The prostate is a gland. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body. A young man's prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is very common after age 50. The older men get, the more likely they are to have prostate trouble.
Some common problems are
- Prostatitis - an infection, usually caused by bacteria. This is the most common prostate problem for men under 50.
- Benign prostatic hyperplasia, or BPH - an enlarged prostate, which may cause dribbling after urination or a need to go often, especially at night. This is the most common prostate problem for men over 50.
- Prostate cancer - a common cancer that responds best to treatment when detected early
"Prostatitis" means that the prostate is inflamed; it could be swollen, red, and warm. If you have prostatitis, you may have a burning feeling when you urinate, or you may have to urinate more often. Or you may have a fever or just feel tired.
Inflammation in any part of the body is usually a sign that the body is fighting germs or repairing an injury. Some kinds of prostatitis are caused by germs, or bacteria. If you have bacterial prostatitis, your doctor can look through a microscope and find bacteria in a sample of your urine. Your doctor can then give you an antibiotic medicine to fight the bacteria.
If you keep getting infections, you may have a defect in your prostate that allows bacteria to grow. This defect can usually be corrected by surgery.
Most of the time, doctors don't find any bacteria in men with prostatitis. If you have urinary problems, the doctor will look for other possible causes, such as a kidney stone or cancer.
If no other causes are found, the doctor may decide that you have a condition called nonbacterial prostatitis.
Antibiotics will not help nonbacterial prostatitis. You may have to work with your doctor to find a treatment that's good for you. Changing your diet or taking warm baths may help. Your doctor may give you a medicine called an alpha blocker to relax the muscle tissue in the prostate. No single solution works for everyone with this condition.
If you're a man over 50 and have started having problems urinating, the reason could be an enlarged prostate, or BPH. As men get older, their prostate keeps growing. As it grows, it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.
If you have BPH, you may have one or more of these problems:
- A frequent and urgent need to urinate. You may get up several times a night to go to the bathroom.
- Trouble starting a urine stream. Even though you feel you have to rush to get to the bathroom, you find it hard to start urinating.
- A weak stream of urine.
- A small amount of urine each time you go.
- The feeling that you still have to go, even when you have just finished urinating.
- Leaking or dribbling.
- Small amounts of blood in your urine.
You may barely notice that you have one or two of these symptoms, or you may feel as though urination problems have taken over your life.
BPH and Cancer
It's true that some men with prostate cancer also have BPH, but that doesn't mean that the two conditions are always linked. Most men with BPH don't develop prostate cancer. However, because the early symptoms are the same for both conditions, you should see a doctor to evaluate these symptoms.
By itself, BPH is not a serious condition, unless the symptoms are so bothersome that you can't enjoy life. But BPH can lead to serious problems. One problem is urinary tract infections.
If you can't urinate at all, you should get medical help right away. Sometimes this happens suddenly to men after they take an over-the-counter cold or allergy medicine.
In rare cases, BPH and its constant urination problems can lead to kidney damage.
Several tests help the doctor identify the problem and decide on the best treatment.
- Digital rectal exam. This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate that sits next to it. This exam gives the doctor a general idea of the size and condition of the prostate.
- Blood test. The doctor may want to test a sample of your blood to look for prostate-specific antigen, or PSA. If your PSA is high, it may be a sign that you have prostate cancer. But this test isn't perfect. Many men with high PSA scores don't have prostate cancer.
- Imaging. The doctor may want to get a picture of your prostate using either x rays or a sonogram. An IVP, or intravenous pyelogram, is an x ray of the urinary tract. For an IVP, dye will be injected into a vein. Later, when the dye passes out of your blood into your urine, it will show up on the x ray. A rectal sonogram uses a probe, inserted into the rectum, to bounce sound waves off the prostate.
- Urine flow study. You may be asked to urinate into a special device that measures how quickly the urine is flowing. A reduced flow may mean that you have BPH.
- Cystoscopy. Another way to see a problem from the inside is with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the bladder through the urethra while the doctor looks through the cystoscope.
Several treatments are available. You'll have to work with your doctor to find the one that's best for you.
- Watchful waiting. If your symptoms don't bother you too much, you may choose to live with them rather than take pills every day or have surgery. But you should have regular checkups to make sure your condition isn't getting worse. With watchful waiting, you can be ready to choose a treatment as soon as you need it.
- Medicines. In recent years, scientists have developed several medicines to shrink or relax the prostate to keep it from blocking the bladder opening.
- Nonsurgical procedures. A number of devices have been developed to remove parts of the prostate. These procedures can usually be done in a clinic or hospital without an overnight stay. The procedures are transurethral, which means the doctor reaches the area by going through the urethra. The doctor's devices use thin tubes inserted through the urethra to deliver controlled heat to small areas of the prostate. A gel may be applied to the urethra to prevent pain or discomfort. You won't need general drugs that make you go to sleep. These procedures are called transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA).
- Surgical treatment. Surgery to remove a piece of the prostate can be done through the urethra or in open surgery, which requires cutting through the skin above the base of the penis. Your doctor may recommend open surgery if your prostate is especially large. The most common surgery is called transurethral resection of the prostate, or TURP. In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop under direct vision through a cystoscope. TURP and open surgery both require general anesthesia and a stay in the hospital.