Prostate Problems: Overview

The prostate (PRAH-state) is the walnut-sized gland located below the bladder and in front of the rectum * in males. It may enlarge, become inflamed (prostatitis), or develop cancer, especially as men grow older.

Prostatic (prah-STAT-ik) enlargement is more commonly known by the name benign prostatic hyperplasia (be-NINE pros-TAT-ik HI-per-PLAYzha), or BPH. Breaking this name down into parts makes it easier to understand. Prostatic indicates that this enlargement is a condition that affects the prostate gland. The prostate surrounds the upper part of the urethra (yoo-REE-thra), the tube that empties urine from the bladder and outward through the penis. The prostate makes a thick fluid that is important in the transportation of sperm * . Hyperplasia means that there is an excessive formation of normal cells. The term indicates that in this condition too much tissue is growing in the prostate gland, making it larger than normal. Finally, benign means that this extra tissue is not cancerous and will not spread to nearby tissues or other parts of the body. BPH mainly affects men over the age of 50. Doctors believe that roughly half of men over age 60, and 8 out of 10 men over age 80, have this condition. Researchers are not sure what causes benign prostatic hyperplasia, but they believe it may involve changes in hormone * levels related to aging.

BPH is rarely a threat to life, but may require treatment to relieve symptoms. As the prostate enlarges, it pushes against the urethra and bladder, blocking the normal flow of urine, similar to the action of a clamp on a garden hose. Men with this condition usually feel like they need to urinate more often because they cannot empty the bladder completely. Two types of drugs are commonly prescribed to shrink the prostate: alpha blockers and 5-alpha-reductase inhibitors. The alpha blockers block cell receptors in the prostate so that factors causing tissue growth cannot interact. These drugs (for example, Flomax, Hytrin, Cardura) also treat high blood pressure. The reductase inhibitors (Avodart and Proscar) limit production of a hormone thought to cause the prostate to enlarge. In some cases, surgery may be necessary to treat BPH.

Prostatitis (prah-sta-TITE-is) is the inflammation of the prostate. It is a fairly common problem, accounting for almost 2 million outpatient visits per year in the United States. Eight percent of American men will experience prostatitis at some point in their lives. It can be sudden and serious (acute) or develop over time (chronic) and cause urinary problems and pain. Chronic prostatitis is sometimes referred to as chronic pelvic pain syndrome, or CPPS.

Bacteria in the prostate or irritation from a variety of sources causes swelling and soreness in the prostate. Symptoms can include fever; the urge to urinate frequently; pain when urinating or ejaculating, or pain in the prostate itself and lower back; and blood in the urine. Acute prostatitis is less common and may cause flu-like symptoms, and the pain may extend to the genitals. The third and most common type is nonbacterial prostatitis. This form of prostatitis is chronic; has symptoms similar to acute prostatitis but without fever; and as the name implies, has no bacteria in the prostate, although white blood cells or pus cells may appear in the urine. The cause is not clear but may relate to physical exertion, strong vibrations or muscle spasms, or a narrowed urethra.

Doctors perform physical and digital rectal exams and perhaps a PSA test to rule out other conditions. Urine and blood tests help determine the specific type of prostatitis. Antibiotics are used to combat infection, with chronic cases taking longer to treat. Medications may be used to relax muscles and help urination. Surgery may clear ducts in some acute cases.

Prostate cancer occurs when cells in the prostate take on an abnormal appearance and start dividing without control or order. These cancer cells often spread to nearby tissues and organs, and sometimes to other parts of the body.

After skin cancer, prostate cancer is the most common kind of cancer found in men and the number two cause of male cancer deaths in the United States. It is found almost exclusively in men age 50 and older. With each decade of life after 50, a man's chance of developing prostate cancer increases. About 181,000 men in the United States were diagnosed with prostate cancer every year, as of 2016, with African American men at higher risk than Hispanic or Caucasian men. This cancer occurs when cells in the prostate divide without control or order, forming tumors. Tumors may or may not be cancerous. Prostate cancer varies widely among men with the condition. Some men develop small, slow-growing tumors that remain within the prostate gland. Others develop fast-growing, aggressive tumors that spread quickly into the surrounding bone. Prostate tumors also can spread to nearby organs such as the bladder, rectum, and lymph nodes * . Still other cases fall between these extremes. How doctors treat the disease usually depends on how rapidly the tumor is growing.

Prostate cancer usually does not cause any symptoms when it begins to develop. That is why doctors recommend that men age 40 and older have digital rectal examinations every year. A gland that feels hard, lumpy, or enlarged may indicate the presence of prostate cancer. Later symptoms may include a need to urinate frequently, especially at night; difficulty urinating or holding back urine; pain or burning while urinating or having sex; blood in the urine or semen; and frequent pain or stiffness in the lower back, hips, or upper thighs. Although these symptoms may indicate prostate cancer, they can also be caused by some other condition.

Doctors usually start with a digital rectal examination. They also may take a blood sample and test it for PSA. Physicians may order additional laboratory tests or a urine sample to check for blood or other signs of infection. The only sure way to know whether cancer is present is to do a biopsy (BI-op-see). The doctor uses a needle to remove a small amount of tissue from the prostate and has it examined under a microscope. The appearance of the cells will show whether cancer is present; and if so, how quickly it is likely to grow and spread. Cells that are just slightly abnormal suggest that the cancer is slow-growing. Extremely abnormal cells suggest that the cancer is likely to grow and spread more quickly. If cancer is diagnosed, the doctor may order additional tests to determine whether the disease has spread to other parts of the body.

Treatment depends on several different factors: the man's age and general health; how aggressive the cancer is; and whether it has spread beyond the prostate. Sometimes, the best treatment is no treatment at all. For some older men and men with serious health problems, the possible risks and side effects of treatment may outweigh the benefits. Men whose cancer is slow-growing or found at an early stage may not require treatment right away. In these cases, doctors may prefer to monitor the patients’ condition carefully and wait to see how the cancer develops. The usual treatments are surgery, radiation therapy, or hormonal (hoar-MOAN-al) therapy. Some patients may receive a combination of these treatments.

The surgery is called radical prostatectomy (RAD-i-kal prah-staTEK-to-mee), and it involves removing the entire prostate gland. Sometimes, nearby lymph nodes are removed as well. Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing and dividing. These rays might come from a machine, or they may come from radioactive material that is placed into or near the tumor.

Hormonal therapy works by blocking the male hormones that the prostate cancer cells need to grow. There are different approaches to hormonal therapy. Sometimes surgeons remove the testicles (TES-tih-kulz), the smooth, oval-shaped glands located behind the penis. These are the body's main source of male hormones. Doctors also might give drugs or other hormones that prevent the testicles from making testosterone (tesTOS-ter-ohn), the primary male sex hormone.

In many men, prostate cancer can be controlled or even cured, but the treatments often cause lasting side effects. Some men can no longer have an erection, which means that the penis no longer becomes hard during sexual activity. Other men lose control of their urinary bladder. Fortunately, new treatments and surgical procedures are available that may avoid or minimize these side effects. If these side effects occur, men may feel depressed or upset. Some men find it helpful to join a support group so they can discuss their symptoms with others in the same situation.

As of 2016, there was nothing a man could do to prevent prostate cancer. A diet high in fruits and vegetables and low in fat may help, but researchers have not confirmed this theory. Studies continue to test drugs that might help to prevent prostate cancer, but no definite results are available. The best way for men to protect themselves is to have annual checkups and report any unusual symptoms right away. Like other types of cancer, prostate cancer is easier to treat when found early.

See also Aging • Cancer: Overview • Incontinence • Testicular Cancer • Tumor

* rectum is the final portion of the large intestine, connecting the colon to the anus.

* sperm are the tiny, tadpole-like cells males produce in their testicles. Sperm can unite with a female's egg to result eventually in conception.

* hormone is a chemical substance that is produced by a gland and sent into the bloodstream carrying messages that have specific effects on other parts of the body.

* lymph nodes (LIMF) are small bean-shaped masses of tissue containing immune system cells that fight harmful microorganisms. Lymph nodes may swell during infections.