The prostate is about the size of a walnut. It sits at the base of the penis and wraps around the urethra (the tube that urine comes from). Benign prostatic hypertrophy (BPH) is the medical term for an enlarged prostate. Half of men 60 and older, will experience BPH. Nearly all men by age 80 will experience an enlarged prostate. As the prostate continues to grow bigger as a man gets older, it can cause problems.
Urinary Health and the Prostate
Urinary problems are common with an enlarged prostate. The most common medication used to treat urinary symptoms related to prostate enlargement are alpha-blockers. These medications enlarge the urethral channel by relaxing the muscle fibers in it. 5-alpha-reductase inhibitors may also be used to shrink the prostate gland by as much as a third of its size. There are also medical procedures that help to remove excess prostatic tissue.
Inflamed Prostate – Prostatitis
Prostatitis, or an inflamed prostate, occurs in about 10% of men at least once during their lives. If you have prostatitis, you will likely know it as urination will be frequent and painful. Important steps to avoid prostatitis are staying hydrated, treating BPH when it occurs, not skipping preventative prostate exams and test and urinating regularly.
Although most prostate cancer affects men older than 50 years old, it has been found in men in their late 30s and 40s as well.
Risk factors for prostate cancer include race and genetics. It is well-documented that men who have a single first-degree relative suffering from prostate cancer have two-times the risk factor of developing prostate cancer while men with two or more first-degree relative suffering from prostate cancer have five times the risk of developing prostate cancer. Studies have also shown that African-American men have a greater risk of not only developing prostate cancer but have a higher morbidity and mortality rate as well. Recent advances in genomics are beginning to reveal a correlation between mutations in BRCA1 and BRCA2 genes and the development of prostate cancer. Various other factors including but not limited to diet, level of sexual activity, obesity and exposure to herbicides like Agent Orange also play a role in prostate cancer.
Common symptoms of prostate cancer can include:
- Difficulty initiating or stopping a urine stream
- Frequent urination
- Pain on urination
- Pain on ejaculation
- Blood in your semen
Two primary initial tests for prostate cancer include:
- A digital rectal examination is one of the most critical methods of screening for prostate cancer, as the most common form of prostate cancer is adenocarcinoma. This form of prostate cancer commonly occurs in the posterior portion of the prostate that is closest to the rectum.
- Another method of screening prostate cancer is a blood test called the PSA. Although there is much controversy surrounding the PSA blood test, early forms of prostate cancer are often detected when it is combined with a digital rectal examination.
When an individual is suspected of having prostate cancer, a prostate biopsy is usually performed under ultrasonic guidance. In addition to the traditional tests mentioned, there are a growing number of additional DNA studies (PTEN/ERG/Prolaris/OncoType Dx, etc.) that can be performed on the cancer specimen to potentially provide more information on the aggressiveness of the disease. Additional studies may also be indicated to determine the stage of the cancer as well as the potential treatment recommendations.
Treating Prostate Cancer
Management of prostate cancer is dependent on the information gathered from the biopsy as well as the staging studies that are performed. The age of the individual as well as their overall health will further determine the proper treatment course.
Treatments may include the following:
- Active surveillance: Regular office visits combined with blood tests and prostate exams as well as possible follow-up prostate biopsies
- Surgical removal of the prostate: robotic-assisted vs open procedures
- Radiation therapy: external beam radiation vs. brachytherapy
- Cryoablation therapy – focal or complete prostate treatment
- High-frequency ultrasound (HIFU)
- Hormonal therapy: medical castration vs. surgical castration
The 5-year survival rate for most men with local or regional prostate cancer is nearly 100%. Ninety-eight percent (98%) are alive after 10 years. Early detection is very important in managing and treating prostate cancer.
While prostate problems are very common as men age, they are often treatable – especially if diagnosed early. Be sure to keep up with your preventative and screening exams to stay ahead of any issues. Learn more about prostate health on Dr. Tay’s urology website.
Dr. Howard Tay is a board-certified urologist in Arizona certified by the American Board of Urology. He is an active member in the American Urological Association. He has practiced urology in Arizona since 1996. Dr. Tay is recognized as a leading Arizona urologist, including several Phoenix Magazine “Top Doc” awards for urology. He is an active member in advancing urology in the state of Arizona and serves on several hospital committees as is past Department Chair of Surgery at Banner Thunderbird Hospital. In addition to his practice, he is an educator training medical student and physician assistants in urology at Midwestern University, Northern Arizona University and the University of Arizona Medical School-Phoenix Campus. Dr. Tay and his wife Christina met while still in college at UC Berkeley and have been together through Dr. Tay’s medical school and residency. They have two children, Kimberly and Kevin. In his spare time, Dr. Tay enjoys tennis, racquet ball and golf as well as target shooting, restoring classic cars and home improvement projects. He and Christina love to travel.