There are two main complications associated with the prostate gland: Benign Prostatic Hyperplasia (BPH) and prostate cancer. The specific cause of these problems is unknown, although they are clearly related to aging and may be a response to hormonal changes.
BPH will affect 50% of men in their lifetimes and prostate cancer is the most frequently diagnosed of cancers in Canadian men. However, BPH discomfort can be managed and prostate cancer develops slowly and responds well to treatment if caught early. Screening and early detection is absolutely essential to catch prostate problems.
What is the Prostate Gland?
The normal prostate gland is a walnut-sized organ located at the base of the bladder, surrounding the urethra. Urine drains from the bladder, through the urethra to exit from the penis. The prostate gland has two functions: to help regulate urination by pressing against the urethra and generating minerals and sugars that are part of semen.
What is BPH?
As men age, the prostate gland enlarges, typically starting about age thirty. The growth rate however is very slow and consequences of prostate enlargement aren’t usually noticeable until after age 50. As the prostate enlarges, it presses against the urethra and gradually starts to block the urine flow. This means the bladder may not empty completely during urination, leaving urine to stagnate in the bladder. This may make men susceptible to urinary tract infection and kidney stones. More severe, but much less common problems include urinary retention (which is painful and makes urination impossible), impaired kidney function or overflow incontinence.
Symptoms develop gradually and may include:
- Difficulty starting urination
- Urination that feels incomplete
- More frequent urination, often during the night
- Greater urgency
- Decreased volume and force of urine flow
- Dribbling at the end of urination
BPH is diagnosed by digital rectal exam (the physician inserts a gloved, lubricated finger into the rectum and feels the prostate gland). If BPH is present, the gland feels smooth and enlarged, but is not painful to the touch.
Treatment is not necessary unless bothersome symptoms and complications need to be controlled. Your doctor may prescribe drugs, which can relax muscles of the prostate and bladder, easing the urine flow. Other drugs control hormone release and may slow growth or even shrink the prostate.
If drugs don’t relieve symptoms, surgery is available. The most common procedure surgically removed part of the prostate and is known as the Transurethral Resection of the Prostate (TURP). TURP is effective, but may lead to complications such as incontinence and erectile dysfunction.
What is Prostate Cancer?
Prostate cancer is a malignant tumour made up of cells from the prostate gland. Prostate cancer grows very slowly and stays confined within the prostate for many years. In these early stages, there are no outward signs or symptoms. Symptoms don’t appear until the cancer is in advanced stages and it has spread beyond the prostate to the neighbouring tissues and throughout the body to the tissues in the bones, lungs or liver.
Because prostate cancer is ‘silent’ for so long, it is advisable to start screening for it around age 40 in order to detect trouble early.
Prostate cancer screening is done with a PSA (prostate specific antigen) test. This requires a blood sample and tells the physician if an abnormal substance, associated with cancer cells is present. A PSA of 0-4 is considered normal, while higher scores incrementally increase the likelihood of prostate cancer. If cancer is suspected, a biopsy is performed on prostate tissue. If cancer is present, it is ‘graded’ based on how far it has spread. A low grade or stage means the tumour is still confined within the prostate and may be easier to treat, while a higher stage may be more aggressive with higher potential to spread.
Who is At Risk?
There are few specific risk factors for prostate cancer, although a higher incidence has been noted in men who:
- Are older
- Are of African descent
- Have a family history of prostate cancer
The symptoms most commonly associated with prostate cancer are:
- Pain or burning feeling during urination
- Difficulty urinating
- A weak or interrupted urine flow
- Fairly constant pain in the lower back, upper thighs or pelvis.
If you are experiencing any of these symptoms, make an appointment with your physician for a physical exam. But, do not wait for these symptoms to develop. As noted above, regular screening for prostate cancer is recommended in all men over 40 to improve chances of earlier detection and successful treatment.
Remember that urination difficulties are also symptomatic of BPH and don’t necessarily mean prostate cancer. However, whatever the cause, any urination difficulties should always be brought to your doctor’s attention.
If cancer is detected, your doctor will help you decide on the treatment that’s best for you. Options include surgery, radiation and hormone therapy and depend on the stage of the tumour.
Removal of the prostate gland by surgery called radical prostatectomy is the most effective way to treat early stage prostate cancer that has not spread beyond the prostate. While up to 80% of men experience erectile problems following prostatectomy, most men regain erectile function within 2 years of the surgery. In addition, there are medications available which can help improve erectile function during this recovery period.
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