How to Make Sense of Prostate Disease and Surgery

Nearly all men dread the very thought of needing prostate surgery for many good reasons. It is a "wakeup" to a man's aging process and can be painful and embarrassing, with post-surgical consequences that are concerning, if not downright scary.

But before you enter the abysses of prostate surgery, you need to be armed with information. You need to know what to expect, what your options are and how the potential post-operative consequences, such as urinary incontinence and erectile dysfunction, will be handled. You are the patient; therefore you are in charge.

Prostate cancer is one of most common types of cancer in men. There are numerous treatment options from chemotherapy to radiation to surgery. Prostate cancer can affect anyone. Broadway composer Andrew Lloyd Webber was diagnosed with it.

With all prostate disease, there are several things every man needs to do and know.

Things You'll Need

• An understanding of how the prostates functions
• A review of the clinical conditions that may impact a healthy prostate
• A review of options, treatments, side effects and your choices

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Instructions

• 1

  Know your family history of prostate disease. If prostate disease has been a factor in your family you need to consider getting regular screening tests and exams. Although the standard screening typically does not begin until age 40 for most men, that can change significantly if there has been a strong and early history of prostate disease in your family. Also, some very compelling research has demonstrated that men of color and men who have sex with men may be at higher risk for many forms of prostate disease.

  You should review some basics of what the prostate is, what it does and what clinical problems can result with their prostate as men age. The prostate is a sex gland whose main function is to produce fluid to help create semen, which is the substance that transports sperm during male ejaculation. Semen is the milky white substance that is released from a man's body during orgasm, and sperm is the man's biological substance that when combined with a female's egg can result in pregnancy.

  The normal prostate is about the size of a walnut and is located underneath a man's urinary bladder. The tube (known as urethra) passes through the prostate and serves the dual function of carrying urine and semen from a man's body. When semen is passed through the prostate gland it "picks up" seminal fluid to help sperm become viable for pregnancy.

  The urethra being embedded in the prostate gland can sometime become constricted if the prostate gland become enlarged or inflamed, which can lead men complaining of urinary frequency, urgency, hesitancy, and even some urinary dribbling.

• 2

  Get an annual prostate exam that includes both a digital rectal exam (DRE), whereby the clinician gently inserts a gloved finger in your anus to palpate the size, shape and consistency of the prostate gland. The second test is a blood test known as the Prostatic Specific Antigen (PSA). The normal level of the PSA is about 0 to 4. An elevated PSA may indicate some type of infection, growth or other abnormality of your prostate gland. Both tests, the DRE and PSA, should be done annually. One test does NOT replace the other.

• 3

  Talk to your primary care provider about the condition, size and shape of your prostate. Also, do not shy away from letting your clinician know about any of the annoying constitutional symptoms such as urinary frequency, urgency and dribbling.

• 4

  You and your provider may elect to attempt a trial of medications at first if your prostate exam and PSA are within a reasonable range. This is fine, but it should be noted that intervention with medications can take up to several months for real results to be seen by the patient. Please talk to your doctor about this and develop a game plan of care.

  Before looking at surgical considerations with prostate disease it is important to review three of the most common types of prostate problems that impact men.

  An inflamed or infected prostate is termed prostatitis. Prostatitis can be an acute or chronic inflammation of the gland cause by bacterial, viruses and sexually transmitted disease. Treatment for prostatitis is usually medical in nature and does not involve surgery. Prostatitis can happen to men of any age, and usually resolves with symptom treatment and some medications.

  The second most common prostate condition is an enlarged prostate. The prostate gland begins to enlarge in men in their 40s. As men age, the prostate takes a second growth spurt that slowly compresses the flow of urine and semen from the urethra. Benign prostatic hyperplasia (BPH) is a normal part of aging and usually progresses as a man ages. Common symptoms will include trouble with urination, maybe some burning, hesitancy and even erectile dysfunction. There are several drugs available that help relieve the symptoms of BPH.

  Medical treatment of BPH can include one or two medications. The first group of medications, Finasteride (Proscar) and Dutasteride (Avodart), can actually prevent progression of growth of the prostate or shrink the prostate in some men. The other class of drugs help by relaxing the smooth muscle of bladder that can constrict urine flow. These agents, terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Uroxatral), work in this manner. They DO NOT, however, decrease the size of the prostate. A recent study looked at using two different agents together to achieve better symptoms relief. Finasteride (which helps reduce prostate size) and doxazosin (which relieves bladder neck constriction) used together nearly doubled the improvement of symptoms then when each drug was used alone. Think about it; the drug that relieves the contrition works faster and provides some early symptom relief while the drug that reduces the prostate's size takes longer to achieve its goal, so you are getting the best of both worlds and faster.

• 5

  Do not settle for having ED just because you have a prostate problem. You have the right to have healthy sex just like anyone else. There or numerous treatment options available from oral medications to injections or even implants. Stand up for your sexual rights.

• 6

  Discuss getting involved in a support group for men with prostate cancer and/or surgery. You are not alone. There are millions of men just like you who are craving support.

• 7

  Know and discuss your options with your provider and your partner. Sex is an incredible gift and should never be dismissed as "over" just because a man is of a certain age or has a medical condition. There are answers out there; demand to know what they are!