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The Prostate

The prostate is basically a male sex gland, about the size of a walnut, located beneath the bladder. (Read about "The Urinary System") It makes some of the fluid that carries sperm. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

 

Prostate problems are not unusual for men over age 50. As men age, the likelihood of problems increases. In fact, according to the National Institute on Aging, as many as 90 percent of American men in their 70's and 80's experience prostate problems.

The American Foundation for Urologic Disease says there are three main types of prostate problems - prostatitis or infections and inflammation, enlargement (also known as benign prostatic hypertrophy or benign prostatic hyperplasia), and cancer. Prostatic Intraepithelial Neoplasia (PIN) is another concern. Below find information on these four prostate concerns.

Prostatitis and Infertility

Prostatitis is one of potential cause of male infertility. It is an infection in the prostate gland and its symptoms range from none to urgency, painful urination, and pain during or after ejaculation, with or without pain in the prostate. It can usually be diagnosed though a physical examination and lab tests, and may be require treatment with antibiotics. Please warn him about this if you plan kids.  

Definition

Prostatitis is inflammation or infection of the prostate gland � an organ about the size and shape of a walnut, located just below the bladder in males. The prostate gland produces semen, the fluid that helps nourish and transport sperm. Prostatitis can cause a variety of symptoms, including a frequent and urgent need to urinate and pain or burning when urinating � often accompanied by pelvic, groin or low back pain.

Prostatitis has been classified by the National Institutes of Health (NIH) into four categories.

  • Category 1 is acute bacterial prostatitis.

  • Category 2 is chronic bacterial prostatitis.

  • Category 3 includes the conditions previously known as nonbacterial prostatitis, prostatodynia and chronic pelvic pain syndrome.

  • Category 4 is asymptomatic inflammatory prostatitis.

Pain relievers and several weeks of treatment with antibiotic are typically needed for category 1 and 2 prostatitis, which are bacterial infections. A variety of treatments as well as self-care measures also can provide relief. Treatment for category 3 prostatitis (nonbacterial) is less clear and mainly involves relieving symptoms. Category 4 prostatitis is usually found during examination for another reason and often doesn't require treatment.

Symptoms

The signs and symptoms vary depending on the various types of prostatitis.

Acute Bacterial Prostatitis: Category 1

  • Fever and chills

  • Flu-like symptoms

  • Pain in the prostate gland, lower back or groin

  • Urinary problems, including increased urinary urgency and frequency, difficulty or pain when urinating, inability to completely empty the bladder, and blood-tinged urine

  • Painful ejaculation

Acute prostatitis can be a serious condition and requires immediate medical treatment. See your doctor right away if you develop any of these signs and symptoms.

Chronic Bacterial Prostatitis: Category 2

The signs and symptoms of this type of prostatitis develop more slowly and usually aren't as severe as those of acute prostatitis. In addition, times when symptoms are better tend to alternate with times when symptoms are worse. Signs and symptoms of chronic bacterial prostatitis include:

  • A frequent and urgent need to urinate

  • Pain or a burning sensation when urinating (dysuria)

  • Pain in the pelvic area

  • Excessive urination during the night (nocturia)

  • Pain in the lower back and genital area

  • Difficulty starting to urinate, or diminished urine flow

  • Occasional blood in semen or in urine (hematuria)

  • Painful ejaculation

  • A slight fever

  • Recurring bladder infections

Chronic Nonbacterial Prostatitis: Category 3

The signs and symptoms of nonbacterial prostatitis are similar to those of chronic bacterial prostatitis, although you probably won't have a fever. The only way to determine whether prostatitis symptoms are caused by bacterial infection or are nonbacterial is through lab tests to find out whether bacteria is present in the urine or prostate gland fluid.

Other Conditions

Prostatitis can be difficult to diagnose, in part because its signs and symptoms often resemble those of other conditions, such as bladder infections, bladder cancer or prostate                                            

Causes

Acute Bacterial Prostatitis: Category 1

Bacteria normally found in your large intestine typically cause acute prostatitis. Most commonly, acute prostatitis originates in the prostate, but occasionally the infection can spread from a bladder or urethral infection.

Chronic Bacterial Prostatitis: Category 2

It's not entirely clear what causes a chronic bacterial infection. Sometimes it develops after an episode of acute prostatitis when bacteria remain in the prostate. Catheter tubes used to drain the urinary bladder, injury to the urinary system (such as from bike riding or horseback riding ) or infections in other parts of the body can be the source of the bacteria.

Chronic nonbacterial prostatitis: Category 3

The cause or causes of this condition are not well-defined. Some theories regarding the causes are as follows:

  • Other infectious agents. Some experts believe nonbacterial prostatitis may be caused by an infectious agent or agents that do not show up in standard laboratory tests.

  • Heavy lifting. Lifting heavy objects when your bladder is full may cause urine to back up into your prostate causing inflammation.

  • Interstitial cystitis. This condition that's more frequently diagnosed as a cause of chronic pelvic pain in women is being more frequently recognized in men.

  • Physical activity. Although regular exercise, especially jogging or biking, is great for the rest of your body, it may irritate your prostate gland.

  • Pelvic muscle spasm. Urinating in an uncoordinated fashion with the sphincter muscle not relaxed may lead to high pressure in the prostate and the development of inflammation and prostatitis symptoms.

  • Structural abnormalities of the urinary tract. Narrowings (strictures) of your urethra may cause increased pressure during urination and result in inflammation and symptoms.

Prostatitis is not contagious and is not a sexually transmitted disease argement due to benign or cancerous growth of the prostate.

Risk Factors

Unlike other prostate problems, you're more likely to develop prostatitis when you're younger, even before age 40. You may also be at increased risk if you:

  • Recently had a bladder infection or an infection of your urethra

  • Recently had a urinary catheter inserted during a medical procedure

  • Do not empty your bladder frequently enough and you perform vigorous activities with a full bladder

  • Jog or bicycle on a regular basis or ride horses

Men with HIV also are at increased risk of bacterial prostatitis. It's not clear why.

Tests and Diagnosis

Diagnosing prostatitis involves ruling out any other conditions that may be causing your signs and symptoms and then determining what kind of prostatitis you have.

Your doctor will likely begin by taking a medical history and performing a physical exam. You may be asked to complete a questionnaire about your symptoms. The physical exam may include checking your abdomen and pelvic area for tenderness and a digital rectal exam of your prostate.

Digital Rectal Exam

During a digital rectal exam, your doctor manually examines your prostate gland by gently inserting a lubricated, gloved finger into your rectum. Because the prostate gland is in front of the rectum, your doctor can feel the back surface of the gland this way. If it seems enlarged and tender to the touch, you may have prostatitis.

Urine And Semen Test

Your doctor may want to evaluate samples of your urine and semen for bacteria and white blood cells � key cells in your immune system's response � to help establish a diagnosis of prostatitis. 

Complications

There's no evidence that having acute or chronic prostatitis increases your risk of prostate cancer, but it may increase the level of prostate-specific antigen (PSA) in your bloodstream. PSA is a substance naturally produced in your prostate gland, and high levels in your blood may sometimes � but not always � be a sign of prostate cancer. For that reason, if you have an elevated PSA level and also have acute prostatitis, you should be rechecked after you've been treated with antibiotics and all prostate inflammation has resolved.

Because prostatitis interferes with the transport of sperm cells and may interfere with normal ejaculation, it can sometimes affect fertility. In addition, untreated acute prostatitis can lead to an inability to urinate, and in severe cases may result in bacteria in your bloodstream (bacteremia).

Lifestyle and Home Remedies

Because traditional treatments aren't always effective for prostatitis, many men experiment with various lifestyle changes to control their symptoms. Although no scientific evidence proves these practices are beneficial, you may want to try one or more of the following suggestions:

  • Drink plenty of water.

  • Limit or avoid alcohol, caffeine and spicy foods.

  • Urinate at regular intervals.

  • Have regular sexual activity.

  • If you're a cyclist, use a "split" bicycle seat, which reduces the pressure on your prostate.

Men with category 3 prostatitis can learn to live with the disease by limiting the things that make their symptoms worse and emphasizing the things that make them feel better.

Prostate Enlargement (Hypertrophy/Hyperplasia)

Benign prostatic hypertrophy or BPH is an enlargement of the prostate. The National Institute on Aging (NIA) says that more then half of men in their 60's have BPH. An enlarged prostate can block the urethra. That can make it hard to urinate and create other issues. (Read about "The Urinary System")

If you have BPH, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says you may have one or more of these problems:

  • a frequent and urgent need to urinate, even getting up several times a night to go to the bathroom

  • trouble starting a urine stream, even when you feel you have to rush to get to the bathroom

  • a weak stream of urine

  • a small amount of urine each time you go

  • the feeling that you still have to go, even when you have just finished urinating

  • leaking or dribbling

  • small amounts of blood in your urine

You may barely notice that you have one or two of these symptoms, or you may feel as though urination problems have taken over your life.

BPH is diagnosed usually with a digital rectal exam. The doctor inserts a gloved finger into the rectum and feels the part of the prostate that sits next to it. This exam gives the doctor a general idea of the size and condition of the prostate. X-rays or ultrasound may be used as well. (Read about "X-rays" "Ultrasound Imaging") Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. (Read about "Endoscopy") The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.

Once confirmed, patients have a number of treatment options, in consultation with their doctors. According to the National Institutes of Health, these include:

  • Watchful waiting - This is where no treatment occurs, but regular exams follow the progress of the disease. This path is often chosen by men who aren't bothered by the symptoms.

  • Drugs - There are a number of new drugs that are being used to treat BPH. Some act on muscles near the prostate, to relax them. Side effects can include headaches and dizziness. Other drugs act directly on the prostate by impacting the effect of hormones, causing the prostate to shrink. Side effects can include sexual dysfunction issues. NIDDK says the long-term effect of all these drugs is unknown since they are so new.

  • Surgical techniques are the third option for BPH. Some are what is called minimally invasive, others are more involved and can result in potential complications. Some of the less invasive techniques include:

  • Prostatic stents are placed in the urethra to hold it open. They do have complications and aren't usually considered a good long-term solution.

  • Microwave therapy uses the heat generated by microwave energy to destroy enlarged portions of the prostate surrounding the urethra. It is also called transurethral microwave therapy (TUMT).

  • Transurethral needle ablation (TUNA) uses radio waves to destroy enlarged tissue surrounding the urethra. It is also called radiofrequency therapy.

  • Interstitial laser therapy (ILT) is a little more invasive. A small laser is actually inserted into the prostate via the urethra. The laser heats and destroys prostate tissue.

Each of these methods involves inserting tools via the tip of the penis into the urethra. Some other surgical techniques also use this method to reach the prostate. They include:

  • Transurethral resection of the prostate (TURP) involves cutting and removing prostate tissue.

  • Transurethral incision of the prostate (TUIP) involves just cutting the prostate to relieve the pressure. Prostate tissue is not removed.

  • Laser surgery can also be used to remove prostate tissue by vaporizing it.

The most invasive form of prostate surgery is called open prostatectomy. With this, the surgeon makes a cut in your lower abdomen to reach the prostate and remove tissue.

Prostatic Intraepithelial Neoplasia (PIN) 

There is another condition called prostatic intraepithelial neoplasia or PIN. The National Cancer Institute (NCI) calls it a noncancerous growth of the cells lining the internal and external surfaces of the prostate gland. The American Cancer Society says PIN can be labeled either low or high grade. It is usually discovered after a biopsy. (Read about "Biopsy") Having high-grade PIN may increase the risk of developing prostate cancer. ACS says there is a 30 to 50 percent chance of finding prostate cancer with later biopsies after finding high grade PIN.

Prostate Cancer

The National Cancer Institute (NCI) reports that prostate cancer is the second most common cancer among men in the United States and the number two cancer killer. (Skin cancer is more common and lung cancer is deadlier; read about "Skin Cancer" "Lung Cancer")

Age is the biggest risk when it comes to prostate cancer. The older a man gets, the more likely he might develop it. Black males have a higher risk in all age groups. The U.S. Centers for Disease Control and Prevention say that prostate cancer among African Americans is the highest known rate in the world. Family history (Read about "Family Health History") also seems to play a part, with a higher then average risk for those whose father, brother or son has had the disease, according to NCI.

Prostate cancer often does not cause symptoms for many years. By the time symptoms occur, the disease may have spread beyond the prostate. When symptoms do occur, NCI says they can affect your urinary system (Read about "The Urinary System") and other areas, and may include:

  • frequent urination, especially at night

  • inability to urinate

  • trouble starting or holding back urination

  • a weak or interrupted flow of urine

  • painful or burning urination

  • blood in the urine or semen

  • painful ejaculation

  • frequent pain in the lower back, hips, or upper thighs

These can be symptoms of cancer, but more often they are symptoms of noncancerous conditions. It is important to check with a doctor.

Finding the cancer isn't always easy. There is much discussion at this time about screening methods and when they should start. You should discuss with your doctor what would be the best path for you as you age. NCI says diagnosing cancer is done in a variety of ways:

  • A digital rectal exam can discover hard areas or lumps that could be cancer. The doctor inserts a gloved finger into the rectum and feels the part of the prostate that sits next to it. This exam gives the doctor a general idea of the size and condition of the prostate.

  • A PSA or prostate specific antigen blood test can show elevated levels of this substance if the patient has cancer or BPH. PSA isn't always accurate. That means it can give elevated levels when there isn't a problem, or it may not show high levels even though there is.

  • A biopsy will take a small portion of the prostate with a needle and examine it under a microscope to look for cancer cells. (Read about "Biopsy")

The American Cancer Society recommends regular screenings for prostate cancer for men beginning at age 50, or earlier if there are risk factors present, including African-American men and men with a family history of prostate cancer. Remember, cancer of the prostate can have no noticeable symptoms in its early stages - and when it's in its early stages, the cancer can more readily be cured. So talk with your doctor about the screenings you need now and in the coming years.

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