Diseases of the Prostate
The prostate is an accessory sex gland that is about the size of a walnut and sits below the bladder surrounding the urine tube as it exits the bladder. The prostate contributes about 50% of the ejaculate and has a role in nourishing the sperm. There are many disorders of the prostate that affect men at different times in their lives. Because the prostate surrounds the urethra, the urine flow can be affected for example.
The most common disease affecting the prostate is Benign Prostatic Hyperplasia (BPH). This condition affects the majority of men at some time during their lives. The prostate is sensitive to the male hormone testosterone. As men age, the prostate tends to enlarge secondary to stimulation by testosterone and eventually causes voiding difficulties. Even men in their 20’s start to develop microscopic evidence of BPH. However, men older than 50 years are most commonly afflicted by these symptoms. As the prostate enlarges and encroaches on the urethra, a multitude of symptoms may develop. Obstructive symptoms such as hesitancy, double-voiding, weak stream, dribbling and a sensation of incomplete emptying may occur. Irritative symptoms may also occur which include frequency, urgency and getting up at night to urinate. A thorough history and physical exam are important in diagnosing BPH. A prostate specific antigen (PSA) and possibly a urine flow and assessment of residual urine with a bladder ultrasound may be necessary to assess the severity of the symptoms. An American Urologic Association assessment questionnaire will be need to be filled out to quantitate the degree of voiding difficulty. Treatment includes medication for some men, while others with severe symptoms and inability to urinate (urinary retention) often require a surgical procedure to allow the urine to flow better through the prostate. Some of these surgical procedures are performed on an outpatient basis while others require 1-2 days in the hospital.
Prostatitis is another condition affecting the prostate. This is a condition in which bacteria invade the prostate. The bacteria are usually from the urine and as a result the patient may have symptoms of a urinary tract infection (burning, frequency, odor, discolored urine). In some cases the patient may become systemically ill from prostatitis and may have fevers, severe difficulty voiding, low back pain, or pain near the rectum. The treatment relies on antibiotics, anti-inflammatory medications and warm soaks. Patients may have a relapse of symptoms and for that reason may need prolonged treatment. A thorough physical exam, urine cultures and close follow-up are important in treating this disease.
The last major disease affecting the prostate is prostate cancer. Cancer occurs when normal cells change to malignant cells. Prostate cancer is the most common cancer found in men with over 300,000 cases detected per year in the U.S. It affects men from their 40’s to 90’s. It is usually a slow-growing cancer that is found primarily in older men who may have died of unrelated causes. However, some prostate cancers are more aggressive and may afflict much younger men. Men with a family history of prostate cancer as well as men of African-American descent are known to be at increased risk for this disease. A thorough history and physical examination and PSA test are important in detecting prostate cancer. When the PSA or the rectal exam are abnormal, a prostate biopsy is necessary to rule out prostate cancer. An ultrasound probe is placed in the rectum and small amounts of tissue are sampled. The pathologist can then make the proper diagnosis. If prostate cancer is identified then the patient undergoes a staging evaluation with blood work and x-rays. The treatment options are varied and include observation, radiation therapy, cryosurgery (freezing the prostate), and radical surgical removal. The patient and the doctor will then decide on the appropriate treatment based upon the stage of the disease and other factors such as the stage of the disease and the patient's age.
Copyright © 2003 Memorial Urology Associates - ALL RIGHTS RESERVED
