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Prostate Disease and Prostate CancerThe prostate gland is an organ which secretes a fluid found in semen. This gland is anatomically located "around" the urethra (a tube that connects the bladder to the outside) at the base of the bladder. Benign (noncancerous) enlargement of the gland occurs normally after age 50, probably secondary to the effects of male hormones. If significant enlargement occurs, it may "pinch off" the urethra making urination impossible. Typically, the patient experiences a progressive difficulty in starting his stream, a decreasing caliber of stream, multiple trips to the bathroom at night to void, and dribbling after voiding. All these symptoms are consistent with the diagnosis of benign prostatic enlargement. Symptomatic prostatic enlargement usually necessitates evaluation and possible surgical correction by a Urologist. Patients who fail to have an evaluation for this problem may become victims of urinary retention, prostatitis (see below), urinary tract infections, or prostate cancer (see below). Treatment for benign prostate enlargement may require a surgical procedure to remove the prostate gland if the patient develops difficulty voiding or has recurrent infections. A procedure known as a TURP, or transurethral prostatectomy is performed under general anesthesia by a Urologist. This procedure is performed through the penis with a small fiberoptic scope. The surgeon clears away much of the prostate gland that has been blocking the urethra and causing the problems. In some cases, an "open prostatectomy" is carried out. In this case, the prostate gland is removed entirely through the conventional lower abdominal incision. Some medications (Hytrin) have been shown to reduce prostate size and resolve the urinary symptoms associated with prostatic enlargement. Newer medications(Proscar), currently in the testing phase, may make prostate operations (TURP) less prevalent. PROSTATITISThis is a common bacterial infection of the prostate gland seen more often in males with benign prostate enlargement. It is also seen as a complication of a sexually transmitted disease (venereal disease) in younger males. Prostate inflammation and swelling leads to ineffective emptying of urine from the bladder. Contamination of the prostate gland with urine is then likely to occur. This situation can lead to serious bacterial infections of the prostate gland. Patients will often have lower abdominal pain, rectal pain, fever, chills, nausea, difficulty voiding, or overt urinary retention. Treatment is with IV antibiotics and hospitalization in the older, more ill patient. The younger patient can be placed on oral antibiotics and treated at home. Follow-up with the Urologist will be necessary. PROSTATE CANCERProstate cancer is the second most common cancer in men (lung cancer is the first). Cancer statistics estimate 165,000 new cases for 1993, with 35,000 deaths that will be attributable to prostate cancer in 1993. Prostate cancer is most often seen in older men, with 73 as the average age at the time of diagnosis. The cause of prostate cancer is unknown, but several predisposing factors have been identified. Studies show, most en over the age of 50 contain at least some microscopic evidence for prostate cancer. Family history for the disease can increase the risk of prostate cancer. There is some concern that a diet high in fat could increase risk. There are usually NO symptoms associated with early prostate cancer. This is why the digital rectal examination (the physician can feel the prostate and any nodules) is important on an annual basis after age 40. Recently, a blood test known as the prostate specific antigen (PSA) has been used as a key indicator of early disease. Current recommendations by the American Cancer Society include annual PSA blood tests in those men over age 50, and sooner in higher risk groups (African Americans and those with a family history of prostate cancer). In those found to have an elevated PSA blood test, an ultrasound examination of the prostate gland can be performed which can find cancers undetected by digital rectal examination. Digital rectal examinations are currently recommended annually for those 40 and older (due to colorectal cancers). More advanced prostate cancer can present with difficulties in urination, much like those described above for benign prostate enlargement. In some cases of prostate cancer, urinalysis may indicate the presence of (microscopic) blood in the urine. Localized prostate cancer can be treated with surgical removal of the prostate, and/or radiation therapy to the area. Advanced prostate cancer, due to its propensity to spread to bone, requires systemic treatment. Hormone therapy has been reasonably successful. Most prostate cancers grow in response to testosterone (male hormone produced by the testicles). For this reason, treatments to reduce the production of this hormone has been advocated. These include LH and RH agonists (e.g. Lupron or Zoladex) or the surgical removal of the testicles. Chemotherapy has been used in advanced cases when hormonal therapy fails. With well localized disease, patients have a good chance of a normal life expectancy. A Urologist is the expert in the evaluation of this problem. |
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