Prostate Problems

Understanding Prostate Problems

The prostate is a small organ about the size of a walnut. It lies below the bladder (where urine is stored) and surrounds the urethra (the tube that carries urine from the bladder). The prostate makes a fluid that becomes part of semen. Semen is the white fluid that contains sperm.

Prostate problems are common in men 50 and older. Most can be treated successfully without harming sexual function. A urologist (a specialist in diseases of the urinary system) is the kind of doctor most qualified to diagnose and treat many prostate problems.

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Noncancerous Prostate Problems

Acute prostatitis is a bacterial infection of the prostate. It can occur in men at any age. Symptoms include fever, chills, and pain in the lower back and between the legs. This problem also can make it hard or painful to urinate. Doctors prescribe antibiotics for acute prostatitis and recommend that the patient drink more liquids. Treatment is usually successful.

Chronic prostatitis is a prostate infection that comes back again and again. The symptoms are similar to those of acute prostatitis except that there is usually no fever. Also, the symptoms are usually milder in chronic prostatitis. However, they can last a long time.

Chronic prostatitis is hard to treat. Antibiotics often work when the infection is caused by bacteria. But sometimes no disease causing bacteria can be found. In some cases, it helps to massage the prostate to release fluids. Warm baths also may bring relief. Chronic prostatitis clears up by itself in many cases.

Benign prostatic hypertrophy (BPH) is enlargement of the prostate. This condition is common in older men. More than half of men in their 60’s have BPH. Among men in their 70’s and 80’s, the figure may go as high as 90 percent.

An enlarged prostate may eventually block the urethra and make it hard to urinate. Other common symptoms are dribbling after urination and the urge to urinate often, especially at night. In rare cases, the patient is unable to urinate.

A doctor usually can detect an enlarged prostate by rectal exam. The doctor also may examine the urethra, prostate, and bladder using a cytoscope, an instrument that is inserted through the penis.

BPH Treatment Choices

There are several different ways to treat BPH:

Watchful Waiting is often chosen by men who are not bothered by symptoms of BPH. They have no treatment but get regular checkups and wait to see whether or not the condition gets worse.

Alpha blockers are drugs that help relax muscles near the prostate and may relieve symptoms. Side effects can include headaches. Also, these medicines sometimes make people feel dizzy, lightheaded, or tired. Alpha blockers are new drugs, so doctors do not know their long term effects. Some common alpha blockers are doxazosin (Cardura), prazosin (Minipress), and terazosin (Hytrin).

Finasteride (Proscar) is a drug that inhibits the action of the male hormone testosterone. It can shrink the prostate. Side effects of finasteride include declining interest in sex, problems getting an erection, and problems with ejaculation. Again, because it is new, doctors do not know its long-term effects.

Surgery is the treatment most likely to relieve BPH symptoms. However, it also has the most complications. Doctors use three kinds of surgery for BPH:

  • Transurethral resection of the prostate (TURP) is the most common. After the patient is given anesthesia, the doctor inserts a special instrument into the urethra through the penis. With the instrument, the doctor then removes part of the prostate to lessen its obstruction.
  • Transurethral incision of the prostate (TUIP) may be used when the prostate is not too enlarged. In this procedure, the doctor passes an instrument through the urethra to make one or two small cuts in the prostate.
  • Open surgery is used when the prostate is very enlarged. In open surgery, the surgeon makes an incision in the abdomen or between the scrotum and the anus to remove prostate tissue.

Men should carefully weigh the risks and benefits of each of these options. The Agency for Health Care Policy and Research has designed a booklet to help in choosing a treatment; call 800-358-9295 and ask for their free patient guide on prostate enlargement.

Protecting Yourself

The best protection against prostate problems is to have regular medical checkups that include a careful prostate exam. See a doctor promptly if symptoms occur such as:

  • a frequent urge to urinate,
  • difficulty in urinating, or
  • dribbling of urine.

Regular checkups are important even for men who have had surgery for BPH. BPH surgery does not protect against prostate cancer because only part of the prostate is removed. In all cases, the sooner a doctor finds a problem, the better the chances that treatment will work.