overview of prostate problems

Source: National Institute on Aging

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

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

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

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
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.cancer.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

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

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

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
Posted June 2006

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