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September 2007 – Common Prostate Problems
September is national Prostate Cancer Awareness Month. Prostate cancer is the second leading cause of male death in the United States, and one in six men will be affected by the disease in his lifetime. Learn about our free prostate cancer screenings.
Prostate Problems Are CommonThere’s no getting around it — prostate problems are common among men. While men are urged to be screened regularly for prostate cancer, they also need be aware of other common, non-cancerous disorders of the prostate.
“For younger men, the most common prostate problem is prostatitis, and for older men, the most common problem is benign prostatic hyperplasia or BPH,” said Medical College of Wisconsin urologist Aaron Sulman, MD. “Neither prostatitis nor BPH increases a man’s risk of getting prostate cancer.”
ProstatitisProstatitis, an infection or inflammation of the prostate, affects men of all ages. There are three types of prostatitis.
- Chronic nonbacterial prostatitis is typically accompanied by urinary and genital pain.
- Chronic bacterial prostatitis is the result of infections that have entered the prostate. Symptoms are similar to those of chronic nonbacterial prostatitis. Treatment includes antibiotics and nonsteroidal anti-inflammatory agents (NSAIDs) such as ibuprofen.
- Acute bacterial prostatitis, the least common type, is a sudden bacterial infection with inflammation of the prostate. Symptoms are usually severe. The infection is usually treated with antibiotics, fluids and NSAIDs.
“Acute and chronic bacterial prostatitis may be caused by a bacterial infection, while nonbacterial prostatitis may be the result of an obstruction in the urinary tract (caused by BPH) or a nonbacterial microorganism,” Dr. Sulman said. “It’s not always possible to determine the cause of the nonbacterial type.”
Symptoms may include a frequent urge to urinate, difficulty urinating, fever and chills, and pain or burning during urination. Testing to diagnose prostatitis may include a prostate exam, urine culture, prostate secretion culture, and possibly an ultrasound or CT scan of the prostate to see if an abscess is present.
“Prostatitis can be difficult to treat,” Dr. Sulman said. “While some men may complete treatment after a month, others require antibiotics over many months to treat their infection.”
Benign Prostatic Hyperplasia (BPH)“As a man ages, he is more likely to have benign prostatic hyperplasia or an enlarged prostate,” Dr. Sulman said. “In fact, BPH occurs in most men as they get older.”
The prostate slowly grows larger as a man ages. As the prostate enlarges, it compresses the urethra, which carries urine from the bladder. This can cause problems with urination. Many men have no symptoms. For those who do, symptoms may include a weak urine stream, delayed urine stream, straining to urinate, dribbling after urinating, a sudden urge to urinate, incomplete emptying of the bladder, the need to urinate more often at night, complete inability to urinate and pain with urination.
Testing to diagnose BPH may include a prostate exam, bladder scan to assess emptying of the bladder and measure the force of the urine stream, and a blood test to assess kidney function (a long history of BPH increases the risk of damage to the kidneys).
Treatment depends on the severity of symptoms and their affect on daily life, and is usually provided for men with significant symptoms. For men with mild symptoms, “watchful waiting” may be planned. This means a physician monitors the patient over time to see if signs and symptoms worsen.
For men with more significant symptoms, treatment typically starts with medication to shrink the prostate and relax the muscles in the prostate. Medication can relieve BPH symptoms in most cases. If medication is ineffective, tests will be done to determine if surgery may be needed. Tests include a cystoscopy to view the inside of the bladder, urethra and prostate, and urodynamic testing to assess how the bladder is able to store and expel urine.
Surgery can be performed to remove part of the prostate to relieve the blockage of urine flow. The surgery can be done as a minimally invasive procedure (through the urethra) or as an open surgery, which requires an incision through the skin. The type of surgery depends on the size of the prostate.
Minimally invasive procedures include:
- Transurethral resection of the prostate (TURP), in which a cystoscope (a lighted scope) is inserted through the urethra and up to the prostate. A cautery instrument is inserted to remove the obstructing protions of the prostate piece by piece, and an electric current stops the bleeding during the procedure.
- Transurethral LASER ablation of the prostate, similar to TURP, in which a cystoscope is inserted through the urethra to the prostate. A LASER fiber is then used to vaporize the obstructing portions of the prostate under direct visualization.
- Transurethral needle ablation (TUNA), also called radiofrequency therapy, in which radio waves are used to heat and destroy the part of the prostate that blocks urine flow. A cystoscope is passed into the urethra and needles are placed in the prostate gland. Radio waves pass through the needles and heat the prostate, destroying the blockage.
Complete removal of the prostate (radical prostatectomy) is usually done only to cure prostate cancer.
There are different kinds of prostate problems, and only a doctor can tell one from another. That’s why men need to see their doctor regularly and if they are concerned about symptoms they are experiencing.
Health ResourcesSmall Stones, a health resource center of Froedtert & the Medical College of Wisconsin, offers many resources on prostate health and disease:
Dr. Peter Scardino’s Prostate Book by Peter T. Scardino, MD, and Judith Kelman
The Prostate Diet Cookbook by Buffy Sanders
Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer by Patrick C. Walsh, MD, and Janet Farrar Worthington
Prostate and Cancer by Sheldon Marks, MD
Complete Guide to Prostate Cancer by the American Cancer Society
Author: Marla Fraunfelder Date: Sept. 1, 2007 | Medical Reviewer: | Aaron Sulman, MD | | Medical College of Wisconsin urologist |
Online Editor(s): Christopher Sadler
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