Posted 5/12/2017 by UHBlog
Your prostate can be a puzzle.
Most guys may not know what their prostate gland does. Almost all men will experience some symptoms of uncomfortable but nonthreatening enlargement of their prostate gland as they age. And many men, if they live long enough, may develop prostate cancer. Although most guys with prostate cancer will die from something besides cancer – and may never even know they have the disease – prostate cancer is the second leading cause of cancer death in men, after lung cancer.
There are two categories of common prostate problems that are completely unrelated, says urologist Ehud Gnessin, MD. They are:
- Benign prostatic hyperplasia (BPH) or enlargement of the prostate
- Prostate cancer
“By the age of 60, half of all men will have some symptoms of benign prostatic hyperplasia,” Dr. Gnessin says. “By the age of 70, 80 percent of all men will have some symptoms of BPH.”
According to Dr. Gnessin, the prostate is a male gland that produces enzymes that help to keep sperm healthy in semen. The gland surrounds the urethra, which carries urine from the bladder.
“As men get older, the prostate increases in size, pressing against the urethra, obstructing the flow of urine,” he says. “In most cases, it’s a partial obstruction. In severe cases, a full obstruction requires catheterization to release the urine.”
BPH, says Dr. Gnessin, isn't usually a life-threatening condition, and it is not directly associated with cancer. Its symptoms, however, can be uncomfortable or even painful. They include:
- Feeling the need to urinate more frequently than normal
- Frequently waking up at night to urinate
- Weak urine flow
- The feeling of incomplete emptying of the bladder
- Painful urination or ejaculation
“Over time, complications can develop, such as urinary tract infections, bleeding, bladder stones or a complete obstruction,” he says. “As symptoms get worse, you may want see your doctor for treatment.”
Several types of treatments are available to relieve an obstructed urine flow due to an enlarged prostate, including:
- Medications called alpha blockers that temporarily dilate the urethra
- Testosterone blockers, which can control the growth of the prostate and are effective about 50 percent of the time, Dr. Gnessin says
- Surgery, such as a transurethral resection of the prostate (TURP), during which an instrument is inserted up the urethra to remove the obstructive section of the prostate
- Laser ablation, which uses a laser to remove obstructing tissue
- Laser enucleation, which uses a laser to shell out the obstructive tissue
The laser enucleation procedure – which is called a HoLEP procedure – doesn’t diminish a man’s ability to have an erection nor the sensation of an orgasm, Dr. Gnessin says. However, it usually does reduce the volume of semen that is ejaculated.
“Between 70 and 90 percent of men who have prostate surgery have what is called dry ejaculation,” he says. “Normally, by the age at which they have the surgery, however, they are past the age when they plan to have children.”
The other common prostate problem – prostate cancer – is usually checked in one of two ways:
- A digital rectal examination, during which the doctor uses a finger to feel for bumps or abnormalities on the prostate through the rectum
- A blood test for the presence of a substance called prostate-specific antigen (PSA)
Dr. Gnessin recommends that men between the ages of 55 and 72 years old discuss the pros and cons of these tests with their doctor. In the past, one or both of them were routine parts of an annual physical exam, but some recent studies have shown the tests created many false positives that led to unnecessary cancer treatments.
“There is some debate in the field about screening,” he says. “About five years ago, some large population studies showed that in order to save one patient’s life, you need to screen 400 to 1,000 patients. Today, we usually don’t screen patients who are 75 years or older, or younger than 50. Besides age, family history of cancer is another factor to consider when deciding whether to be screened for prostate cancer.”
The screenings themselves don’t reveal the presence of cancer. However, elevated PSA or suspicious bumps discovered during a digital rectal exam can trigger a biopsy, in which samples of the prostate are tested for cancer cells.
“Usually, by examining cancer cells, we’re able to determine whether the cancer is a low risk or an aggressive, more life-threatening type,” Dr. Gnessin says. “If it is low risk, usually no treatment is prescribed. Aggressive cancer that remains localized in the prostate is usually treated by surgically removing the gland – usually by robotic surgery – or by some method of radiation therapy.”
Prostate cancer that has spread to other parts of the body is typically treated with hormonal therapy or chemotherapy.
Ehud Gnessin, MD, is a urologist at University Hospitals Cleveland Medical Center. You can request an appointment with Dr. Gnessin or any other doctor online.