PROSTATE CARE

Overview

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

The prostate secretes fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen.

An enlarged prostate gland can cause uncomfortable urinary symptoms, such as,

blocking the flow of urine out of the bladder. 

It can also cause bladder, urinary tract or kidney problems. 

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older.

• There are several effective treatments for prostate gland enlargement, including;
• Medications,
• Minimally invasive therapies and surgery. To choose the best management, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have and your preferences.

common Prostate Conditions

Prostatitis

prostatitis is Inflammation of the prostate, sometimes caused by infection. It is typically treated with antibiotics.

Enlarged prostate

Enlarged prostate Called benign prostatic hypertrophy or BPH, prostate growth affects virtually all men over 50 years. Symptoms of difficult urination tend to increase with age. Medicines or surgery can treat BPH.

Prostate cancer

It’s the most common form of cancer in men (besides skin cancer), but only one in 41 men die from prostate cancer. Surgery, radiation, hormone therapy, and chemotherapy can be used to treat prostate cancer. Some men choose to delay treatment, which is called watchful waiting.

Symptoms of Prostate Enlargement

The severity of symptoms in people who have prostate gland enlargement varies, but symptoms tend to gradually worsen over time. Common signs and symptoms of BPH include:

1. Frequent or urgent need to urinate
2. Increased frequency of urination at night (nocturia)
3. Difficulty starting urination
4. Weak urine stream or a stream that stops and starts
5. Dribbling at the end of urination
6. Inability to completely empty the bladder

Less common signs and symptoms include

• Urinary tract infection
• Inability to urinate
• Blood in the urine

The size of your prostate doesn’t necessarily determine the severity of your symptoms. Some men with only slightly enlarged prostates can have significant symptoms, while other men with very enlarged prostates can have only minor urinary symptoms.

In some men, symptoms eventually stabilize and might even improve over time.

Other possible causes of urinary symptoms

Conditions that can lead to symptoms similar to those caused by enlarged prostate include:

• Urinary tract infection
• Inflammation of the prostate (prostatitis)
• Narrowing of the urethra (urethral stricture)
• Scarring in the bladder neck as a result of previous surgery
• Bladder or kidney stones
• Problems with nerves that control the bladder
• Cancer of the prostate or bladder

When to see a doctor

In case you’re having urinary problems, discuss them with your doctor. Even if you don’t find urinary symptoms bothersome, it’s important to identify or rule out any underlying causes. Untreated, urinary problems might lead to obstruction of the urinary tract.

If you’re unable to pass any urine, seek immediate medical attention.

Causes of Prostate Enlargement

The prostate gland is located beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

It isn’t entirely clear what causes the prostate to enlarge. However, it might be due to changes in the balance of sex hormones as men grow older.

Risk factors

Risk factors for prostate gland enlargement include

• Aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than age 40 years.  About one-third of men experience moderate to severe symptoms by age 60 years, and about half do so by age 80 years.
• Family history. Having a blood relative, such as a father or a brother, with prostate problems means you’re more likely to have problems.
• Diabetes and heart disease. Studies show that diabetes, as well as heart disease and use of beta blockers, might increase the risk of BPH.
• Lifestyle. Obesity increases the risk of BPH, while exercise can lower your risk.

Complications of an enlarged prostate can include

• Sudden inability to urinate (urinary retention). You might need to have a tube (catheter) inserted into your bladder to drain the urine. Some men with an enlarged prostate need surgery to relieve urinary retention.
• Urinary tract infections (UTIs). Inability to fully empty the bladder can increase the risk of infection in your urinary tract. If UTIs occur frequently, you might need surgery to remove part of the prostate.
• Bladder stones. These are generally caused by an inability to completely empty the bladder. Bladder stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow.
• Bladder damage. A bladder that hasn’t emptied completely can stretch and weaken over time. As a result, the muscular wall of the bladder no longer contracts properly, making it harder to fully empty your bladder.
• Kidney damage. Pressure in the bladder from urinary retention can directly damage the kidneys or allow bladder infections to reach the kidneys.

Most men with an enlarged prostate don’t develop these complications. However, acute urinary retention and kidney damage can be serious health threats.

Having an enlarged prostate is not believed to increase your risk of developing prostate cancer.

Diagnosis of BPH / Prostate Cancer

Your doctor will start by asking detailed questions about your symptoms and doing a physical exam. This initial exam is likely to include:

• Digital rectal exam. The doctor inserts a finger into the rectum to check your prostate for enlargement.
• Urine test. Analyzing a sample of your urine can help rule out an infection or other conditions that can cause similar symptoms.
• Blood test. The results can indicate kidney problems.
• Prostate-specific antigen (PSA) blood test. PSA is a substance produced in your prostate. PSA levels increase when you have an enlarged prostate. However, elevated PSA levels can also be due to recent procedures, infection, surgery or prostate cancer.

After that, your doctor might recommend additional tests to help confirm an enlarged prostate and to rule out other conditions. These tests include:

• Urinary flow test. You urinate into a receptacle attached to a machine that measures the strength and amount of your urine flow. Test results help determine over time if your condition is getting better or worse.
• Postvoid residual volume test. This test measures whether you can empty your bladder completely. The test can be done using ultrasound or by inserting a catheter into your bladder after you urinate to measure how much urine is left in your bladder.
• 24-hour voiding diary. Recording the frequency and amount of urine might be especially helpful if more than one-third of your daily urinary output occurs at night.

If your condition is more complex, your doctor may recommend any of the following

• Transrectal ultrasound. An ultrasound probe is inserted into your rectum to measure and evaluate your prostate.
• Prostate biopsy. Transrectal ultrasound guides needles used to take tissue samples (biopsies) of the prostate. Examining the tissue can help your doctor diagnose or rule out prostate cancer.
• Urodynamic and pressure flow studies. A catheter is threaded through your urethra into your bladder. Water — or, less commonly, air — is slowly injected into your bladder. Your doctor can then measure bladder pressure and determine how well your bladder muscles are working. These studies are usually used only in men with suspected neurological problems and in men who have had a previous prostate procedure and still have symptoms.
• Cystoscopy. A lighted, flexible instrument (cystoscope) is inserted into your urethra, allowing your doctor to see inside your urethra and bladder. You will be given a local anesthetic before this test.

Treatment of BPH / Prostate Cancer

A wide variety of treatments are available for enlarged prostate, including medication, minimally invasive therapies and surgery. The best treatment choice for you depends on several factors, including:

• The size of your prostate
• Your age
• Your overall health
• The amount of discomfort or bother you are experiencing

If your symptoms are tolerable, you might decide to postpone treatment and simply monitor your symptoms. For some men, symptoms can ease without treatment.