As
was discussed in part
1 of this series, the prostate is
a small organ that lies below the bladder and surrounds
the urethra. The prostate makes a fluid that becomes part
of the semen. Semen is the white fluid that contains sperm.
Prostate problems are common in men older than 50 years.
A urologist is the kind of a doctor most qualified to
diagnose and treat many prostate problems.
Benign
prostatic hypertrophy (BPH)
Benign prostatic hypertrophy (BPH) is enlargement
of the prostate. An enlarged prostate may eventually block
the urethra and make it hard to urinate.
BPH
Treatment Choices
There are several different ways to treat BPH:
Watchful waiting is often chosen by men who are
not bothered by symptoms of BPH. They have no treatment
but get regular checkups and wait to see whether or not
the condition gets worse.
Alpha blockers are drugs that help relax muscles
near the prostate and may relieve symptoms. Side effects
can include headaches. Also, these medicines sometimes
make people feel dizzy, lightheaded or tired. Alpha blockers
are new drugs, so doctors still do not know their long
term effects. Some common alpha blockers are doxazosin
(Cardura), prazosin (Minipress) and terazosin (Hytrin).
Finasteride (Proscar) is a drug that inhibits the
action of the male hormone testosterone. It can shrink
the prostate. Side effects of finasteride include declining
interest in sex, problems getting an erection and problems
with ejaculation. Again, because it's new, doctors may
not know its long-term effects.
Surgery is the treatment most likely to relieve
BPH symptoms. However, it also has losts of complications.
Doctors use three kinds of surgery for BPH:
1. Transurethral resection of the prostate (TURP)
is the most common surgery performed for BPH. After the
patient is given anesthesia, the doctor inserts a special
instrument into the urethra through the penis. With the
instrument, the doctor then removes a part of the prostate
to lessen its obstruction.
2. Transurethral incision of the prostate (TUIP)
may be used when the prostate is not too enlarged. In
this procedure, the doctor passes an instrument through
the urethra to make one or two small cuts in the prostate.
3. Open surgery is often used when the prostate
is very large in size. In open surgery, the surgeon makes
an incision in the abdomen or between the scrotum and
the anus to remove prostate tissue.
Prostate Cancer
Prostate cancer is one of the most common forms of cancer
among American men. About 80 percent of all cases occur
in men older than 65 years. In the early stages of prostate
cancer, the disease stays in the prostate and is usually
not life threatening. But without treatment, cancer can
spread to other parts of the body and eventually cause
death. Some 40,000 men die every year from prostate cancer
that has spread to other organs of the body.
Diagnosis -- To find the cause of prostate symptoms,
the doctor performs a physical exam, with a careful medical
history. The physical exam includes a digital rectal exam,
in which the doctor feels the prostate through the rectum.
Hard or lumpy areas in the prostate may mean that cancer
is present.
Some doctors also recommend a blood test for a substance
called prostate specific antigen (PSA). PSA levels may
be high in men who have prostate cancer or BPH. However,
the test is not always accurate. Researchers are studying
changes in PSA levels over time to learn whether the test
may someday be useful for early diagnosis of prostate
cancer.
If a doctor suspects a prostate cancer, he or she may
recommend a biopsy. This is a simple surgical procedure
in which a small piece of prostate tissue is removed with
a needle and examined under a microscope. If the biopsy
shows prostate cancer, other tests are done to determine
the type of the treatment needed.
Prostate Cancer Treatment
Doctors have several ways to treat prostate cancer. The
choice depends on many factors, such as whether or not
the cancer has spread beyond the prostate, the patient's
age, general health and how the patient feels about the
treatment options and their side effects. Approaches to
treatment include:
Watchful waiting. Some men decide not to have treatment
immediately if the cancer is growing slowly and not causing
symptoms. Instead, they have regular checkups so they
can be closely monitored by their doctor. Men who are
older or have another serious illness may choose this
option.
Surgery usually removes the entire prostate and
surrounding tissues. This operation is called a radical
prostatectomy. In the past, impotence was a side effect
for nearly all men undergoing radical prostatectomy. But
now, doctors can preserve the nerves going to the penis
so that men can have erections after prostate removal.
Incontinence, the inability to hold urine, is common for
a time after radical surgery for cancer. Most men regain
urinary control within several weeks. A few continue to
have problems that require them to wear a device to collect
urine.
Another kind of surgery is a transurethral resection,
which cuts cancer from the prostate but does not take
out the entire prostate. This operation is sometimes done
to relieve symptoms caused by the tumor before other treatments
or in men who cannot have a radical prostatectomy.
Radiation therapy uses high energy rays to kill
cancer cells and shrink tumors. It's often used when cancer
cells are found in more than one area. Impotence may occur
in men treated with radiation therapy.
Hormone therapy uses various hormones to stop cancer
cells from growing. It's used for prostate cancer that
has spread to distant parts of the body.
Protecting Yourself
As was noted in part
1 of this series, the best protection
against prostate problems is to have regular medical checkups
that include a careful prostate exam. See a doctor promptly
if symptoms occur such as a frequent urge to urinate,
difficulty in urinating or dribbling of urine. Regular
checkups are important even for men who have had surgery
for BPH. BPH surgery does not protect against prostate
cancer because only a part of the prostate is removed.
In all cases, the sooner a doctor finds a problem, better
are the chances for the treatment to work.
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