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Prostate Problems
What it does and why it can cause trouble
It seems like the prostate gland gets more media attention these days than any other part of the male anatomy. Sitting like a cuff around the urethra (the urine passage just beneath the male bladder), the prostate gland is about the size and shape of a chestnut. In the early lives of most men, the prostate gland quietly does its work. Later in life, it may cause trouble - either through prostate growth (which interferes with the flow of urine from the bladder) or through prostate cancer.
Why do men have a prostate if it causes so much trouble? Without the prostate, reproductive function would not be very efficient. During sexual arousal the prostate swells to block the urethra, so urine is not released during intercourse. It also forms a barrier that prevents sperm from ending up in the bladder. As well, the prostate makes a thick mucous plug that acts like a piston during ejaculation, propelling sperm from the penis.
Benign Prostatic Hyperplasia
As men reach middle age (40 years and older), the core of the prostate doesn’t know when to quit growing. This condition is called benign prostatic hyperplasia, or BPH for short.
As the prostate grows, the urine stream becomes slower and thinner. Dribbling after passing urine is common - ‘No matter how you shake and dance, the last drop’s always in your pants.’ Sleep can be disturbed by repeated nightly trips to the bathroom. Your family doctor can advise you about the scoring system which helps judge who may benefit from medical or surgical treatment of BPH.
Sometimes the flow of urine stops completely. Men arrive at the emergency department suffering from a full bladder which they are unable to empty. A rubber tube (catheter) is put into the penis and threaded up to the bladder to bring relief. Cough and cold medications sometimes trigger this event in middle-aged men.
The bladder may also, over time, empty less and less completely. Men are then at risk of a dangerous urinary infection, which can gradually destroy the kidneys. Your doctor may order urine and blood tests to diagnose this condition. An ultrasound of the bladder shows how well it empties.
A urologist (a doctor who works with the urine system) may look at the urine passage and the bladder with a scope, under local freezing. Treatment could consist of medications such as Flomax™ or Proscar™. Sometimes surgery is needed to remove the prostate tissue blocking the flow of urine.
The vast majority of men over 40 experience slowing of the urine stream and need to empty the bladder once or twice a night. Symptoms more severe than these, or others including blood in the urine, painful passing of urine, and interrupted stream, need to be assessed by a doctor, often with the help of a urologist. Bladder cancer, for example, may irritate the urinary system.
Prostate Cancer
Prostate cancer is a harmful growth that starts in the outer part of the gland. By the time the cancer grows enough to cause systems like those of BPH, it may be controllable but not curable. This is why there is a keen interests in tests like the PSA (prostate specific antigen). This simple blood test can diagnose cancer early enough to allow a cure.
Many doctors and urologists recommend a yearly PSA after age 50. Another plan may be a PSA at age 40, 45 and every two years starting at age 50. However, the situation is not quite as simple as it appears. Of men over 50, about one in three will have at least microscopic spots of prostate cancer. About one in eight will eventually be diagnosed with prostate cancer, but only a small percentage (around three per cent) will die from it.
Although prostate cancer is very common, many cases either do not progress or progress so slowly that there is no effect on men’s lives. Treatment may result in complications including poor sexual function or urine leaking from the penis. The PSA is also far from perfect. It sometimes scores a high result in men without a trace of cancer, or normal results in those with cancer.
The PSA, and follow-up needle biopsies, cannot reliably tell apart the cancers that will progress and need surgery, from those for which surgery would not be necessary. (A needle biopsy is the removal of a small amount of tissue for testing.) Doctors find that men with family members or friends who have been diagnosed with prostate cancer, and men from families in which many members have experienced cancer, are receptive to PSA testing.
On the other hand, men whose relatives and friends have not experienced cancer may be more concerned about other health issues such as heart disease, and are less interested in PSA.
What about the rectal exam (DRE) with the doctor’s finger?
At the yearly health examination of men over 40, most doctors will don a glove and ask the patient to turn onto his side and draw up his knees so that the prostate can be examined. If a firm lump on the prostate is felt, a needle biopsy will be needed. An exam that finds no lump on the prostate does not do away with the need for a PSA (for those who believe in it), as the rectal exam will not catch all cancers.
When the cancer is confined to the prostate gland the usual treatment is to remove it by surgery. This is called a radical prostatectomy and it offers a high probability of cure. Radiation with x-rays is done to control cancer if there is very little spread in the area. Medications can also be used to slow the growth of prostate cancer that cannot be cured.
Can prostate cancer be prevented?
Research has not yet confirmed a reliable prevention strategy. However, the risk is lowered by a diet low in fat and adequate in selenium, fibre, fruits, vegetables, vitamin E, soya beans and tomato products.
The prostate can cause trouble, but being born with a prostate is worth it.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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