About Prostate Gland Treatments

The prostate is part of the male reproductive system. The walnut-sized (3 by 4 cm) prostate lies below the bladder and wraps around the urethra (the tube carrying urine from the bladder). The prostate produces milky alkaline fluid that neutralizes the acidic fluid containing sperm, increasing sperm motility (movement) and reducing the acidity of vaginal fluid to allow sperm to swim upward into the cervix. Prostate disorders are common in men over 50.

Prostatitis

• Prostatitis is an inflammation of the prostate. It may be caused by a bacterial infection, such as E. coli, and is often related to urinary infection or sexually transmitted diseases. Symptoms include frequent and burning urination, dribbling or difficulty initiating urinary flow and pain throughout the genital area. According to Mayo Clinic, acute bacterial prostatitis is treated with up to four weeks of antibiotics while chronic prostatitis requires longer and sometimes repeated treatment.

  Some people develop chronic prostatitis and/or chronic related pelvic pain without a clear cause and may receive alpha blockers (Uroxatral, Cardura) to relax the muscles above the opening to the bladder and non-steroidal anti-inflammatory drugs (aspirin, ibuprofen) for pain. Some physicians recommend prostatic massage (with gloved finger inserted into the rectum) to relieve congestion of the prostate, but the effectiveness of this procedure is not clear.

Benign Prostatic Hyperplasia

• Benign prostatic hyperplasia is common in men over 50. The prostate enlarges and compresses the urethra and may press on other structures, such as the bladder. Symptoms include decrease in the force of urination, dribbling and inability to empty the bladder, resulting in frequency, urgency, and sometimes pain in the bladder area and incontinence. Complications include bladder infection and/or bladder stones.

  Treatment for BPH includes oral medications, such as finasteride to reduce the size of the prostate if hyperplasia is mild. Alpha-blockers (Flomax, Cardura) may relax the muscles of the prostate enough to relieve compression of the urethra and allow urination. If urinary difficulties persist, then surgical treatment is usually necessary. The most common procedure is transurethral resection of the prostate (done through the urethra), but numerous other procedures include laser prostatectomy, open surgical prostatectomy , needle ablation (using radiofrequency waves to generate heat to destroy prostatic tissue) and placement of metallic stents (tubes) to keep the urethra open.

Prostate Cancer

• Prostate cancer tends to develop on the outside of the prostate, so there are usually no symptoms in the early stages. As the tumor grows, symptoms mirror those of BPH with difficulty with urination. Pain in the lower back usually indicates the cancer has spread. Prostate cancer is fed by androgens (male hormones) and elevated levels of prostate-specific antigen may help determine the size of the tumor.

  Prostatic cancer progresses slowly and may not cause serious problems in all people, so sometimes, especially with older adults, the physician may advise no specific treatment except monitoring. According to the National Cancer Institute, younger men (50 to 60) may consider treatment because of longer life expectancy. Surgical procedures include radical prostatectomy with removal of the prostate and lymph nodes. Most men choose nerve-sparing procedures, but erectile dysfunction and/or impotency can occur. If the cancer has spread, further treatment includes external beam radiation therapy and androgen (male hormone) suppression therapy. As an alternative to surgery and radiation, some choose implantation of radioisotopes. Those with more advanced cancer may have a combination of therapies.

Prevention

• All men over 50 should have regular annual examinations of their prostate and should be aware of changes in patterns of urination that may indicate prostate enlargement.

PSA

• The prostate-specific antigen (PSA) test can indicate tumor growth, but using the test routinely to screen men is controversial as many things can affect PSA level, and high levels may prompt medical intervention when no cancer exists. The PSA test is FDA-approved for use for men over 50, and the test provides monitoring during treatment.