The prostate is part of the male urinary and reproductive system. It is a small gland in the abdomen, located just below the bladder, in front of the rectum. It surrounds the urethra, the tube that drains the urine from the bladder and out of the body, through the penis. At birth, the prostate is about the size of an almond; in an adult male, it is about the size of a walnut. Although small, the prostate serves an important function. It secretes semen (the fluid that carries sperm) and helps move it into the urethra so it can be released from the body during ejaculation.
A digital rectal exam (DRE) is a very fast, simple test that lets a healthcare provider determine the size of the prostate and identify anything irregular. It is a simple procedure in which the healthcare provider puts on a rubber or latex glove and inserts a finger into the man’s rectum. This allows the healthcare provider to feel the surface of the prostate through the bowel wall. If the healthcare provider finds an unusual lump, abnormal texture, or area of hardness, further testing can be done to determine the cause. While some men may find a DRE uncomfortable or embarrassing, it is not painful, and it can save lives. For men with a higher than normal risk of developing prostate cancer, a healthcare provider may recommend annual rectal exams beginning at age 40.
If the prostate is enlarged, the healthcare provider may also do a blood test known as a prostate specific antigen (PSA) test, which may help rule out prostate cancer. There is some controversy about the benefits of a PSA test, because not all men with high PSA levels have cancer. The test may cause unnecessary psychological distress, especially with ensuing medical tests, and not all men with normal levels are cancer-free. However, while the PSA test is not foolproof, it can be an important tool for healthcare providers in many cases.
One of the most common problems that affect the prostate is excessive growth. Enlarged prostate is especially common in men over the age of 40, and it is generally caused by a condition called benign prostatic hyperplasia (BPH). Around the age of 40 or 50, it is not uncommon for the prostate to start creating new cells, causing the gland to enlarge. About 80% of all men will have enlarged prostates by the time they reach the age of 80. BPH is not a life threatening disease; it is not the same thing as prostate cancer and does not lead to cancer, though it may be possible to have BPH and prostate cancer at the same time. BPH can cause problems, because as the prostate grows, it can squeeze the urethra and create symptoms related to urination, such as the need to urinate often or leaking or dribbling of urine. These symptoms may appear and gradually worsen over time.
Not all men who develop BPH will have symptoms, but those who do should discuss this with their healthcare provider. Similar symptoms can be due to a variety of conditions, and a physical exam will enable the healthcare provider to discover the underlying cause. Any man, no matter what his age, should see his healthcare provider if ejaculation becomes painful, or if he notices any changes in the way he normally urinates or in the appearance of his urine. From the age of 50 on, all men should have a physical examination every year, even if they have no symptoms. It is likely that the physical will include a DRE and a PSA test, as necessary.
Healthcare providers manage or treat BPH in several ways:
As mentioned earlier, even though there does not seem to be any link between BPH and prostate cancer, a man with an enlarged prostate can still get prostate cancer. For this reason, when a man has surgery for BPH, his healthcare provider will generally check the removed prostate tissue for signs of cancer. Even if a man is treated for BPH and shows no signs of cancer, it continues to be important for him to have a check-up every year.
Prostatitis is an inflammation of the prostate gland and surrounding tissues as a result of infection. There are different types of prostatitis, and each type is associated with different symptoms. It is not certain how common this condition is, but it is estimated that about 40% of the visits men make to urologists are for prostatitis. It is not a contagious condition, so a man does not have to be concerned about passing it along to his partner during sexual relations. Having prostatitis does not increase a man’s risk of developing other prostate problems.
Treatment depends on the cause of the inflammation. If it is due to an infection, it can often be treated with antibiotics or antimicrobial drugs. If it is not due to an infection, it may still be treatable with medication.
There are other options as well, including surgery and biofeedback to help correct urination problems. Some men find relief from the application of ice packs, soaking in a hot tub, and changing their eating habits to eliminate spicy and acidic foods, caffeine, and alcohol.
Scientists are not sure of the exact cause of prostate cancer, but many believe that hormones (such as high testosterone levels), family history, a diet high in meat and saturated fat, and environmental factors all play a role. Early detection is important, because it lets treatment begin when the disease is still in its early stages. The first step in detecting a problem is to have a digital rectal exam (DRE) each year. It is important to go through a DRE as men who have prostate cancer in its early stages generally do not have any symptoms. The next step is often a test to measure the amount of PSA in a man’s blood.
The method of treatment for prostate cancer will depend on a number of factors, including the symptoms, size of the tumour, whether it has spread beyond the prostate gland, how fast it is growing, and the man’s age and general health. Some of the options are watchful waiting, surgery, radiation, hormone therapy and chemotherapy.
Each treatment has benefits and drawbacks, and the type of treatment will be determined by the particular details of each individual case as discussed with healthcare providers.