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Is Your Prostate Prostrate?

The prostate is a male sex gland about the size of a walnut. It has three lobes and surrounds the neck of the bladder and urethra -- the tube that carries urine from the bladder. It secretes a weakly alkaline fluid which forms part of the seminal fluid through ducts that open into the prostatic portion of the urethra.
While prostate cancer may be the most well known and feared disease of the prostate, there are other conditions that can afflict this male gland, most notably benign prostatic hyperplasia and prostatitis. These conditions are quite common; most men will encounter some type of prostate problem in their lifetime.

Prostatitis
Prostatitis is often described as an infection of the prostate, but it can also be an inflammation with no sign of infection. Prostatitis affects men of all ages and may account for up to 25% of all office visits by young and middle-aged men for urinary complaints. Types of prostatitis include:

Acute bacterial prostatitis: This is the least common, but most serious, form of prostatitis. This acute urinary tract infection is marked by increased urinary frequency and urgency and pain in the pelvis and genital area. Patients often have fever, chills, nausea and vomiting, and pain with urination and ejaculation. Acute bacterial prostatitis requires prompt treatment and sometimes hospitalization, as the condition can lead to bladder infections, abscesses in the prostate or, in extreme cases, completely blocked urine flow.

Chronic bacterial prostatitis: The symptoms are similar to acute bacterial prostatitis, but wax and wane and are generally less severe. The diagnosis of this condition is often challenging as it is often difficult to find bacteria in the urine. Treatment includes extended courses of antibiotics and pain medications. Some patients require suppressive low-dose, long-term antibiotic therapy.

Chronic nonbacterial prostatitis/chronic pelvic pain syndrome: This is easily the most common form of the disease, but also the most difficult to treat. Patients have no bacteria in their urine, but may have other signs of inflammation, like white blood cells. Antibiotics do not help and treatment often has to be tailored to the specific individual.

Men who have an enlarged prostate or other urinary tract abnormality, who have had a recent bladder infection or recently had any object inserted into the penis (such as a urinary catheter), or who engage in rectal intercourse are at higher risk for getting prostatitis.

The diagnosis of prostatitis typically involves a comprehensive examination, including a digital rectal exam which allows the doctor to evaluate whether the prostate is enlarged or tender. Additional tests may be performed, such as a prostate fluid analysis for signs of infection, transrectal ultrasound, or voiding studies. Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected. Patients are often referred to a urologist to confirm the diagnosis.

Treatment varies depending on the type of prostatitis, the patient, and the doctor, and can include a combination of stool softeners, warm sitz baths, pain and anti-inflammatory medications, muscle relaxants, and sometimes surgery. Infectious prostatitis requires antibiotics as well (usually 14 days for acute prostatitis, 4 to 12 weeks for chronic infectious prostatitis). Some patients with chronic nonbacterial prostatitis benefit from osteopathic manipulation, relaxation, counseling, avoiding spicy foods and caffeinated drinks, and may need to avoid activities like bicycling which can aggravate the condition.

Chronic prostatitis cannot always be cured, but most patients can get good relief by following their recommended treatment.

Benign Prostatic Hyperplasia
Benign prostatic hyperplasia (BPH for short) is the most common prostate problem in men. Almost all men will develop some degree of this non-cancerous enlargement of the prostate as they age. By age 60, 50% of men will have some signs of BPH. By age 85, 90% of men will have signs of the condition. A third of these men will require treatment for their symptoms.

The prostate gland surrounds the urethra (the tube that carries urine out of the body), so if it gets enlarged it can start pinching off this tube. This can cause symptoms like a dribbling or weak stream of urine, difficulty starting to urinate, frequent urination or urgency.

Doctors can diagnose BPH by taking a medical history and performing a physical exam, including a digital rectal examination. Because the prostate gland is in front of the rectum, the doctor can feel if the gland has any abnormalities (such as nodules that could be cancerous) and estimate the size of the prostate.

Patients with minimal symptoms may not initially require treatment. Once symptoms become bothersome, a number of treatment options are available. Patients are usually started on one of several different medications (two heavily advertised ones are Flomax and Avodart). A minority of patients, however, may require more invasive treatments, or even surgery to get relief. In addition to medical and surgical treatments, the herb saw palmetto has been used as a treatment for BPH. While it is generally considered safe, studies have been inconclusive to date. More studies are underway to investigate the effects and establish the effectiveness of this herb.

BPH has no known connection to prostate cancer, but both have similar symptoms, so a man with BPH may have prostate cancer and not know it. It is therefore critical to get proper and timely screening for prostate cancer regardless of whatever other prostate conditions a man may have.

Dr. Ravi Chandrasekaran is a General Internist at Maine Centers for Healthcare with admitting privileges at Maine Medical Center and Mercy Hospital in Portland. MCHC is a large, multi-specialty practice located in Westbrook, Maine. For more information, please contact the office at (207)857-9311 or visit www.mainecenters.com

 

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