Every single man at some point in his life is at risk of developing prostate issues. Because all men have a prostate, all men in your life – whether it is your grandfather, father, brother, husband, son, or boyfriend – have the chance of having to face a diagnosis of a prostate problem.
The walnut-sized prostate gland is tucked away inside a man’s body where it resides in front of the rectum between the bladder and penis. Weighing around 1 ounce (28 grams), the prostate surrounds the urethra, the tube that carries urine from the bladder to the penis. The prostate’s purpose is to secrete fluid that nourishes and protects sperm, making it a vital part of the proper functioning of the male reproductive system. It is during ejaculation when the prostate contracts, squirting its fluid into the urethra as the millions of sperm speedily travel down to their destination.
Like any part of the human body, the prostate gland can develop certain problems over the course of a man’s life. But there are three prostate issues that are more likely to cause problems in which a man will need to seek the advice and expertise of a urologist. These three issues most likely to affect the prostate gland are the following:
Affecting men of all ages, prostatitis or inflammation of the prostate, is a painful condition for which more than two million men seek help every year from their doctor. Symptoms of prostatitis can include the following:
- Burning or painful urination
- Urgent need to urinate
- Trouble voiding
- Difficult or painful ejaculation
- Pain in the area between the scrotum and rectum known as the perineum
- Lower back pain
There are four types of prostatitis:
- Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)
- Chronic bacterial prostatitis
- Acute (sudden) bacterial prostatitis
- Asymptomatic inflammatory prostatitis
Examination of a man’s symptoms will help a doctor determine which type of prostatitis he is suffering from. It is not completely understood what causes prostatitis but the condition is usually caused by common strains of bacteria. One way an infection may start is by bacteria getting into the prostate when infected urine flows backwards from the urethra. Antibiotics are used to treat this problem, but if the bacteria are not completely eliminated with antibiotics, then prostatitis may recur or be more difficult to treat.
Other possible causes of prostatitis include:
- Recent placement of a catheter or another instrument in the urethra
- An abnormality found in the urinary tract
- A recent bladder infection
Treating prostatitis usually involves taking an antibiotic along with anti-inflammatory drugs, pain medications, or muscle relaxants. Other treatment methods might include hot baths or a heating pad to ease pain or, in rare cases, surgery on either the urethra or prostate.
2. Benign prostatic hyperplasia (BPH)
One of the most common conditions affecting a man’s prostate is benign prostatic hyperplasia or BPH. This condition is an enlargement of the prostate that puts pressure on the urethra making it difficult to urinate, along with other associated symptoms.
This condition becomes more prevalent as a man ages with the risk of BPH increasing each year after a man turns 40. By age 60, more than half of all men will have BPH and by age 85, about 90% of men have this condition.
Most of the signs and symptoms of BPH are urinary related. As the prostate enlarges, this puts pressure on the urethra, reducing the flow of urine. This can result in various symptoms, such as:
- Urinary urgency
- Frequent urination
- Dripping and leaking after urination
- Straining to urinate
- Waking up during the night to urinate
- A weak or slow urinary stream
- Incomplete emptying of the bladder
- A urinary stream that starts and stops
Not every man who has BPH will necessarily know this is the case, as only about 30% of men with the condition will have noticeable symptoms. The causes of BPH are not known or understood. What is known, however, is that it mainly occurs in older men. There appears to be an association with the hormone testosterone as BPH does not develop in men whose testicles were removed before puberty. Therefore, researchers believe that factors related to aging and the testicles may cause BPH.
BPH is generally confirmed through urinalysis, PSA blood testing, and a rectal exam. There is also a BPH Symptom Score Index developed by the American Urological Association (AUA) that will rate BPH from mild to severe based on urinary symptoms.
Because BPH progresses rather slowly over a number of years, the decision to treat the condition depends on the severity of the symptoms. Mild cases of BPH may not need any treatment whatsoever.
The main treatments for BPH include:
- Watchful Waiting/Active Surveillance
- Medical Therapies
- Minimally Invasive Surgeries
- Transurethral Resection of the Prostate (TURP)
3. Prostate cancer
Prostate cancer consists of the uncontrolled growth of cells within the prostate gland. According to the National Cancer Institute (NCI) approximately 14% of men will be diagnosed with prostate cancer at some point during their lifetime, based on 2010-12 data. This cancer is considered a fairly common one for men with estimates for 2017 predicting 161,360 new cases will be diagnosed while an estimated 26,730 men are predicted to die from the disease.
However, if prostate cancer is discovered in its early stages, it has a 98.9% survival rate as reported from the NCI. The best defense is to have a game plan of a good offense when it comes to prostate cancer. Men need to have yearly exams to assess what is going on with their prostate. A simple rectal exam, which takes less than a minute, and a yearly PSA blood test starting at age 40 are good screening tools urologists use to detect any changes in the prostate gland. Not getting screened is unwise as a man will be missing his opportunity to catch any changes before it’s too late.
Treating prostate cancer depends on the staging and aggressiveness at the time of diagnosis. If prostate cancer is diagnosed at an early stage, one option a man and his doctor may decide on is active surveillance. This is the decision not to treat prostate cancer at the time of diagnosis based on the man’s age, health condition and the rate of growth of the cancer.
However, if test results show a man’s prostate cancer to be aggressive, there are several methods of therapy to consider, all depending again on each individual man’s prostate cancer, the expected rate of growth, staging and other factors. The doctor may decide to choose one type of therapy or a combination to beat back the cancer. His choices range from the da Vinci prostatectomy, radiation therapy, Cyberknife SBRT procedure, IMRT procedure, seed implant procedure, or hormone therapy.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical contributor for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pinterest, SamadiMD.com, davidsamadiwiki, davidsamadibio and Facebook.