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Prostate Problems
The prostate is a small organ about the size of a walnut. It
is found below the bladder (where urine is stored) and surrounds
the tube that carries urine away from the bladder (urethra).
The prostate makes a fluid that becomes part of semen. Semen
is the white fluid that contains sperm.
Prostate problems
are common in men age 50 and older. Sometimes men feel symptoms
themselves, or sometimes their doctors find prostate problems
during routine exams. Doctors who are experts in diseases of
the urinary tract (urologists) diagnose and treat prostate problems.
There are many
different kinds of prostate problems. Many don’t involve cancer,
but some do. Treatments vary but prostate problems can often
be treated without affecting sexual function.
Common
Problems
There are several
common prostate problems including:
Acute prostatitis
is an infection of the prostate caused by bacteria. It usually
starts fast and can cause fever, chills, or pain in the lower
back and between the legs. It also can cause pain when you urinate.
If you have these symptoms, see your doctor right away. Antibiotic
drugs usually help heal the infection and relieve the symptoms.
Your doctor also may suggest that you drink more liquids.
Chronic prostatitis
is a prostate infection that keeps coming back time after time.
Symptoms may be milder than in acute prostatitis, but they can
last longer. Chronic prostatitis can be hard to treat. Antibiotics
may work if bacteria are causing the infection. But if bacteria
are not the cause, antibiotics won’t work. Massaging the prostate
sometimes helps to release fluids. Warm baths also may bring
relief. Often chronic prostatitis clears up by itself.
Benign prostatic
hyperplasia (BPH) is the
term used to describe an enlarged prostate. BPH is common in
older men. Over time, an enlarged prostate may block the urethra,
making it hard to urinate. It may cause dribbling after you
urinate or a frequent urge to urinate, especially at night.
Your doctor will conduct a rectal exam to diagnose BPH. The
doctor also may look at your urethra, prostate, and bladder.
Treatment choices
for BPH include:
¨
Watchful waiting.
If your symptoms are not troubling, your doctor may suggest
that you
wait before starting any treatment. In that case, you will need
regular checkups to make sure the condition does not get worse.
¨
Alpha-blockers
(some generic names are doxasozin, terazosin) are medicines
that can relax muscles near the prostate and ease symptoms.
Side effects may include headaches, dizziness, or feeling lightheaded
or tired.
¨
Finasteride (Proscar)
acts on the male hormone (testosterone) to shrink the prostate.
Side effects of this medication can include less interest in
sex and problems with erection or ejaculation.
¨
Surgery
also can relieve symptoms. But surgery can cause complications.
Also, it does not protect against prostate cancer.
Talk with your
doctor about this treatment choice. Regular checkups are important
even for men who have had BPH surgery.
There are three
kinds of surgery:
¨
Transurethral resection
of the prostate (TURP) is the most common type of surgery. While
the patient is under anesthesia, the doctor uses a special device
to take out part of the prostate and remove the blockage.
¨
Transurethral incision
of the prostate (TUIP) may be used when the prostate is not
too enlarged. The doctor makes a few small cuts in the prostate
near the opening of the bladder. This relaxes the bladder muscles
and improves the flow of urine.
¨
Open surgery
is used when the prostate is very enlarged. In this process,
prostate tissue is removed directly rather than through the
urethra.
Prostate Cancer
Prostate cancer
is one of the most common types of cancer among American men.
It is more common among African American men than white men.
Treatment for prostate cancer works best when the disease is
found early.
Diagnosing Prostate
Cancer
Doctors will ask questions about your medical history and perform
a physical exam to find the cause of prostate problems. In the
exam, the doctor feels the prostate through the rectal wall.
Hard or lumpy areas may mean that cancer is present.
Your doctor also
may suggest a blood test to check your prostate specific antigen
(PSA) level. PSA levels may be high in men who have an enlarged
prostate gland or prostate cancer. PSA tests are very useful
for early cancer diagnosis. But PSA test results alone do not
always tell whether or not cancer is present.
When doctors suspect
cancer, they also may perform a biopsy. Using this simple method,
doctors can take out a small piece of the prostate and look
at it under a microscope.
Prostate Cancer
Treatment
There are many options for treating prostate cancer. Each treatment
plan is based on details, such as whether or not the cancer
has spread beyond the prostate (stage of cancer), your age and
general health, and how you feel about the treatment options
and side effects. Some of the treatment choices include:
Watchful waiting,
as with BPH, if the cancer is slow growing and not causing problems,
you may decide not to have treatment right away. Instead, your
doctor will watch closely for changes in your condition. Men
who are older or have another serious illness often choose this
option.
Surgery
is used to take out the cancer. Among the different types of
surgery for prostate cancer are:
¨
Radical prostatectomy.
This surgery takes out the entire prostate and nearby tissues.
Side effects may include lack of sexual function (impotence)
or problems holding urine (incontinence). Improvements in surgery
now make it possible for some men to keep their sexual function.
Some men with trouble holding urine may regain control within
several weeks of surgery. Others continue to have problems that
require them to wear a pad.
¨
Cryosurgery
kills the cancer by freezing it.
Radiation therapy
uses high-energy X-rays to kill cancer cells and shrink tumors.
Radiation therapy sometimes is beamed into the prostate from
outside the body. It can cause problems with impotence and bowel
function.
¨
Brachytherapy
is a type of radiation therapy often used when the cancer is
found only in the prostate gland. It also is sometimes called
internal radiation, implant radiation, or interstitial radiation
therapy. In this treatment, the doctor places radioactive “seeds”
directly into the prostate. This focuses the radiation directly
on the cancer and lowers the chance of affecting other, healthy
areas around the prostate.
Hormone therapy
stops cancer cells from growing. The growth of prostate cancer
often depends on testosterone. Drug treatment is one effective
way to block testosterone. This treatment is often used for
prostate cancer that has spread to other parts of the body.
You can get more
detailed information on the pros and cons of these treatment
choices by calling the National Cancer Institute’s Cancer Information
Service at 1-800-422-6237. Ask for prostate cancer information
in “PDQ for Patients.”
Protecting Yourself
These are the signs
of prostate problems:
¨
Frequent urge to urinate,
¨
Blood in urine or semen,
¨
Painful or burning urination,
¨
Difficulty in urinating,
¨
Difficulty in having
an erection,
¨
Painful ejaculation,
¨
Frequent pain or stiffness
in lower back, hips or upper thighs,
¨
Inability to urinate,
or
¨
Dribbling of urine.
If you have any
of these symptoms, see your doctor right away to find out if
you need treatment.
More information
on prostate problems is available from:
Cancer Information
Service
National Cancer Institute
1-800-4-CANCER (422-6237)
1-800-332-8615 (TTY)
E-mail: webmaster@cancer.gov
http://www.nci.nih.gov
National Kidney
and Urological Diseases Information Clearinghouse
Attn: NKUDIC
3 Information Way
Bethesda, MD 20892-3580
1-800-891-5390
301-654-4415
E-mail: nkudic@info.niddk.nih.gov
http://www.niddk.nih.gov/health/kidney/nkudic.htm
Agency for Healthcare
Research & Quality
Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907-8547
1-800-358-9295
E-mail: info@ahrq.gov
http://www.ahrq.gov
American Cancer
Society
1599 Clifton Road, NE
Atlanta, GA 30329
1-800-227-2345
404-320-3333
http://www.cancer.org
The American
Foundation for Urologic Disease
Prostate Health Council
1128 North Charles Street
Baltimore, MD 21201
1-800-242-2383
410-468-1800
http://www.afud.org/education/prostate.html
For more information
about health and aging, contact:
National Institute
on Aging
Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225
1-800-222-4225 (TTY)
E-mail: niainfo@jbs1.com
http://www.nia.nih.gov
Ask for free brochures in English and Spanish
on prostate disease and prostate cancer.
The NIA distributes free Age Pages on a number of topics, including
Cancer Facts for People Over 50, Urinary Incontinence,
and Considering Surgery.
National
Institute on Aging
U.S. Department of Health and Human Services
National Institutes of Health
January 2002
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