Prostate cancer is a malignant tumor of the prostate, the muscular gland that is responsible for making seminal fluid in the male reproductive system. In the early stages, it does not spread beyond the prostate gland and many patients with prostate cancer can live for years without health problems. The longer it is left untreated, however, the more likely the cancer will grow and spread to other areas of the body.
Symptoms
This type of cancer rarely shows symptoms; in fact, most men who are diagnosed with the disease don't even know they have it because it grows so slowly. If you are experiencing any of the following symptoms, be sure to see your urologist immediately for a prostate cancer screening.
Benign Prostatic Hyperplasia (BPH):
A non-cancerous enlargement of the prostate gland that may lead to: [HYPERLINK TO BPH SUBLINK]
- Difficulty urinating
- An urge to urinate even when the bladder is empty
- A weak or irregular stream of urine
Prostatitis:
An inflammation of the prostate, typically caused by a bacterial infection, which includes these symptoms:
- Difficulty urinating
- Frequent urination, especially at night
- Pain or burning during urination
- Chills and fever
Prostate Cancer:
Symptoms for prostate cancer appear late, as the cancer has progressed, so you want to make every effort to screen for preventative measures before you notice these signs:
- A need to urinate frequently, especially at night
- Difficulty starting urination
- Inability to urinate
- Weak or interrupted flow of urine
- Painful or burning urination
- Painful ejaculation
- Blood in urine or semen
- Frequent pain or stiffness in the back, hips, or upper thighs
Presentation/Screening/Diagnosis
Prostate cancer is most commonly diagnosed by finding an elevated prostate-specific antigen (PSA). Screening involves both a digital rectal examination (DRE) and a blood test for PSA. If either the PSA value is elevated or a prostate exam is abnormal, a trans-rectal ultrasound guided (TRUS) biopsy of the prostate is performed.
Read "Prostate Cancer Screening Options and Revelations" for more information.
Treatment Options
Treatment options for prostate cancer depend on a variety of factors, including the size of the tumor, how much the cancer has spread and, of course, your own personal preferences. Based on these variables, your doctor may recommend one or more of the following options.
- Observation
- Radical Prostatectomy
- Radiation Therapy
As you consider treatment, be sure to make an educated decision that you can feel confident about. Do your research. Speak to people who've been through similar experiences. Discuss your options with your family. Then, choose the treatment that is best suited to your situation, your age and your health.
Read "Prostate Cancer Treatment Options" for more information.
Learn more about the most advanced prostate cancer treatment option available today by reading: "Robotic Assisted Radical Prostatectomy."
Possible Causes and Prevention
Unfortunately, there are no conclusive studies proving that prostate cancer can be prevented. The good news is that you can significantly lower your risk by choosing a healthy lifestyle and starting screening early.
- Eat a low-fat diet that's high in vegetables, fruits and grains
- Consume more antioxidant-rich foods such as tomatoes, spinach, artichoke hearts, beans, berries, grapefruit, oranges and watermelons
- Get regular exercise and maintain a healthy weight
- Visit your doctor to get tested for prostate cancer, starting at age 45
Resources
National Prostate Cancer Coalition: www.fightprostatecancer.org
The American Prostate Society: www.ameripros.org
The Prostate Help Association: www.pha.u-net.com
Us Too Prostate Support Group: www.ustoo.com
Prostate Health: www.prostatehealth.com
Benign prostatic hypertrophy (BPH) is the nonmalignant enlargement of the prostate gland. Prostatic growth and enlargement is a natural process that occurs in all men; in some men, growth can be excessive and can obstruct the flow of urine. Those with an enlarged prostate might find that they have to strain more than they did previously to start their urinary stream. In addition, they might find that they have to get up once, twice, or even three times during the night to urinate.
When men attempt to urinate, they contract the urinary bladder and relax the urinary sphincter, which allows urine to pass from the bladder and out of the body through the urethra, a tube that runs from the bladder through the prostate and the penis. The prostate completely surrounds the first part of the urethra so, as it enlarges, it can pinch off the urethra, causing the flow of urine to be obstructed. In some cases, obstruction may occur without dramatic prostatic enlargement. For other patients, significant enlargement of the prostate can be present without noticeable urinary symptoms. Although urinary problems are more common as men age and the prostate enlarges, prostate size does not directly correlate with urinary symptoms or obstruction.
BPH primarily affects men over the age of 40, of all races and ethnic backgrounds. In fact, approximately 80% of men over the age of 70 have some degree of BPH. Failure to treat BPH can result in recurrent infections, inability to urinate, bladder muscle dysfunction or kidney failure .
Symptoms
While BPH is not a fatal condition, its symptoms can affect quality of life. Fortunately, not all men will suffer bothersome symptoms. Currently, it is estimated that 25%-50% of men with an enlarged prostate have some degree of bothersome urinary symptoms and require some form of medical or surgical treatment . It can also be an early sign of prostate cancer, so men who show symptoms must see their physician for testing.
- Difficulty urinating
- An urge to urinate even when the bladder is empty
- A weak or irregular stream of urine
Treatment Options
Most men do not seek treatment for BPH unless their symptoms are extreme or complications occur. In this case, it can be treated with medication or surgery. Read on to learn more about treatment options.
Observation
Usually reserved for those patients with minimal symptoms (AUA-PSS < 7) from BPH. Although symptoms are not particularly bothersome, these patients should still continue to see their physicians regularly (yearly) for examinations and routine laboratory tests. These tests are designed to avoid having urine back up toward the kidneys (hydronephrosis) or bladder decompensation ("silent prostatism"). Patients followed by observation may eventually require medications or surgical interventions for BPH if they develop complications such as: bladder stones, urinary retention (inability to urinate), recurrent urinary tract infections, or signs of kidney damage.
Medical
Medical therapy or office laser therapy represent first line treatment of symptomatic prostatic enlargement. Currently, alpha-adrenergic receptor blockers and 5-alpha reductase inhibitors are the two classes of drugs are used to treat BPH.
Read "Treating BPH with Drug Therapy" for more information about these options.
Minimally Invasive Treatments
Physcians Urology offers a variety of minimally invasive treatment options. Several different laser procedures are available to treat enlargement of the prostate. When compared to standard transurethral resection of the prostate (TURP), these procedures offer a decreased risk of complications such as bleeding and fluid absorption, retrograde ejaculation, impotence, and incontinence. Your physician will carefully evaluate your individual condition to determine which procedure is right for you.
- Interstitial laser coagulation of the prostate (ILC): indicated as initial treatment for patients who do not want to take medication on a daily basis or for those who do not respond to medications. This is an office procedure performed under local anesthetic. Total treatment time averages 5 min with over 70% of patients experiencing significant improvement in their symptoms. Complications can include urinary tract infection, bleeding and irritative voiding symptoms.
- Transurethral laser photoselective vaporation of the prostate (PVP): PVP is a new laser technology that promises to be as effective as TURP with less complications. It is designed for larger glands and is performed in the operating room under general anesthesia.
Surgery
Standard surgical options include: photoselective vaporation of the prostate (PVP), transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP), and open prostatectomy.
TURP, the gold standard of effective treatment for BPH, involves removal of the core of the prostate using an instrument passed through the urethra. High frequency current flowing through a wire loop allows removal of "chips" of prostatic tissue and coagulation of blood vessels. The prostate tissue is removed through the cystoscope that is used to visually guide and monitor this process. Patients require a urethral catheter for 1-2 days and usually stay in the hospital overnight. Most patients (80% to 90%) experience dramatic improvement in their symptoms and urinary flow rates after TURP. Possible side effects include bleeding requiring transfusion, salt imbalances from fluid absorption, impotence (less than 5%) and incontinence (1% to 2%).
TUIP results are similar to TURP, however, instead of removing prostatic tissue, an electrical knife is used to make small cuts in the prostate. This relieves pressure on the urethra and generally results in decreased symptoms and increased flow rates. TUIP is generally used in smaller prostates.
Open prostatectomy is performed for those patients with very large prostates (greater than 80 grams) in whom transurethral surgery would be difficult to perform safely. In this procedure, an incision is made from the navel to the pubic bone. The bladder is opened and prostatic tissue is removed through the bladder. A urethral catheter remains for approximately 7 days and patients stay in the hospital 3-5 days. It is a more invasive procedure and complications include bleeding and infection.
Possible Causes and Prevention
BPH is a normal process of aging in most men. It's typically caused by hormonal changes or cell growth factors. Genetics play a role, but there are no conclusive studies that show why some men have more extreme cases of BPH than others.
Resources
Urologix: www.urologix.com
The American Prostate Society: www.ameripros.org
The Prostate Help Association: www.pha.u-net.com
Us Too Prostate Support Group: www.ustoo.com
Prostate Health: www.prostatehealth.co
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