Prostate and PSA

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What is a Prostate?

The Prostate is a gland in men that is shaped like a walnut, roughly about an inch and a half in diameter, located underneath the urinary bladder and in the area behind the pubic bone and the base of the penis. The male hormone, testosterone, produced by the testes ("balls") along with sperm, stimulates the prostate to secrete part of the semen (whitish, thick, cloudy fluid) in which the spermatozoa (sperm) wiggles and travels.

What are the commonest prostate problems?

While there are other ailments affecting the prostate gland, the three most common are prostatitis (inflammation, infection), benign prostatic hypertrophy (enlargement), and cancer of the prostate.

What causes infection of the prostate?

Prostatitis could be either non-bacterial or bacterial. The non-bacterial is the more common of the two, where the cause is not known, and, therefore, harder to treat. The bacterial prostatitis is caused by gram negative enteric organisms. The treatment for this is a course of specific antibiotics for at least a week, anti-inflammatory or muscle relaxant drugs, increase fluid intake, stool softener, and bed rest.

How does a man know he has prostatitis?

The symptoms of acute prostatitis include fever and chills, urinary urgency and frequency, burning on urination, low back and perineal pain, sometimes bleeding in the urine, and usually with joint and muscle pains. The prostate gland is tender and warm to the physician's palpating finger (thru rectal examination).

How about benign prostatic hypertrophy?

Benign prostatic hypertrophy or hyperplasia, or BPH for short, usually happens among men between the ages of 40 to 45, mostly due to hormonal changes. Discomfort and difficulty in urination happens when new prostate tissue grows, squeezing the urethra (the tiny passage tube in the penis connected to the urinary bladder and the seminal vesicles) like a tight clamp around a rubber water hose. As the prostate hypertrophies more, the "clamp" becomes tighter, causing even more difficulty in passing urine, many times leading to complete obstruction at the bladder neck, inability to empty the bladder, and bladder distention. This obviously requires emergency care. If the obstruction is not total, the symptoms are usually a frequent sensation of urgency to urinate and passing only a small amount of urine at a time.

Does cancer of the prostate cause symptoms?

Cancer of the prostate does not cause symptoms early because the malignant tumor usually develops in the outer portion of the prostate, and therefore does not cause blockage of the urethra. Even without symptoms, this form of early stage of the cancer may be detected during a medical examination. This is the reason why a regular checkup, including a digital (finger) rectal prostate examination (once or twice a year) is very important among men who are 40 years and older, even those without symptoms, to catch prostate cancer before it spreads. Blood (serum) PSA level is also an important test for prostate cancer. When symptoms occur, the cancer may already be advanced.

What is a PSA Test?

PSA stands for Prostate-Specific Antigen, which is done by radioimmunoassay methods, and is the most sensitive marker for monitoring progression of prostate cancer and response to therapy. Its precise role in early detection is still being evaluated. PSA is elevated in 25 to 92% of those with cancer of the prostate and 30 to 50% of those with benign prostatic hyperplasia. Trans-rectal ultrasound (TRUS) could provide a preliminary diagnosis by means of sound waves, and confirmed by guided-needle biopsy of the prostate for a more definitive histologic tissue diagnosis. The other routine initial tests include urinalysis and blood tests, urine flow test, IVP (intravenous pyelogram) kidney X-rays and cystoscopy ("telecopic" examination of the urethra and the bladder, done through the penis).

What is the treatment for BPH?

Those patients with mild symptoms of BPH may be treated with oral medications (prostate muscle relaxants, hormone suppressors, bladder relaxants) and/or behavorial changes. For BPH that is so severe as to cause inability to urinate freely or inability to empty the urinary bladder because of the blockage of the urethra, TransUrethral Resection of the Prostate (TURP) is the treatment of choice. This surgery is done with a cystoscope passed through the penis, to remove hypertrophied prostatic tissues blocking the urethra and the bladder. Laser may also be used to remove these tissues. The results from TURP are very good to excellent.

What about for Cancer of the Prostate?

Localized cancer of the prostate gland may be CURED by Radical RetroPubic Prostatectomy (RRPP), with an incision done in the lower abdomen, about 4 inches above the front base of the penis. However, if there is extensive local spread, if the patient is too old or in poor health, or if there is already metastasis (distant spread of the cancer, usually to the bones), RRPP is not the preferred modality. In these cases, hormone control therapy, irradiation (X-Ray treatment), or bilateral orchiectomy (removal of both testicles) may provide palliation (improvement but not a cure). Radiation for control of pains due to spread of the cancer to the bones may provide relief. Chemotherapy after failure of hormone treatment has been found to be ineffective.

What is the prognosis of these patients?

The ten-year cure rates among patients with localized (with no spread) cancer of the prostate treated by radical prostatecomy or radiation therapy is about 65%. In other words, ten years after the treatment, 65 out of a hundred are still alive and well. Those patients who are not candidates for the radical prostate surgery or for irradiation may respond for several years to adequate hormonal control and/or orchiectomy. The prognosis among those with metastases is obviously worse but treatment may provide a long-term palliation.

Does this surgery cause impotence?

Unfortunately, yes. But Sildenafil (Viagra) is now available for Erectile Dysfunction and this restore the sexual "health" of these patients. To them, this pill is indeed heaven-sent.

What are some helpful habits and tips?

Some of these behavioral modifications and helpful habits are good not only for men and but also for women (habits 1 thru 6). They are: (1) Drink at least 8 glasses of fluid each day, but drink less during the times when a bathroom is not nearby or available, because holding your urine is not healthy; (2) Don't drink too much fluid at one time or before going to bed; (3) Minimize caffeine (coffee and Cola drinks), tea, and alcohol, as these increase the urine volume; (4) Make it a habit to urinate regularly; (5) If at all possible, urinate the moment you feel the urge, and relax, don't force your urine; (6) After urinating, try to urinate again to completely empty the bladder; (7) Do not sit on hard surfaces as this will bruise the prostate; (8) Avoid certain medications, like cold medications, diuretics (waterpills), anti-depressants, which can worsen BPH symptoms.

©2003Raoul R. Diez, M.A.O.D.