Prostate Problems
By Roland Larrabee, MD
The prostate gland is part of the reproductive system of men. It is the size and shape of a walnut. The prostate gland is located below the urinary bladder and in front of the rectum. The prostate surrounds the upper part of the urethra. (The urethra is the tube that carries urine from the bladder to the outside.)
The prostate gland produces a fluid that is ejaculated with sperm. Prostate problems are fairly common in men over the age of 50. Because of the location of the prostate gland, enlargement or inflammation can constrict the urethra and cause problems with urination.
Prostatitis is inflammation of the prostate. It is usually caused by bacteria that enter the urethra. Prostatitis causes pain while urinating and a discharge from the penis. There may be fever, pain in the lower back or groin, and blood in the urine. Prostatitis is treated with antibiotics. The infection can be slow to clear up and may come back again.
Benign prostatic hypertrophy (BPH) is an enlarged prostate. It is one of the most common health problems in men over age 60. The cause is unknown. In the early stage of prostate enlargement, the bladder muscle forces urine through the narrowed urethra by squeezing more strongly. As a result, the bladder muscle often becomes thicker and more sensitive.
You have to urinate much more often. You begin to get up several times a night to urinate. When you do, you have trouble starting and stopping urine flow, and you have a weak stream when you are urinating. Sometimes as the prostate grows larger, the urethra is squeezed more tightly. This may make the bladder unable to empty completely. Rarely, BPH may cause repeated urinary tract infections. It may even damage the bladder or kidneys over time. It may also cause a sudden inability to urinate (acute urinary retention), a medical emergency.
Many men with enlarged prostates have no symptoms at all. Fewer than half of those diagnosed with BPH will develop symptoms severe enough to need treatment. Symptoms of BPH should always be checked by your health care provider because prostate cancer causes similar symptoms. If you have BPH but your symptoms are mild, you may not need treatment other than one or more exams a year.
Two types of medicine are used to treat BPH. One type can cause the prostate to shrink. This may take care of the urinary symptoms. The other type, called alpha blockers, relaxes the muscles in the prostate, and may relieve symptoms. If your symptoms are severe, your provider may recommend surgery. There are many types of surgery for BPH, and fortunately most of them are well tolerated and relatively easy to perform.
Prostate cancer is the most common cancer in American men. It is the second most common cause of cancer death (after lung cancer). The symptoms are very similar to those of BPH at first. Both BPH and prostate cancer cause enlargement of the prostate and squeezing of the urethra.
The symptoms of prostate cancer vary depending on the size of the tumor and how far the cancer has spread. This disease may show no symptoms at all when it begins. In men who do show symptoms, possible symptoms are: the need to urinate frequently and urgently, trouble starting a stream of urine, decreased force in the stream of urine, increased need to urinate at night, inability to urinate, bone pain or back pain if the cancer has spread, weight loss, and swollen lymph nodes. .
The outlook is much better if prostate cancer is treated before it spreads. Prostate cancer screening includes a blood test (prostate specific antibody or PSA test) and a rectal examination. Prostate cancer is treated by various combinations of surgery, radiation therapy, hormonal therapy, and chemotherapy. Because prostate cancer tends to be very slow growing, it may not be treated at all in patients over 75 years of age unless the enlarged prostate is causing urinary problems.
Dr. Larrabee is Associate Director of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.
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