Facts about Prostate Problems

The prostate is a small organ about the size of a walnut. It is found below the bladder (where urine is stored) and surrounds the tube that carries urine away from the bladder (urethra). The prostate makes a fluid that becomes part of semen. Semen is the white fluid that contains sperm.

Prostate problems are common in men age 50 and older. Sometimes men feel symptoms themselves, or sometimes their doctors find prostate problems during routine exams. Doctors who are experts in diseases of the urinary tract (urologists) diagnose and treat prostate problems.

There are many different kinds of prostate problems. Many don't involve cancer, but some do. Treatments vary but prostate problems can often be treated without affecting sexual function.

Click on the links below for more information

Symptoms of Prostate Problems	What is Prostate Cancer?
Acute Prostatitis	Who is at Risk for Prostate Cancer?
Chronic Prostatitis	Symptoms of Prostate Cancer
Benign prostatic Hyperplasia (BHP)	How is Prostate Cancer Diagnosed?
Treatment Choices for BHP	Prostate Cancer Treatments
Glossary of Terms	Surgery to Relieve Prostate Symptoms

These are the signs of prostate problems:

• Frequent urge to urinate
• Blood in urine or semen
• Painful or burning urination
• Difficulty in urinating
• Difficulty in having an erection
• Painful ejaculation
• Frequent pain or stiffness in lower back, hips or upper thighs
• Inability to urinate
• Dribbling of urine
  
  If you have any of these symptoms, see your doctor right away to find out if you need treatment.

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Common Problems

There are several common prostate problems including:

Acute prostatitis is an infection of the prostate caused by bacteria. It usually starts fast and can cause fever, chills, or pain in the lower back and between the legs. It also can cause pain when you urinate.

If you have these symptoms, see your doctor right away. Antibiotic drugs usually help heal the infection and relieve the symptoms. Your doctor also may suggest that you drink more liquids.

Chronic prostatitis is a prostate infection that keeps coming back time after time. Symptoms may be milder than in acute prostatitis, but they can last longer.

Chronic prostatitis can be hard to treat. Antibiotics may work if bacteria are causing the infection. But if bacteria are not the cause, antibiotics won't work. Massaging the prostate sometimes helps to release fluids. Warm baths also may bring relief. Often chronic prostatitis clears up by itself.

Benign prostatic hyperplasia (BPH) is the term used to describe an enlarged prostate. BPH is common in older men. Over time, an enlarged prostate may block the urethra, making it hard to urinate. It may cause dribbling after you urinate or a frequent urge to urinate, especially at night. Your doctor will conduct a rectal exam to diagnose BPH. The doctor also may look at your urethra, prostate, and bladder.

Treatment choices for BPH include:
Watchful waiting. If your symptoms are not troubling, your doctor may suggest that you wait before starting any treatment. In that case, you will need regular checkups to make sure the condition does not get worse.

Alpha-blockers (some generic names are doxasozin, terazosin) are medicines that can relax muscles near the prostate and ease symptoms. Side effects may include headaches, dizziness, or feeling lightheaded or tired.

Finasteride (Proscar) acts on the male hormone (testosterone) to shrink the prostate. Side effects of this medication can include less interest in sex and problems with erection or ejaculation.

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Surgery also can relieve symptoms. But surgery can cause complications. Also, it does not protect against prostate cancer.
Talk with your doctor about this treatment choice. Regular checkups are important even for men who have had BPH surgery.
There are three kinds of surgery:

Transurethral resection of the prostate (TURP) is the most common type of surgery. While the patient is under anesthesia, the doctor uses a special device to take out part of the prostate and remove the blockage.

Transurethral incision of the prostate (TUIP) may be used when the prostate is not too enlarged. The doctor makes a few small cuts in the prostate near the opening of the bladder. This relaxes the bladder muscles and improves the flow of urine.

Open surgery is used when the prostate is very enlarged. In this process, prostate tissue is removed directly rather than through the urethra.

Prostate Cancer
Prostate cancer is one of the most common types of cancer among American men. It is more common among African American men than white men. Treatment for prostate cancer works best when the disease is found early.

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Diagnosing Prostate Cancer
Doctors will ask questions about your medical history and perform a physical exam to find the cause of prostate problems. In the exam, the doctor feels the prostate through the rectal wall. Hard or lumpy areas may mean that cancer is present
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Your doctor also may suggest a blood test to check your prostate specific antigen (PSA) level. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. PSA tests are very useful for early cancer diagnosis. But PSA test results alone do not always tell whether or not cancer is present.

When doctors suspect cancer, they also may perform a biopsy. Using this simple method, doctors can take out a small piece of the prostate and look at it under a microscope.

The diagnosis of prostate cancer can be confirmed only by a microscopic examination to identify cancerous prostate tissue. This is done by a biopsy performed in the doctor's office
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Prostate cancer is characterized by both grade and stage. Grade is a term used to describe how closely a tumor resembles normal tissue. Based on the microscopic appearance of a tumor, pathologists (doctors who identify diseases by studying tissues under a microscope) 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. The higher the score, the higher the grade of the tumor. High-grade tumors grow more quickly and are more likely to spread than low-grade tumors.
Staging of prostate cancer means determining the site and location of the disease. Early prostate cancer, stages 1 and 2, is localized to the prostate gland. Stage 3 prostate cancer is locally advanced outside the gland. Stage 4 prostate cancer has spread to other organs or tissues.

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Prostate Cancer Treatment
There are many options for treating prostate cancer. Each treatment plan is based on details, such as whether or not the cancer has spread beyond the prostate (stage of cancer), your age and general health, and how you feel about the treatment options and side effects.
Some of the treatment choices include:

Watchful waiting, as with BPH, if the cancer is slow growing and not causing problems, you may decide not to have treatment right away. Instead, your doctor will watch closely for changes in your condition. Men who are older or have another serious illness often choose this option.

Surgery is used to take out the cancer.

Among the different types of surgery for prostate cancer are:
Radical prostatectomy. This surgery takes out the entire prostate and nearby tissues. Side effects may include lack of sexual function (impotence) or problems holding urine (incontinence). Improvements in surgery now make it possible for some men to keep their sexual function. Some men with trouble holding urine may regain control within several weeks of surgery. Others continue to have problems that require them to wear a pad.

Cryosurgery kills the cancer by freezing it.
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation therapy sometimes is beamed into the prostate from outside the body. It can cause problems with impotence and bowel function.

Brachytherapy is a type of radiation therapy often used when the cancer is found only in the prostate gland. It also is sometimes called internal radiation, implant radiation, or interstitial radiation therapy. In this treatment, the doctor places radioactive "seeds" directly into the prostate. This focuses the radiation directly on the cancer and lowers the chance of affecting other, healthy areas around the prostate.

Hormone therapy stops cancer cells from growing. The growth of prostate cancer often depends on testosterone. Drug treatment is one effective way to block testosterone. This treatment is often used for prostate cancer that has spread to other parts of the body.
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You can get more detailed information on the pros and cons of these treatment choices by calling the National Cancer Institute's Cancer Information Service at 1-800-422-6237. Ask for prostate cancer information in "PDQ for Patients."
Protecting Yourself

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Except for skin cancer, cancer of the prostate is the most common malignancy in American men. It is estimated that in 1999 in the United States nearly 179,300 men will be diagnosed with prostate cancer. In the majority of men with prostate cancer, it is very slow growing, and many, if not most, of these men will not die because of the prostate cancer, but rather will live with it until they eventually die of some other cause.

Who is at risk for prostate cancer?
All men are at risk. The most common risk factor is age. More than 75 percent of men diagnosed with prostate cancer each year are over the age of 65. African American men have a higher risk of prostate cancer than white Americans. Dramatic differences in the incidence of prostate cancer are seen in different countries, and there is some evidence that a diet higher in animal fat may, in part, underlie these differences in risk. Genetic factors also appear to play a role, particularly for families in whom the diagnosis is made in men under 60 years of age. The risk of prostate cancer rises with the number of close relatives who have the disease.

What are the symptoms of prostate cancer?
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, they 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 (the fluid that is released through the penis during orgasm and made up of sperm from the testicles and fluid from the prostate and other sex glands)
• Painful ejaculation (the release of semen through the penis during orgasm)
• Frequent pain or stiffness in the lower back, hips, or upper thighs.
  
  These can be symptoms of cancer, but more often they are symptoms of non-cancerous enlargement of the prostate. It is important to check with a doctor.
  
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  How is localized prostate cancer treated?
  There are three generally accepted options for treatment of patients with localized prostate cancer: radical prostatectomy, radiation therapy, and surveillance (also called watchful waiting).
  
  Radical prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area (the lower part of the abdomen, located between the hip bones) are also removed. Radical prostatectomy may be performed using a technique called nerve-sparing surgery that may prevent damage to the nerves needed for an erection and prevent damage to the opening of the bladder.
  
  Radiation therapy involves the delivery of radiation energy to the prostate. The energy is usually delivered in an outpatient setting using an external beam of radiation. The energy can also be delivered by placing radioactive seeds in the prostate during a surgical procedure.
  
  A third option, surveillance, is recommended by doctors for some patients, particularly those who are older or have other medical conditions that are likely to compromise their health. These patients are followed with regular examinations. If there is evidence of cancer growth, active treatment may be recommended.

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