Prostate Health

What is a prostate?

The prostate is a small (normally smaller than a golf ball) gland located beneath the urinary bladder and wrapped around the urethra.

Due to its location below the bladder and directly in front of the rectum, the prostate can be palpated through the rectum. A normal prostate has a soft feel to the touch, even in consistency without lumps.

Although it is called a gland, an organ would be a more descriptive term for the prostate. It is made of two lobes (or regions) completely surrounded by an outer tissue layer.

What does it do?

The prostate’s function is that it makes a fluid that activates sperm as they are being ejaculated. Prostatic fluid makes up about 30 percent of semen. Before ejaculation, prostate fluid lubricates the urethra.

It also bathes the sperm, providing them nourishment and activating them to “swim”. Prostatic fluid has a high pH (alkaline) which makes the receiving vagina less acidic. These prostatic responsibilities mean men without prostates are generally sterile.

What diseases affect the prostate?

The prostate is affected by three main categories of problems:

Benign Prostatic Hypertrophy– non-cancerous overgrowth of the prostate. This is the most common prostate problem for men over 50
Prostatitis– inflammation of the prostate. This is the most common prostate problem for men under 50
Prostate Cancer– A male only cancer which will affect one in three men in their lives.

What is Benign Prostatic Hyperplasia?

Benign prostatic hyperplasia (BPH) stands for benign prostatic hyperplasia which means a noncancerous enlargement of the prostate gland.

• “Benign” refers to the fact that the growth is noncancerous.
• The term “prostatic” refers to the prostate gland.
• “Hyperplasia” describes a condition in which the number of cells in an organ increases, leading to an overall increase in size of the prostate.

An enlarged prostate gland is a common condition, affecting the lifestyles and, to some degree, the health of many men over the age of 60. It can play havoc on a man’s ability to urinate with ease and, in some cases, can lead to serious medical complications.

However, the condition is not cancerous. And there are many methods to improve the flow of urine if it does become obstructed by an enlarging prostate.

Enlargement in the size of the prostate:

• Is the result of an increase in the number of cells in the prostate gland
• May occur at different locations within the prostate and give rise to different prostate shapes

How common is BPH?

The prostate gland normally increases in size as men age. This does not usually create a urinary flow problem for men under 40 years of age.

After age 40, however, the prevalence of BPH rises sharply.

• The incidence of BPH is at least 50 percent for all men at the age of 50.
• The incidence of BPH rises to at least 80 percent of all men in their eighth decade of life.
• However, only about 25 percent of men will actually be treated for BPH by the age of 80.
• Only about 50 percent of men with an enlarged prostate gland have a condition in which there is some degree of obstruction of the bladder outlet.

What causes Benign Prostatic Hyperplasia:

Theories regarding EP’s origin abound, but no one/single cause has yet been determined. However, scientists believe the key factor determining condition onset is the hormonal variation in males, most notably, specific androgenic compounds. Androgens are male hormones, including the principle hormonal compound in men, testosterone.

The prostate converts testosterone into dihydrotestosterone, or DHT. This androgen is an important component in prostate cell growth in the tissues that line the prostate gland (glandular epithelium). Additionally, dihydrotestosterone is a key contributor to rapid enlargement of the prostate; a process which occurs between puberty and adulthood (years 11-14), as well as in later adulthood (around 25 years of age). And although the prostate will continue to grow throughout the majority of a man’s life, enlargements to this gland rarely cause symptoms before the age of 40.

The female hormone estrogen may also play a particular role in prostate gland enlargement, as the testosterone to estrogen level is dramatically decreased with age. Other plausible causes of Benign Prostatic Hyperplasia include:

• Blood vessel injury
• Defective cell death (cell proliferation)
• Late Activation of prostate cell growth

Signs and Symptoms of BPH:

There is a large discrepancy regarding the enlargement of the prostate and how severe the symptoms will present. These symptoms are collectively called LUTS, or lower urinary tract symptoms. Some men with very enlarged prostates will be relatively asymptomatic, while others whose glands are less enlarged may have more urethral blockage and present greater complications. However, the primary symptoms of BPH often arise as abnormalities in urination. These can include;

• a hesitant, interrupted, or weak stream of urine
• leaking or dribbling
• urgency
• frequent urination, especially during periods of rest
• impacting your quality, or way of life

Many men find that detecting a blockage or obstruction within the urethra is difficult. For some, inconsistencies in urination may fall into their personal perspective of the aging process. However, it remains important to speak with your physician if you are currently suffering from any of the symptoms listed above. Some 80% of men who present such symptoms are diagnosed with BPH. Although this is beneficial, there is cause for greater concern. Urinary complications may be a sign of a more complex and serious disorder that requires immediate medical attention.

The most severe of all EP’s symptoms is not a symptom at all, rather an acute condition. Acute urinary retention results from both the squeezing of the urethra from the enlarged prostate and chronic urine retention (often caused by ignoring the initial signs and symptoms of BPH). This condition occurs when a man suddenly finds himself unable to urinate. It can be triggered by fluctuations in temperature, adverse reaction to prescription medications, alcohol consumption, etc. Urine retention (acute and chronic) and strain on the bladder may result in urinary tract infections, kidney or liver damage, bladder or urinary stones, and incontinence.

Early diagnosis remains key in lowering the complications of BPH and potential for acute urinary retention.

Diagnosing BPH:

The procedures needed for an accurate diagnosis of benign prostatic hyperplasia are usually left to a urologist, a doctor who specializes in problems of the urinary tract and male reproductive system. There are a number of tests that can be conducted to determine the severity and extent of your condition. The most common tests are listed below. However, it is important to note that there are more specific tests that can be done to check for prostate enlargement. As well, testing procedures are determined by the urologist and will vary from individual to individual.

Urine Flow Study: Patients will be asked to urinate into a special device. This will provide data that is used to evaluate the rate at which urine flows.

Rectal Ultrasound: This type of ultrasound is conducted when prostate cancer is suspected. The echo patterns emitted from the probe returns patterns of sound waves which form an image of the prostate gland on a display monitor.

Cytoscopy: A cytoscope, or tube that contains a lens and light system (inserted into the opening of the urethra), shows the health of urethra and bladder by displaying a real-time picture. The doctor is able to determine the size of the prostate gland and locate the area of obstruction.

Digital Rectal Exam: This test is considered standard when assessing prostate enlargement. It is commonly the first test that is performed. During this procedure your physician will insert a gloved finger into the rectal cavity and will feel the part of the prostate closest to the rectum. This provides the doctor with the approximate size of the gland, and will give him an idea of the prostate’s current condition.

Prostate Specific Antigen (PSA) Test: PSA tests are used to rule out infection (prostatitis) and cancer as a possible cause for urinary symptoms. PSA is the protein produced by the prostate’s cells, as elevated levels of this protein are witnessed in both BPH and prostate cancer patients. In fact, the U.S. Food and Drug Administration recommends both the digital rectal exam and PSA testing for detection of cancer in men over the age of 50. However, because it is difficult to discriminate cancer from benign prostate conditions, specialists will usually only implement PSA tests to find elevations that are abnormal, rather than differentiate between the two conditions.

International Prostate Symptoms Score: The International Prostate Symptoms Score, or IPSS, this test, unlike laboratory or other objective tests, is based on the patients personal experience. Prostate conditions are rated on the basis of severity. The higher the score, the more severe the condition. Other indexing systems, including the Symptom Problem Index (SPI) and the BPH Impact Index (BII), are often used in conjunction with the IPSS to guage different quality-of-life and disease issues resulting from the condition.

Conventional Treatments for Enlarged Prostate:

Conventional treatments for BPH are dependant upon a number of factors, namely, urine flow, prostate inflammation, prostate size, and PSA levels. In addition, the IPSS is used by numerous physicians as a means to determine condition severity and individual treatment options. Men over the age of 50 are more likely to need treatment for symptom management. That being said, mild prostate enlargement is often treated with “watchful waiting.” “Watchful waiting” involves lifestyle changes and annual examinations after an initial examination has shown that there are no other underlying prostate disorders.

Moderate symptom management usually encompasses the use of prescription medications to ease the discomfort of the enlarged prostate. There are two common types of medication used: alpha-blockers and anti-androgens (e.g finasteride). Most men are administered alpha-blockers. It is estimated that 40% of men suffering from what they deem as moderate symptoms will seek prescription drug treatments.

Patients with scores indicated the severest of symptoms almost always seek treatment. Again, prescription medications are the primary choice. However, nearly a quarter of all men who present severe symptoms opt, or need, surgery. There are many choices with surgical procedures to ease prostate discomfort. The standard procedure (90% of cases), however, remains a transurethral resection of the prostate (TURP). During this procedure, the surgeon uses a resectoscope to remove any obstructing tissue. The pieces of tissue are carried by fluid to the bladder where it is then flushed out at the end of the 90 minute operation.

Despite the advances is conventional prostate treatments, four out of ten men require invasive surgical procedures for symptom relief. Additionally, the recovery time for these procedures is months. Many men also have resounding effects in areas of sexual functioning and pleasure during intercourse. Finally, what many patients fail to realize, is that BPH surgeries leave much of the prostate intact; therefore BPH can still be possible in patients even though surgery and the healing process has been completed.

What is Prostatitis?

Prostatitis is a term used to describe inflammatory conditions of the prostate gland. It is thought that most cases of prostatitis result from bacterial infection, but evidence of infection is not always found. An infected or inflamed prostate can cause painful urination and ejaculation, and if left untreated, serious complications.
Prostatitis can affect men of any age and it is estimated that 50% of men experience the disorder during their lifetime. Prostatitis is the most common urological disorder in men over the age of 50 and the third most common disorder in men younger than 50.

According to the National Institutes of Health, prostatitis accounts for 25% of all office visits involving the genitourinary system by young and middle-aged men.

Nonbacterial prostatitis and prostatodynia, which is also called chronic pelvic pain syndrome (CPPS), are the most common diagnoses. Bacterial prostatitis (acute and chronic) accounts for less than 5–10% of cases. Acute bacterial prostatitis occurs most often in men under age 35, and chronic bacterial prostatitis primarily affects men between the ages of 40 and 70.

Four types of Prostatitis and their symptoms:

• Acute bacterial prostatitis is the least common of the four types. It is also the easiest to diagnose and treat effectively. The man with this disease often experiences chills, fever, pain in the lower back and genital area, body aches, burning or painful urination, and the frequent and urgent need to urinate, often at night. The urinary tract is infected, as is evidenced by white blood cells and bacteria in the urine. The treatment of acute bacterial prostatitis is with an antibiotic appropriate for the particular bacteria. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.
• Chronic bacterial prostatitis is also relatively uncommon. This condition is basically longstanding prostatitis associated with an underlying defect in the prostate, which then becomes a focal point for the persistence of bacterial infection in the urinary tract. The symptoms include low back pain, discomfort in the perineum (the area between the anus and the genitalia), testicular pain and, if the infection spreads to the bladder, mild pain or burning on urination (dysuria) and frequent and urgent need to urinate (frequency and urgency). The effective treatment of chronic bacterial prostatitis usually requires the identification and removal of the defect in the prostate and then treatment with antibiotics. Antibiotics alone often do not cure the infection. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.
• Nonbacterial prostatitis is the most common and least understood form of prostatitis. It is believed to occur eight times more often than bacterial prostatitis. Nonbacterial prostatitis is frequently a chronic, painful condition that is found in men of any age. Symptoms go away and then come back without warning. The urine and fluids from the prostate show no evidence of a known infecting organism, but the semen and other fluids from the prostate contain cells that the body usually produces to fight infection. Doctors often treat nonbacterial prostatitis with antibiotics and drugs that relax the muscles of the prostate gland, but these treatments have not been proven to work and, in fact, often fail. This form of prostatitis can be associated with other diseases, such as reactive arthritis (formerly called Reiter’s disease). Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.
• Prostatodynia is similar to nonbacterial prostatitis with regard to symptoms, age of patients, and ineffectiveness of treatment. However, there are no objective findings, such as the presence of infection-fighting white blood cells, in the urine of men who suffer from prostatodynia. Sometimes nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are given to relieve pain.

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