MEN HEALTH (Prostate)

Awareness of prostate health has come a long way since the days when comedians would confuse "prostate" with "prostrate." Yet, many men still aren't sure what the prostate is, what its functions are, and how to have good prostate health. Knowing the answers to these questions is the key to understanding prostate health.

What Is the Prostate?

The prostate is a small gland in men that is part of the reproductive system. It's about the shape and size of a walnut. The prostate rests below the bladder and in front of the rectum. It surrounds part of the urethra, the tube that carries urine from the bladder. The prostate helps make semen, which carries sperm from the testicles when a man ejaculates.

Enlarged Prostate

As a man ages, the prostate can grow larger. When a man reaches the age of 40, the prostate gland might have increased from the size of a walnut to that of an apricot. By the time he reaches the age of 60, it might be the size of a lemon.

Because it surrounds part of the urethra, the enlarged prostate can squeeze the urethra. This causes problems in the passing of urine. Typically, these problems passing urine don't occur in men until they are age 50 or older. They can, though, occur earlier.

An enlarged prostate is also called benign (noncancerous) prostatic hyperplasia or BPH. It is common and cannot be prevented. Age and a family history of BPH are risk factors. Eight out of every 10 men eventually develop an enlarged prostate. About 90% of men over the age of 85 will have BPH. About 30% of men will find their symptoms bothersome.

Symptoms of an enlarged prostate may include:

• Trouble starting to urinate or urinating freely
• Having to urinate frequently, particularly at night
• Feeling that the bladder is not empty after urinating
• Feeling a sudden urge to urinate
• Having to stop and start repeatedly while urinating
• Having to strain to urinate

To maintain prostate health, it is important for men who have early symptoms of BPH to see their doctor. BPH is a progressive disease. It can lead to serious, although rare, health problems, such as kidney or bladder damage.

• Watchful waiting. Patients who have an enlarged prostate but who are not suffering symptoms or whose symptoms are not bothersome may be advised by their doctor to merely get an annual checkup, which might include a variety of tests.
• Making lifestyle changes. Changes could include limiting drinking at night and before bedtime, especially drinks containing alcohol or caffeine.
• Drug therapy. Two common treatments for BPH are alpha-blockers, which alleviate BPH symptoms, and 5 alpha-reductase inhibitors, which help shrink the prostate. Many men take them together. The FDA is revising labels on several BPH drugs -- Proscar, Avodart, and Jalyn -- to include a warning that the drugs may be linked to an increased risk of prostate cancer.
• Surgery. This is generally used for men with severe symptoms who haven't been helped by other treatment.

Prostatitis

There are four types of prostatitis. Prostatitis is an infection or inflammation of the prostate. It can affect men in their late teens to those well into old age. Its symptoms include trouble passing urine, chills and fever, and sexual problems. The condition is not contagious and cannot be transmitted sexually to a partner. Treatment usually includes antibiotics.

A man who has recently had a catheter or other medical instrument inserted into his urethra is at higher risk of bacterial prostatitis. Some sexually transmitted diseases, such as chlamydia, may cause chronic prostatitis.

Maintaining Prostate Health: Tests

Doctors use several tests to check on the condition of the prostate. They include:

DRE, or digital rectal exam: This is the standard prostate test. A doctor feels the prostate from the rectum, checking for things such as size, lumps, and firmness.

PSA , or prostate-specific antigen test: This blood test measures the amount of a protein called PSA that is produced by prostate cells. Elevated levels may indicate cancer. They are not, though, proof that a man has prostate cancer. Levels may be elevated with noncancerous prostate conditions such as an enlarged prostate or prostatitis. Levels may be low with prostate cancer. 

Maintaining Prostate Health: Tests continued...

The American Urological Association recommends that men ages 55 to 69 who are considering screening should talk with their doctors about the risks and benefits of testing and proceed based on their personal values and preferences. The group also adds:

• PSA screening in men under age 40 years is not recommended.
• Routine screening in men between ages 40 to 54 years at average risk is not recommended.
• To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening after a discussion with their doctor. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
• Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

The U.S. Preventive Services Task Force, however, doesn't recommend routine PSA screening for men in the general population, regardless of age. They say the tests may find cancers that are so slow-growing that medical treatments -- which can have serious side effects -- would offer no benefit.

Prostate biopsy : Men with high PSA results or other symptoms of cancer may have a tissue sample taken of their prostate to determine if cancer is present.