September is National Prostate Cancer Awareness Month--a great time for men to visit their doctors for a checkup and PSA test. Many men over age 50 develop prostate trouble, so make sure you're in the know about the problems that can affect the prostate. Here's a quick overview of the most common conditions, their symptoms and how to treat them.
Taking Charge! How to handle benign prostatic hyperplasia and prostatitis By Beth Howard MDminute: Prostate Health Third Quarter 2008
Age may improve a man’s judgment and boost his wisdom. But it’s no friend to his prostate, the walnut-sized gland that sits below the bladder. A key part of the male reproductive system, the prostate is responsible for making seminal fluid, without which sperm could not survive.
As a man ages, his prostate grows larger and more prone to inflammation, which may cause troublesome symptoms, while at any age he may find that he has an infection that affects the prostate. More worrisome, growing older increases his chances of developing prostate cancer, the leading cancer in men. Here, we explain some of the most common prostate problems.
Benign Prostatic Hyperplasia (BPH) The prostate surrounds the urethra, the tube through which urine passes. BPH is a disorder that causes the prostate to enlarge, gradually constricting the urethra. “Men frequently complain they don’t have the stream they used to,” says Cy Stein, M.D., head of the medical genitourinary oncology program at the Montefiore-Einstein Cancer Center in New York City.
Men with BPH also may experience frequent urination and symptoms of irritation, such as burning or urgency. In addition, BPH can eventually cause a backflow of urine, triggering bladder or kidney infections, urine blockage or even kidney failure—so it pays to seek treatment early. An enlarged prostate usually begins to bother men after age 50; almost all men are affected by the time they reach 80.
Luckily, having BPH does not increase your risk for prostate cancer. Help is available, but you need to be open with your doctor. “Unfortunately, men are often hesitant to disclose urination problems to their doctor,” notes Muta Issa, M.D., associate professor of urology at the Emory Clinic and chief of urology at the Atlanta V.A. Medical Center.
“They consider it part of aging,” he observes, “and tend to tolerate these symptoms for too long.”
Treatment For many men, the first step is to change behaviors that may worsen symptoms, such as drinking too much liquid before bedtime. In addition, many patients don’t realize that some medications increase symptoms,” Dr. Issa adds. These include over-the-counter cold and sinus medications, as well as certain antidepressants, tranquilizers and blood pressure medications.
Two types of drug therapies can help if the condition becomes bothersome. Alpha-blockers help relax the muscles in the prostate, relieving the pressure and allowing urine to flow more freely. Medications called 5-alpha reductase inhibitors retard prostate growth and actually shrink the prostate to reduce symptoms. They work by blocking enzymes that act on testosterone, a hormone that promotes organ growth.
When symptoms can’t be managed with medication, your doctor may recommend removing or destroying excess prostate tissue.
Surgical techniques may involve trimming the tissue or destroying it with lasers, radio-frequency energy, electrical currents or microwave energy. These procedures carry a small risk of incontinence and sexual dysfunction.
Prostatitis According to the National Institute of Diabetes and Digestive and Kidney Diseases, 10 to 12 percent of men experience prostatitis-like symptoms. The term prostatitis means inflammation of the prostate, but doctors use the term to describe the following four distinct disorders:
Chronic prostatitis Also called chronic pelvic pain syndrome, this is the most common form of the disorder. It causes pain or discomfort in the groin or bladder area. Treatment may include anti-inflammatory drugs, antibiotics, analgesics for pain, or alpha blockers to relax the muscles in the prostate. This allows the urine to pass more freely.
Acute bacterial prostatitis This condition appears as a sudden infection triggered by bacteria. Symptoms include fever, chills and blood in the urine, and they warrant an immediate trip to the doctor. Treatment is an initial high dose of antibiotics, followed by several weeks at a lower dose.
Chronic bacterial prostatitis This condition is also caused by bacteria. The main symptom is recurring bladder infections. A 4- to 12-week course of antibiotics is usually prescribed to clear up the problem, but a longer-term, low-dose antibiotic may be needed for cases that don’t respond.
Asymptomatic inflammatory prostatitis Because it has no symptoms, you may learn that you have this condition when a doctor evaluates you for another problem, such as prostate cancer or infertility. Often, a blood test revealing an elevated prostate-specific antigen (PSA) level triggers an investigation. Men with the condition usually go on antibiotics for four to six weeks and then repeat the PSA test.
Whether or not you have symptoms, it’s important to talk with your doctor about your prostate health. That way, you can avoid or manage the discomfort and disruption that prostate problems can cause.
Sources: National Cancer Institute: Understanding Prostate Changes; American Cancer Society; FDA: Prostate Health: What Every Man Needs to Know
Checkups Current guidelines advise that all men get an annual prostate exam beginning at age 50 (40 if you are African-American and/or have a family history of prostate cancer). At these exams, your doctor should perform a digital rectal exam (DRE) to search for prostate enlargement and any irregularities associated with BPH or prostate cancer. Your doctor should also give you a blood test to measure your PSA level—when elevated, this protein produced in the prostate may be a marker for prostate cancer or other conditions.
Some doctors advise that all men, whatever their race or family history, have their first PSA test in their early 40s. That way, notes Peter Carroll, M.D., chair of urology at the University of California, San Francisco (UCSF) School of Medicine, “[you can] get a base PSA value and assess your long-term risk of prostate cancer.” Knowing your base PSA value lets your doctor evaluate later changes, which can help detect prostate cancer at its earliest, most treatable stages.
Urinalysis may be done as well, especially to detect an inflammation or infection of the prostate (prostatitis). This test uses a chemically treated dipstick that changes color when it comes in contact with urine that contains nitrite (a by-product of bacterial infection) or blood. —Sid Kirchheimer
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