
• small amounts of blood in your urine

You may barely notice that you have one or two of these symptoms, or you may feel as though urination problems have taken over your life.

BPH is diagnosed usually with a digital rectal exam. The doctor inserts a gloved finger into the rectum and feels the part of the prostate that sits next to it. This exam gives the doctor a general idea of the size and condition of the prostate. X-rays or ultrasound may be used as well. (Read about "X-rays" "Ultrasound Imaging") Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. (Read about "Endoscopy") The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.

Once confirmed, patients have a number of treatment options, in consultation with their doctors. According to the National Institutes of Health, these include:

• Watchful waiting - This is where no treatment occurs, but regular exams follow the progress of the disease. This path is often chosen by men who aren't bothered by the symptoms.
• Drugs - There are a number of new drugs that are being used to treat BPH. Some act on muscles near the prostate, to relax them. Side effects can include headaches and dizziness. Other drugs act directly on the prostate by impacting the effect of hormones, causing the prostate to shrink. Side effects can include sexual dysfunction issues. NIDDK says the long-term effect of all these drugs is unknown since they are so new.
• Surgical techniques are the third option for BPH. Some are what is called minimally invasive, others are more involved and can result in potential complications. Some of the less invasive techniques include:
  • Prostatic stents are placed in the urethra to hold it open. They do have complications and aren't usually considered a good long-term solution.
  • Microwave therapy uses the heat generated by microwave energy to destroy enlarged portions of the prostate surrounding the urethra. It is also called transurethral microwave therapy (TUMT).
  • Transurethral needle ablation (TUNA) uses radio waves to destroy enlarged tissue surrounding the urethra. It is also called radiofrequency therapy.
  • Interstitial laser therapy (ILT) is a little more invasive. A small laser is actually inserted into the prostate via the urethra. The laser heats and destroys prostate tissue.

  Each of these methods involves inserting tools via the tip of the penis into the urethra. Some other surgical techniques also use this method to reach the prostate. They include:

  • Transurethral resection of the prostate (TURP) involves cutting and removing prostate tissue.
  • Transurethral incision of the prostate (TUIP) involves just cutting the prostate to relieve the pressure. Prostate tissue is not removed.
  • Laser surgery can also be used to remove prostate tissue by vaporizing it.

  The most invasive form of prostate surgery is called open prostatectomy. With this, the surgeon makes a cut in your lower abdomen to reach the prostate and remove tissue.

Prostatic Intraepithelial Neoplasia (PIN)

There is another condition called prostatic intraepithelial neoplasia or PIN. The National Cancer Institute (NCI) calls it a noncancerous growth of the cells lining the internal and external surfaces of the prostate gland. The American Cancer Society says PIN can be labeled either low or high grade. It is usually discovered after a biopsy. (Read about "Biopsy") Having high-grade PIN may increase the risk of developing prostate cancer. ACS says there is a 30 to 50 percent chance of finding prostate cancer with later biopsies after finding high grade PIN.

Prostate Cancer

The National Cancer Institute (NCI) reports that prostate cancer is the second most common cancer among men in the United States and the number two cancer killer. (Skin cancer is more common and lung cancer is deadlier; read about "Skin Cancer" "Lung Cancer")

Age is the biggest risk when it comes to prostate cancer. The older a man gets, the more likely he might develop it. Black males have a higher risk in all age groups. The U.S. Centers for Disease Control and Prevention say that prostate cancer among African Americans is the highest known rate in the world. Family history (Read about "Family Health History") also seems to play a part, with a higher then average risk for those whose father, brother or son has had the disease, according to NCI.

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, NCI says they can affect your urinary system (Read about "The Urinary System") and other areas, and may include:

• frequent urination, especially at night
• inability to urinate
• trouble starting or holding back urination
• a weak or interrupted flow of urine
• painful or burning urination
• blood in the urine or semen
• painful ejaculation
• frequent pain in the lower back, hips, or upper thighs

These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.

Finding the cancer isn't always easy. There is much discussion at this time about screening methods and when they should start. You should discuss with your doctor what would be the best path for you as you age. NCI says diagnosing cancer is done in a variety of ways:

• A digital rectal exam can discover hard areas or lumps that could be cancer. The doctor inserts a gloved finger into the rectum and feels the part of the prostate that sits next to it. This exam gives the doctor a general idea of the size and condition of the prostate.
• A PSA or prostate specific antigen blood test can show elevated levels of this substance if the patient has cancer or BPH. PSA isn't always accurate. That means it can give elevated levels when there isn't a problem, or it may not show high levels even though there is.
• A biopsy will take a small portion of the prostate with a needle and examine it under a microscope to look for cancer cells. (Read about "Biopsy")

The American Cancer Society recommends regular screenings for prostate cancer for men beginning at age 50, or earlier if there are risk factors present, including African-American men and men with a family history of prostate cancer. Remember, cancer of the prostate can have no noticeable symptoms in its early stages - and when it's in its early stages, the cancer can more readily be cured. So talk with your doctor about the screenings you need now and in the coming years.

Cancer treatment

Prostate cancer is described by both grade and stage. If cancer is found, more tests will be done to find out if the cancer has spread from the prostate to other parts of the body (staging) and what grade it is. NCI says grade describes how closely the tumor resembles normal prostate tissue. Grading uses what is called a Gleason score. The score indicates how likely the tumor is to spread. The higher the score the more likely the tumor will spread in the future. A doctor needs to know the stage and the grade of the disease to plan treatment. The following stages are used for cancer of the prostate, according to NCI:

• Stage I

  In stage I, cancer is found in the prostate only. It is usually found accidentally during surgery for other reasons, such as benign prostatic hyperplasia. Stage I prostate cancer may also be called stage A1 prostate cancer.

• Stage II

  In stage II, cancer is more advanced, but has not spread outside the prostate. Stage II prostate cancer may also be called stage A2, stage B1 or stage B2 prostate cancer.

• Stage III

  In stage III, cancer has spread beyond the outer layer of the prostate to nearby tissues. Cancer may be found in the seminal vesicles (glands that help produce semen). Stage III prostate cancer may also be called stage C prostate cancer.

• Stage IV

  In stage IV, cancer has metastasized (spread) to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or to lymph nodes (Read about "The Lymph System") near or far from the prostate. Metastatic prostate cancer often spreads to the bones. Stage IV prostate cancer may also be called stage D1 or stage D2 prostate cancer

Grading is done by looking at the microscopic appearance of tumor tissue. Pathologists may describe it as low-, medium- or high-grade cancer. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. Another system uses G1 through G4. In both systems, the higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors, according to NCI.

Treatment depends on the stage and the grade of the cancer and the age and overall health of the patient. Treatment options include:

• Watchful waiting is one option. NIDDK says some prostate cancers are slow growing and some men chose to wait.
• Surgery is another option with either partial or full removal of the prostate. Surgical removal of the prostate is called radical prostatectomy. It is typically done under general anesthesia (Read about "Anesthesia") Surgery can provide the most information about the cancer, including how advanced it is. Side effects of surgery vary with the amount of the organ removed and what other damage is done to nerves. (Read about "Nervous System") Potential side effects include incontinence and erectile dysfunction. (Read about "Incontinence" "Erectile Dysfunction") However, it is important to note that procedures have improved greatly according to the NIA, and side effects are no longer as severe as they once were for this type of surgery. Robotic surgery has helped limit nerve damage. (Read about "Robotic Surgery")
• Cryosurgery can be used for localized cancers, according to the American Cancer Society (ACS). A metal probe is inserted into the prostate tumor and the cells are frozen. The procedure is less invasive but still can have many of the side effects of regular surgery.
• Radiation therapy can be used to try to shrink the cancer as well. (Read about "Cancer Treatments") Radiation can be applied through an external beam that directs the dose to the prostate from outside the body. Low-dose radioactive "seeds," each about the size of a grain of rice, can also be used. These seeds are implanted within the prostate to kill cancer cells locally. Called brachytherapy, the seeding technique is sometimes combined with external-beam radiation. Like other treatments, there can be side effects to both kinds of radiation, including impotence, diarrhea and urinary problems. (Read about "Diarrhea" "Urinary System")
• Chemotherapy can also be used to destroy cancer cells, often in cases where prostate cancer has spread to other parts of the body. Chemotherapy uses powerful medicines to attack the cancer cells. In some cases, the tumor may be surgically removed and then chemotherapy will be used to make sure all the cancer cells are killed.
• Hormonal therapy can benefit men in different stages of prostate cancer. NCI says the advantages of certain hormonal therapies can include immediacy and ease of the procedure; disadvantages can include loss of libido and an increased risk of osteoporosis. (Read about "Osteoporosis") Hormonal therapy can be used in combination with surgery, radiation therapy or chemotherapy.
• Biological therapy can also be an option. Biological therapy uses proteins to trigger the body's immune system to produce more white blood cells. (Read about "The Immune System") It can also be used in combination with surgery, radiation therapy or chemotherapy.

The decision on which treatment is best depends on many factors, such as the stage the cancer is at, your age, and your overall health. You and your doctor will need to discuss the advantages and disadvantages of the options that can be used in your case.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

Related Information:

    Genital Health - Male

    Erectile Dysfunction