Prostate Conditions

Benign Prostatic Hyperplasia

A noncancerous enlargement of the prostate that may cause difficulty in urination. Experts do not yet know what causes BPH, but the condition may be related to the hormone testosterone and its relationship to other hormones that changes during the aging process. The fact that the prostate begins to grow larger is not necessarily a problem. In fact, some men have extremely enlarged prostates but suffer no ill effects. On the other hand, some men have prostates that are only slightly enlarged and they suffer from bothersome urinary symptoms.

Signs & Symptoms

• Trouble starting to urinate.
• A weak urine stream that can start and stop, or only urinating a little bit.
• Needing to urinate more often and/or get out of bed a few times at night to urinate.
• Leaking or dribbling urine after going to the bathroom.
• Feeling like the bladder has not been emptied.
• Having a strong, sudden urge to pass urine.

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Treatment Options

• Active Surveillance-This is common for men with mild symptoms.  Active surveillance means monitoring the problem with a doctor to keep a watchful eye on it through regular check-ups. 
• Medication-There are two types of medicines to help enlarged prostate symptoms.
  • Relax muscles in the bladder and around the urethra.  These medicines, known as Alpha-blockers, have been able to help urinary symptoms in men.  Alpha-blockers do not stop or slow down the enlargement of the prostate.  They have also been known to have side effects such as dizziness, ejaculation problems, stomach problems, tiredness, low blood pressure and headaches.
  • Shrink the prostate.  These medicines, known as 5-Alpha-reductase inhibitors, lower the amount of hormone involved in prostate growth.  These medications take longer to reduce symptoms.  However, men taking these medications are less likely to have a blocked bladder and are less likely to need surgery.  The known side effects to these medications are trouble having an erection, lowered sex drive, less semen when you ejaculate and male breast growth.
• Surgery-If symptoms are severe the physician may suggest surgery.  There are a couple types of surgery for BPH.
  • Remove the enlarged part of the prostate.  This procedure is called transurethral resection of the prostate (TURP).  It is the most common approach.  There is a risk of side effects including a decline in sexual function and a loss of bladder control. 
  • Remove the prostate.  This is a major surgery that is typically only done on men with very large prostates.  There is a risk of losing bladder control and experiencing sexual side effects.  More treatment is rarely needed after having this procedure.

Prostate Conditions Treatment

Prostate Conditions Treatment

Prostate Cancer Treatment

Treatment

Over the past 20 years, overall survival rates for all stages of prostate cancer combined have increased from 67% to 89% Some of the possible reasons for the increase in survival rates include public education, new techniques of early detection, and aggressive therapy. The major treatment options for prostate cancer include surgery, radiation, medical therapy and watchful waiting. A patient's treatment options will depend upon his age, the stage of the disease, and the advice of a physician.

Surgery for Prostate Cancer

The goal of surgery is to remove the entire prostate gland and all of the cancer. What follows is a description of a number of techniques used by surgeons when operating on the prostate.

The Complete (Radical) Prostatectomy
Surgical removal of the entire prostate gland is called radical prostatectomy. Radical prostatectomy is usually performed to remove early-stage prostate cancer before it can spread to other parts of the body. Often, the pelvic lymph nodes are also sampled for a biopsy as a precautionary measure. In most cases, taking out the prostate takes out the cancerous tumor as well. If the cancer spreads outside of the prostate, it cannot be cured with surgery. Patients who undergo radical prostatectomy should expect at least a 2- to 4-day stay in the hospital, while full recovery can sometimes take up to 12 weeks.  Radical prostatectomy has become safer and less likely to leave men impotent or incontinent, although results vary from surgeon to surgeon. The risk of impotence often depends on a patient’s age, health, and the stage of his cancer. Incontinence appears to occur less often than impotence in patients after radical prostatectomy.

TURP
A transurethral resection of the prostate (TURP) involves removing tissue from the prostate by inserting an instrument through the urethra into the penis. At the end of the instrument, called a resectoscope, is an electrically heated wire loop, which is used to scoop out the unwanted prostate tissue. This procedure is sometimes necessary to relieve the symptoms of prostate cancer and to make urinating easier. It is also performed on men who cannot have a radical prostatectomy due to age or other illnesses. This type of surgery has several advantages because no surgical incision is required, hospital stays are brief and recovery is usually uneventful. In a vast majority of cases, urinary function returns to normal after a TURP. In most cases, the ability to have sexual relations is also not affected by the procedure.

Orchiectomy
Orchiectomy is a surgical procedure that completely removes the testicles. It is considered hormonal therapy because, like certain prescription drugs, orchiectomy also reduces hormone levels. In fact, LH-RH analog therapy has been shown to be comparable to orchiectomy in decreasing the body’s supply of testosterone. Most patients prefer LH-RH analog therapy over orchiectomy to treat their prostate cancer. Orchiectomy is a routine surgical procedure that usually has no long-term complications. It gives an immediate and permanent reduction in testosterone. However, orchiectomy may require being hospitalized for approximately 2 days or more. Many patients respond favorably to orchiectomy, but for those patients for whom this surgical procedure fails, the operation is often viewed as unnecessary, expensive, and possibly psychologically damaging. Hot flashes, impotence, and loss of sexual desire are common side effects with orchiectomy.

Cryosurgery
Cryosurgery treats localized prostate cancer by freezing and destroying the prostate. There is renewed interest in this procedure due to improved technology, and the fact that the Health Care Financing Administration (HCFA) has authorized reimbursement for the procedure in men with newly diagnosed T1-T3 stage prostate cancer.  HCFA made this decision because 5-year follow-up results with cryosurgery appear to be the same as those of radiation treatment.  One of the main side effects appears to be incontinence. A five-pronged probe filled with nitrogen is guided through a skin incision into the cancer using transrectal ultrasound (TRUS). TRUS allows your physician to monitor the freezing process of the prostate, which can get as low as -195° Celsius. A warming catheter is placed in the urethra to prevent damage. Cryosurgery has several benefits: low morbidity, minimal blood loss, and a short hospital stay. Complications such as impotence and incontinence can arise if the freezing damages nerves near the prostate. Some patients may also experience penile numbness or swelling, or develop obstructions from dead prostate tissue.

Radiation
Radiation therapy involves exposing cancer cells to high doses of radiation in the hope of killing the tumor. The most widely used types are external beam radiation therapy and internal radiation therapy. External beam radiation therapy treats the prostate and other selected tissues with a carefully targeted beam of radiation administered from machines outside the body. In internal radiation therapy, often referred to as brachytherapy, tiny radioactive seeds are implanted in the prostate through a surgical procedure. Compared with external beam radiation, brachytherapy may offer certain advantages: the seeds can be implanted precisely in the tumor. A higher dose can be used with potentially less damage to surrounding tissue. Implanting the seeds takes less time than a full course of external beam radiation treatment. Hormonal therapy is sometimes used before radiation therapy to shrink the prostate and the tumor. The smaller prostate may allow the radiation to be more tightly focused, concentrating the dose so that the tumor receives more rays. Hormonal therapy is often prescribed prior to brachytherapy to shrink the prostate to allow more effective seed placement and distribution. Impotence and incontinence occur slightly less often with radiation therapy than with surgery. Other side effects with radiation therapy include fatigue, skin reaction in treated areas, frequent and painful urination, upset stomach, diarrhea, and rectal irritation or bleeding. Most of these side effects disappear once treatment is stopped.

Medical Treatment of Prostate Cancer

The goal of medical therapy for prostate cancer is to shut down the production of the male hormone testosterone. The reason for this is that testosterone, which is produced almost entirely by the testicles, can stimulate the growth of hormone-dependent prostate cancer cells the same way kerosene fuels a fire.

Hormonal Therapy
Hormonal therapy is used to decrease the production of testosterone, which, in turn, slows cancer cell growth. There are various types of hormonal therapy:

• Drugs that reduce testosterone to castrate levels (i.e., LH-RH analogs)
• Surgical removal of the testicles, which produce the male hormones
• Antiandrogens, estrogens

Hormonal therapy is sometimes used before radiation therapy or before surgery to shrink the prostate cancer tumor. The smaller tumor may allow the radiation to be more tightly focused, concentrating the beam so that the tumor receives more rays. Before surgery, shrinking the tumor may allow it to be removed more effectively.

LH-RH analogs
LH-RH analogs are used to shut down the testosterone produced by the testicles, thus slowing the spread of prostate cancer. LH-RH stands for luteinizing hormone-releasing hormone.  The most common side effect associated with Lupron Depot is hot flashes. Like other treatment options, LH-RH analogs may cause impotence. Symptoms may worsen over the first few weeks of treatment. Periodic monitoring of PSA and testosterone is recommended.

Antiandrogen Therapy
Another treatment alternative for advanced prostate cancer involves the use of a hormone-blocking drug called an antiandrogen, often taken in combination with an LH-RH analog. The antiandrogen may be administered to counteract the small amount of testosterone produced by the adrenal glands.

Prostate Conditions Prevention

Prostate Conditions Prevention

Prostate Cancer Prevention & Early Detection

Prostate Cancer Prevention & Early Detection

Prevention

The exact cause of prostate cancer is unknown.  These are the only confirmed factors currently known to increase one’s risk for prostate cancer: family history, age, African American ethnicity, diet and chemical exposure.  However there have been recent studies done that may suggest ways to prevent prostate cancer include a healthy diet, the avoidance of excessive alcohol, healthy weight maintenance and regular exercise.

Early Detection

Because there are no early warning signs for prostate cancer men may choose to undergo a screening for the disease.  Screening for prostate cancer does not provide a diagnosis, it provides valuable information in finding the disease early.  Screening commonly involves two tests:  the prostate specific antigen (PSA) blood test, and the digital rectal exam (DRE).

Prostate Specific Antigen (PSA) is a protein produced by the prostate gland and there are two types of PSA that occur in the blood; free PSA and complex PSA.  Elevated PSA levels can occur as a result of conditions other than cancer, high levels of PSA can be indicative of a prostate condition or may result from other causes such as trauma, infection or sexual activity.  Some evidence suggests that elevated levels of complex PSA may be associated with prostate cancer while elevated levels of free PSA are associated with benign prostate conditions.  To screen for prostate cancer, the PSA test is often performed in conjuction with a thorough review of family medical history and a digital rectal exam.  Limitations of PSA testing are that the test only indicates a potential prostate problem but it cannot be used to diagnose prostate cancer or predict the severity of the disease.  If the results of the PSA test are positive a biopsy may need to be performed to make a diagnosis.  It is recommended that men over 50 speak to their doctor about whether PSA testing is meant for them.

A Digital Rectal Exam (DRE) is a quick and safe screening technique in which a physician feels the prostate by inserting a gloved, lubricated finger into the rectum. This simple procedure allows your physician to determine whether the prostate is enlarged, has lumps, areas of hardness or other types of abnormal texture.  The entire prostate cannot be felt during a DRE but a significant portion can be examined including the area where most prostate cancers are found.  While this examination may produce momentary discomfort, it causes no significant pain.

New tests, or biomarkers, such as the PCA3 urine test or Prostate Health Index (PHI) may aid in the detection of prostate cancer. A biomarker is a biological molecule found in blood, body fluids, or tissues that is a sign of a normal or abnormal condition or disease. Biomarkers may also be used to see how the body responds to a treatment for a disease.  To learn more about biomarkers for detection of prostate cancer please click here. *Need to link to PCEC biomarker page

Treatment

Over the past 20 years, overall survival rates for all stages of prostate cancer combined have increased from 67% to 89%.  Some of the possible reasons for the increase in survival rates include public education, new techniques of early detection, and aggressive therapy. The major treatment options for prostate cancer include surgery, radiation, medical therapy and watchful waiting. A patient's treatment options will depend upon his age, the stage of the disease, and the advice of a physician.  To learn more about all of the available treatment options for prostate cancer click here.

Prostate Cancer

Prostate Cancer

Prostate Cancer is the most common cancer and the second leading cause of cancer death in men.

• Nearly 31,620 men will die needlessly of prostate cancer.
• 1 in 9 American men will get prostate cancer in their lifetime.
• 1 in 41 American men will die of this disease.
• Prostate cancer is nearly 100% survivable if caught early.

Prostate Cancer Risk Factors

Age: The risk of prostate cancer increases with age.
Race: African American men are more than twice as likely to be diagnosed with prostate cancer and to die from the disease.
Family History: Men with a family member of prostate, breast, ovarian, colon, or pancreatic cancers may be at an increased risk of prostate cancer.
Diet: Studies indicate there may be a link between diet and the cause or prevention of prostate cancer.
Chemical Exposure: Exposure to certain chemicals such as pesticides and herbicides may have higher than average rates of prostate cancer.  Veterans who were exposed to the defoliate Agent Orange are 49% more likely than non-exposed veterans to be diagnosed with prostate cancer.
Firefighters: Recent studies show that firefighters are at a 28% greater risk to develop prostate cancer compared to the general population.
Genetic Mutations: Inherited mutations of the BRCA1 and BRCA2 gene raises the risk of breast, ovarian and prostate cancer in some families.

Prevalence of Prostate Cancer

An estimated 174,650 new cases of prostate cancer will occur in the United States this year. Prostate cancer incidence rates remain significantly higher in African-Americans and in men with a family history of the disease.  Further it is expected that 31,620 deaths will occur this year due to prostate cancer.  This is the second leading cause of cancer death in men.

Men age 40 and older who have at least a 10-year life expectancy should talk with their health care professional about having a baseline digital rectal exam of the prostate gland and a prostate-specific antigen (PSA) blood test.

Most prostate cancers are discovered in the local (confined to the prostate) stage; the 5-year relative survival rate for patients whose tumors are diagnosed at the earliest stages of the disease is nearly 100%.

Prostate Cancer Symptoms

In its early stages not everyone experiences signs or symptoms of prostate cancer.  However, you should go to your doctor if experiencing any of these symptoms because it could also be a sign of other prostate conditions.

• Problems passing urine, such as slow or weak stream.
• Problems with needing to urine frequently, especially throughout the night.
• Problems with holding back urine or even loss of bladder control.
• Finding blood in urine.
• Difficulty getting an erection or getting a painful erection.
• Pain in hips, lower back and chest.

_{-American Cancer Society}

To Learn More About Prevention and Early Detection please click here.
To Learn More About Treatment Options for Prostate Cancer please click here.

Ways to prevent prostate cancer include a healthy diet, the avoidance of excessive alcohol, healthy weight maintenance and regular exercise.

Prostatitis

Prostatitis

Prostatitis is the inflammation of the prostate gland, often resulting in swelling or pain.  There are four main classifications of prostatitis.

Acute bacterial prostatitis is an acute infection of the prostate gland, usually occurs in men aged 40 to 60 years.  Caused by a bacterial infection and comes on suddenly.  There is often blood in the urine and the PSA blood test result may be higher than normal.
Chronic bacterial prostatitis is a recurrent infection of the prostate, occurs in men aged 50 to 80 years. It is associated with chronic urinary infection and, commonly, calcifications in the prostate (prostatic stones). In the cases of bacterial prostatitis, the culprit usually is a bacterium known as Escherichia coli. The cause of bacterial prostatitis is not well defined, but one theory suggests a reflux of urine from the bladder into prostatic ducts. This reflux of urine may lead to prostatitis.  The most common symptom is recurrent bladder infections.
Chronic prostatitis is the most common yet least understood form.  Found in men of any age, the symptoms include pain in the groin or bladder, and come and go without warning.
Asymptomatic inflammatory prostatitis this is a form of prostatitis has no symptoms, and is often found when undergoing tests for other conditions.

Symptoms of Prostatitis: Each form of prostatitis has a slight variation in signs and symptoms.

Acute bracterial prostatitis:
          -Sudden onset of fever and chills.
          -Pain in lower back or rectum.
          -Irritative or obstructive urinary symptoms.
          -Prostate is warm, swollen, and tender upon examination.

Chronic bacterial prostatitis:
          -Relapsing urinary tract infections.
          -Painful urination or other voiding problems.
          -Ejaculatory pain.
          -Pelvic or genital pain.
          -Some men may not have any symptoms.

Chronic prostatitis:
          -Chronic pelvic pain (testicular, penile, lower abdominal, ejaculatory)
          -Persistent inflammation of the prostate
          -Absence of infectious bacteria in urine

Diagnosis of Prostatitis

The gold standard for diagnosing prostatitis would be to perform a biopsy of the prostate, but this is rarely done. Instead, doctors may diagnose prostatitis by examining prostatic secretions for bacteria. To do this, a "four-cup" test may be conducted. To start, the patient must have a full bladder. The doctor will clean the penis with soap and water and will then collect two cups of urine. Next, the prostate will be massaged by a digital rectal examination (DRE) to allow prostatic fluid to travel through the urethra. Two more cups of urine will be collected, and the expressed prostatic secretion (EPS) in the urine is examined for the presence of bacteria. Some physicians may not perform the "four-cup" test, and may just obtain urine before and after massaging the prostate. Sometimes EPS secretions from the urethra can be collected from the tip of the penis after massaging the prostate. After the physician collects these secretions, they can be examined under a microscope. Nonbacterial prostatitis is more difficult to diagnose. With these patients, the EPS will have evidence of inflammation, but bacteria will not be present. The lack of recurrent urinary tract infections distinguishes nonbacterial prostatitis from chronic bacterial prostatitis.

Treatment Options for Prostatitis

• Anti-inflammatory drugs along with warm baths.
• Antibiotics for infectious prostatitis. These drugs are not effective treatments for noninfectious prostatitis.
• For chronic infectious prostatitis, antibiotics are taken for a longer period of time.  About 75% of all cases of chronic infectious prostatitis clear up with this treatment. For cases that don't, taking antibiotics at a low dose for a long time may be recommended to relieve the symptoms.
• Pain medications.
• Muscle relaxants.
• Surgical removal of the infected portions of the prostate. A doctor may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine.
• Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.