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ProstateIntroduction The prostate is a gland found only in males. It is located just below the bladder, and just behind the front wall of the rectum. It is usually about one inch (2.5 cm) across. The urethra, which carries urine from the bladder to the penis, runs through the prostate. The main function of the prostate is that it produces prostatic fluid, which is one of the major fluids that make up your semen when you ejaculate. There are three main conditions that can affect your prostate. They are: prostate enlargement (BPH), prostatitis (inflammation of the prostate gland), and cancer of the prostate. See the entry on prostate cancer for more information. Prostate enlargement and prostate cancer usually only affects men over the age of 50, and about half men over this age will have some sort of prostate enlargement. Prostatitis can affect men of any age. Symptoms depend on what condition you have but common symptoms of prostate disease are difficulty in passing urine, pain when ejaculating, and frequent urinating. Treatment for prostate disease depends on the condition and how severe the symptoms are. Sometimes, no treatment is required. Treatment options include medication, surgery and making lifestyle changes. Symptoms Symptoms of prostate enlargement include: difficulty passing urine because the flow is weak and slow, passing urine frequently (more than 10 times a day), no warning that your bladder is full, resulting in the sudden uncontrollable need to urinate, difficulty in starting to pass urine, frequently waking up in the night to urinate (nocturia), being unable to completely stop the flow of urine mid-flow, incomplete emptying of the bladder, and pain or burning sensation when passing urine. Symptoms of prostatitis include: pain or burning when you pass urine, severe pain behind your scrotum, or around your anus, inner thighs or lower back, blood in your urine, discharge from your penis, and pain when ejaculating. If prostatitis is caused by an infection, you may also get others symptoms associated with the type of infection you have. Symptoms of prostate cancer are similar to prostate enlargement. If you have any of the signs of prostate enlargement, prostatitis or prostate cancer, you should see your GP. Causes Prostate enlargement (BPH) Prostate enlargement is caused when your prostate absorbs large amounts of the male sex hormone, testosterone. This causes an increase in the growth of cells in the prostate, and an increase in how long the cells live. Prostate enlargement is either benign prostatic hyperplasia, or benign prostatic hypertrophy. Although they are two different conditions, they are both often referred to as BPH and doctors diagnose and treat them in the same way. Benign prostatic hyperplasia is when the excess testosterone leads to an abnormal increase in the number of non-cancerous cells in the prostate. Benign prostatic hypertrophy is the abnormal increase in the size of non-cancerous cells in the prostate. Both types of BPH increase the size of the prostate, so putting pressure on the section of the urethra that travels through it. This leads to difficulty when passing urine, as there is less space for it to pass through. BPH is more common in older men as the body produces more testosterone when you get older. Prostatitis There are two types of prostatitis: acute and chronic. Acute prostatitis is usually caused by a bacterial infection. The cause of chronic prostatitis is usually unknown, but some studies show it can be caused by stress, depression and anxiety. Always letting your bladder completely fill up before you pass urine may also be a cause of prostatitis, as some urine can then leak into parts of your prostate causing inflammation. Bacterial infections that cause acute prostatitis can be transmitted as a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. This means that you can catch them by having unprotected sex. Prostatitis can also be caused when common bacteria (such as those found in your bowels) travel up your urethra and infect your prostate, or other parts of your urinary system such as your bladder or kidneys. Cancer of the prostate The cause of prostate cancer is unknown, although some factors appear to increase the likelihood of this type of cancer developing. For example: Men with a brother, uncle or father who have, or have had, prostate cancer are at a slightly higher risk. Afro-Caribbean and African-American men are more affected compared to white men. It is rare among men of Asian origin. Diagnosis If you have any of the symptoms of prostate enlargement and prostate cancer, or prostatitis, you should speak with your GP. Your GP may carry out the following tests, or may refer you to a urologist (a doctor who specialises in the urinary system) for tests. Your doctor will ask you about the symptoms you have been experiencing, and how often you pass urine. You may also have a digital rectal examination (DRE). This is when a doctor inserts a gloved finger into your rectum so they can feel one side of your prostate through the front wall of your rectum. This test may be uncomfortable, but is usually painless. When your prostate is examined during a rectal examination, a cancerous prostate will feel lumpy or irregular, while an enlarged prostate will feel smooth and even. An inflamed prostate (prostatitis) may be tender to the touch, and your penis may discharge a small amount of pus when your prostate is massaged with a finger. Your doctor may also do a blood test that measures your PSA (prostate specific antigen). PSA is a protein that is produced naturally by the prostate, and high levels of it can indicate increased prostate activity. This means that the level can be raised if your prostate is enlarged or cancerous, or if you have prostatitis. A high level of PSA in your blood doesn't however necessarily mean that you have a condition affecting your prostate. It is also possible that the level of PSA in your blood will not be affected by a prostate condition. Therefore, a PSA blood test will be used alongside other methods of diagnosis. Other types of blood and urine tests may also be used. For example, you may have a test taken to find out how your kidneys are working, or to test for bacterial infections that can cause prostatitis. Other tests that your doctor may carry out could include: an ultrasound scan of your bladder to see how it empties urine, a swab test of the lining of your urethra, or penis (when a piece of absorbent material attached to a rod is used to take a sample of secretion), bladder flow test (when the strength of your urine flow is measured), and cystourethroscopy (when a very small camera is passed through the penis to look at the bladder and urethra from the inside of your body). If your doctor suspects that your prostate is cancerous, they may also recommend that you have a biopsy. This is when a probe is inserted into your rectum while your prostate is observed by an ultrasound scan. Then, any abnormal areas that are shown by the scan will have a sample removed with a special needle. This can be uncomfortable but shouldn't hurt. Afterwards you may get some side effects for a few days including blood in your urine, semen, or stools. Some people may also develop a fever after having a prostate biopsy. If tests show that the samples of your prostate are cancerous, you may also have further tests to see if the cancer has spread to other parts of the body. These tests may include scans such as CT and MRI scans that take detailed pictures of inside the body, or further blood tests. Results from these tests will be used to determine the best treatment for you. Treatment Prostate enlargement (BHP) For prostate enlargement, treatment will only be required if symptoms are causing you problems, or if they cause any complications. For mild symptoms, changes to your lifestyle can help symptoms. Changes could include: avoiding alcoholic drinks, or drinks that are high in caffeine, which can make you urinate more often, avoiding drinks late in the evening to reduce the chances of urinating in the night, increasing the amount of fruit and fibre you eat to avoid constipation, which can put pressure on your bladder, and unnecessary use of cold and allergy medicines such as decongestants and anti-histamines, which can affect muscles in the bladder. Medication can also be used to ease symptoms. The two types of medication that can be used are: Alpha-blockers, which reduce the muscle tone in the lower part of your bladder and prostate so it is easier to pass urine. Side effects can include depression, headaches, dizziness and a dry mouth. Finasteride, which acts slowly over a period of months to reduce the size of your prostate, so urine can pass through your urethra more easily. Some people may have side effects such as impotence and a reduced sex-drive. It is also possible to have surgery to remove part of, or the whole of your prostate. This is called prostatectomy. The most common type of prostatectomy is called transurethral resection of prostate (TURP). You will be given a general anaesthetic, and fibre-optic equipment is inserted through your urethra. Then, prostate tissue is removed until a clear passage is made for urine to flow through your urethra to your penis. The operation takes about an hour, and you will stay in hospital for around four days afterwards. Full recovery takes about 4-6 weeks. If your prostate is very large, you may require open prostatectomy. This is when the prostate is removed through an incision in your lower abdomen. As with TURP, you will have a general anaesthetic, but you will have to stay in hospital for 7-14 days. Full recovery may take several months. Long-term complications of prostate surgery can include: Retrograde ejaculation this is when your orgasms are dry or there is less semen than usual. This is because the semen is expelled back into your bladder when you have an orgasm. This affects about 3 in 4 men who have prostate surgery. Men who have dry orgasms may not be able to father children through sexual intercourse. Urinary incontinence this is when you are unable to control urine flow. There is a small chance that the muscle that stops urine leaving your bladder could be damaged. This happens to about 1 in 20 men who have prostate surgery. Impotence or erection problems there is a small chance that nerves that control your erection could be damaged, but in some cases erections actually improve for men who have prostate surgery. Future surgery around 1 in 100 men will require prostate surgery again in the future. Your doctor will explain possible complications to you before the operation, and make sure the benefits of having prostate surgery will outweigh the possible risks. If you're not suitable for surgery, or cannot take medication, a catheter may be placed through your urethra, or abdomen to help relieve some symptoms. However some men find that having a catheter fitted in this way interferes with their sex life. There is also a high risk of getting an infection. Alternative medicines and non-surgical procedures such as laser and microwave therapy can also be used to treat prostate enlargement. However, these methods are still being studied to see how effective they are compared to other forms of treatment, and are not widely available in England. Prostatitis Prostatitis is treated by taking prescribed antibiotics to treat the infection that is causing it. Typically, antibiotics will need to be taken for about 4-6 weeks, but it will depend on what infection you have. You can also paracetamol and ibuprofen can be taken to ease pain and inflammation. If the cause of your prostatitis is unknown, your doctor may still prescribe antibiotics for you. This is because some infections may not show up in blood or urine samples. Cancer of the prostate Prostate cancer may grow very slowly, and some men will not require any treatment if the cancer is growing slowly, and isn't likely to affect how long they live. This is called watchful waiting and you will have regular check-ups and PSA (prostate specific antigen) tests to make sure that the cancer isn't growing more quickly, or spreading to other parts of the body. If cancer symptoms are causing you problems, or if the cancer is growing quickly (so it is more likely to spread to other parts of your body), treatment may include: TURP or prostatectomy (removal of part of, or the whole prostate). Radiotherapy, given through an external X-ray beam, which is directed at the prostate, or by planting a small radioactive seed in the prostate (brachytherapy). Side effects can include sore skin, tiredness and bowel problems. However, the risk of impotence and incontinence is lower than it is with TURP or prostatectomy. Hormone therapy, to reduce the amount of testosterone (the male sex hormone) in your body. Prostate cancer cells use testosterone to grow, so hormone therapy can be used to shrink a cancer before radiotherapy, or control symptoms by stopping the cancer from growing. Side effects of hormone therapy can include low sex drive, impotence, sweats and breast enlargement. Sometimes, several different treatments will be used and it depends on your individual circumstances. Before you receive treatment, your doctor will explain the possible risks and side effects to you. |
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