Meaning of Changes in the Prostate: You may have prostate problems and want to learn more about the symptoms and risk factors for prostate cancer, PSA screenings, and non-cancerous conditions such as an enlarged prostate (BPH) and prostatitis.
The prostate is a small gland in men. It is part of man’s
reproductive system. The prostate is almost the size and shape of a walnut. It is located below the pelvis, below the bladder and almost opposite the rectum. The prostate helps produce semen, the milky fluid that carries sperm from the testicles to the penis when the man ejaculates. The prostate surrounds part of the urethra, a tube that carries urine out of the bladder and through the penis.
Since the prostate gland tends to grow with age, it can press on the urethra and cause problems in passing urine. Sometimes men in their 30s and 40s can start having these urinary symptoms and need medical attention. For others, the symptoms are not felt until much later in life. An infection or a tumor can also cause the prostate to enlarge. Be sure to tell your doctor if you have any of the urinary symptoms listed below.
Tell your doctor if you have these urinary symptoms:
You need to urinate more times during the day
Urgent need to urinate
Has a lower flow of urine
Feels burning when urinating
You need to get up many times at night to urinate
Old age increases your risk of prostate problems. The three most common prostate problems are inflammation ( prostatitis ), an enlarged prostate (BPH, or benign prostatic hyperplasia ), and prostate cancer.
One change does not lead to the other. For example, having prostatitis or an enlarged prostate does not increase your risk of prostate cancer. It is also possible that you have more than one condition at the same time.
Prostatitis is an inflammation of the prostate gland that can result from a bacterial infection. It affects at least half of all men at some point in their life. Having this condition does not increase your risk of another prostate disease.
Feeling of burning or pain when urinating
A strong and frequent urge to urinate, even when there is only a small amount of urine
Chills and high fever
Lower back pain or pains in the body
Low pain in the belly, in the groin or behind the scrotum
Pressure or pain in the rectum
Discharge through the urethra that accompanies bowel movements
Genital and rectal palpitation
Sexual problems and lack of libido
Ejaculation (painful sexual orgasm)
Several tests, such as digital rectal exam and urinalysis, can be done to see if you have prostatitis. The correct diagnosis of your exact type of prostatitis is critical to get the best treatment. Even if you do not have symptoms, you should follow your doctor’s advice to complete the treatment.
Acute bacterial prostatitis: This type is caused by a bacterial infection and appears suddenly ( acute ). The symptoms are severe chills and fever. There is often blood in the urine. The concentration of your PSA (see PSA analysis ) may be higher than normal. You need to go to the doctor’s office or to the emergency room for treatment. It is the least common of the four types, but it is easier to diagnose and treat.
Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need medications to help with the pain and discomfort. If your PSA level was high, it will probably return to normal when the infection has disappeared.
Chronic bacterial prostatitis: Also caused by bacteria, this type of prostatitis does not appear suddenly, but it can be problematic. The only symptoms you may have are bladder infections that come back. The cause may be a defect in the prostate that allows bacteria to accumulate in the urinary tract.
The treatment with antibiotics in a long period of time is the best for this type. The treatment lasts from 4 to 12 weeks. This type of treatment resolves about 60% of cases. Antibiotics for a long time and in low doses can help relieve symptoms in cases that do not go away.
Chronic prostatitis or chronic pelvic pain syndrome: This disorder is the most common type of prostatitis but it is also the least understood. It is found in men of any age from the last years of youth to old age, its symptoms may appear and disappear without warning. There may be pain or discomfort in the groin or area of the bladder. Often, cells that fight infection are present, even though no bacteria are found.
There are several different treatments for this problem, depending on your symptoms. These are anti-inflammatory medications and other treatments for pain control, such as warm baths. Other medicines, such as alpha blockers, can also be given. Alpha blockers relax the prostate tissue to facilitate the passage of urine. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.
Asymptomatic inflammatory prostatitis: With this condition, there are no symptoms. It is often found when tests are done for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this type of prostatitis, your PSA test may show a higher than the normal number.
Men who have this condition usually do not receive treatment, but it is customary to repeat the PSA test if the PSA number is high.
BPH means benign prostatic hyperplasia. Benign means “that is not cancerous” and hyperplasia means abnormal growth of cells. The result is that the prostate becomes enlarged. BPH is not related to cancer and does not increase your risk of prostate cancer-however, the symptoms of BPH and prostate cancer may be similar.
Problems to start the flow of urine or to make it more than a drip
Urinating frequently, especially at night
Feel that the bladder does not empty completely
A strong or sudden urge to urinate
A weak or slow flow of urine
Stop and start again several times when urinating
Push or strain to start urinating
In the worst case, BPH can cause a weak bladder, reflux of urine that causes bladder or kidney infections, a complete blockage of urine flow and kidney failure.
The prostate gland is almost the size of a walnut when the man is about 20 years old. By the time he’s 40, the prostate may have grown a little more, the size of an apricot. At 60, it may be the size of a lemon. The enlarged prostate can press against the bladder and urethra. This can slow or block the flow of urine.
Some men may have trouble starting the flow of urine, even if they feel the need to urinate. Once the flow of urine begins, it can be difficult to stop it. Other men may feel that they need to urinate all the time, or they wake up when they are asleep with the sudden need to urinate. The first symptoms of BPH take many years to become bothersome problems. These initial symptoms are an indication that you have to see the doctor.
Treatments for HPB
Some men with BPH will eventually find that their symptoms are bothersome enough to need treatment. BPH cannot be cured, but medicines or surgery can often relieve your symptoms. Talk to your doctor about the best option for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.
Men with mild symptoms of BPH who do not consider them bothersome can choose this option. Watchful waiting means examining yourself annually. The treatment starts only if the symptoms become very problematic.
If you choose watchful waiting, these simple steps can help relieve your symptoms:
Limit drinking at night, especially drinks with alcohol or caffeine.
Empty your bladder completely when urinating.
Use the bathroom frequently. Do not wait long without urinating.
Some medications can make your BPH symptoms worse, so talk to your doctor or pharmacist about any medicine you are taking, such as:
Over-the-counter medicines for colds and coughs (especially antihistamines)
Medicine for blood pressure
Many American men with mild or moderate symptoms of BPH have chosen prescription drugs instead of surgery since the early 1990s. Two main types of medications are used. One type relaxes the muscles next to the prostate, and the other type reduces the size of the prostate gland. Some evidence indicates that when both medications are taken together it is better to prevent the symptoms of BPH from worsening.
Alpha blockers are drugs that help relax the muscles near the prostate to mitigate pressure and allow urine to flow more easily but do not reduce the size of the prostate. For many men, these drugs can improve the flow of urine and reduce the symptoms of BPH in a few days. The side effects possible are dizziness, headache, and fatigue.
Inhibitors of 5-alpha-reductase are drugs that help reduce the size of the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates the growth of the prostate.
When the action of 5-alpha-reductase is blocked, the production of DHT decreases and the growth of the prostate is slower. This helps reduce the size of the prostate, also reduce urine blockage and limit the need for surgery.
When these drugs are taken, it can help increase the flow of urine and reduce its symptoms. You need to keep taking these drugs to prevent the symptoms from returning. The 5-alpha reductase inhibitors can cause the following side effects in a small percentage of men: decreased interest in sex, problems having or maintaining an erection and a smaller amount of semen in the ejaculate.
It is important to keep in mind that these drugs can lower the number of PSA result. There is also evidence that these drugs lower the risk of prostate cancer, but it is still unclear if they can help lower the risk of dying from prostate cancer.
The number of prostate surgeries has decreased over the years. But operations by HPB are still the most common surgeries for American men. Surgery is used when symptoms are severe or when drug therapy has not worked well. Be sure to discuss your options with your doctor and ask about possible short and long term benefits, and the risks of each procedure.
The types of surgery for BPH are:
TURP (transurethral resection of the prostate): The most common surgery for BPH, TURP represents 90% of all BPH surgeries. The doctor passes an instrument through the urethra and trims the excess tissue of the prostate. A spinal block ( anesthesia ) is used to numb the area. The tissue is sent to the laboratory to check for cancer.
TURP generally avoids the two main dangers that are related to another type of surgery called open prostatectomy (complete removal of the prostate gland by a cut in the lower abdomen): even incontinence and impotence. However, TURP can have serious side effects, such as hemorrhage. In addition, you may be required to stay in the hospital and a catheter is needed for a few days after surgery.
ITUP (transurethral incision of the prostate): This surgery, which is similar to TURP, is used in slightly enlarged prostate glands. The surgeon puts a small cut or two in the prostate. This relieves pressure without cutting tissue. It has a low risk of side effects. Like TURP, this treatment helps with the flow of urine when extending the urethra.
Transurethral ablation with the needle: Radio waves are used to burn off excess prostate tissue. Transurethral needle ablation helps with the flow of urine, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a while after the procedure.
Transurethral thermotherapy with microwaves: Microwaves that are sent through a catheter are used to destroy excess tissue in the prostate. This may be an option for men who should not have major surgery because they have other medical problems.
EVTP (transurethral electron evaporation of the prostate): An electric current is used to evaporate tissue from the prostate.
Laser surgery : The doctor passes a laser fiber through the urethra and into the prostate, using a cystoscope, and then applies several discharges of laser energy. The laser energy destroys the prostate tissue and helps improve the flow of urine. Like TURP, laser surgery requires anesthesia. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. The recovery period of laser surgery may be shorter as well. However, laser surgery may not be effective in larger prostates.
Open prostatectomy: This may be the only option in a few cases, such as when the obstruction is severe, the prostate is very large, or other procedures are not possible. General anesthesia or spinal block is used, and a catheter is placed that remains 3 to 7 days after surgery. This surgery carries the greatest risk of complications. The tissue is sent to the laboratory to look for prostate cancer.
Prostate cancer means that cancer cells are formed in the tissues of the prostate. Prostate cancer tends to grow more slowly compared to most other cancers. Cell changes can start 10, 20, or even 30 years before a tumor is large enough to cause symptoms. Eventually, cancer cells can spread ( metastasize ). By the time the symptoms appear, cancer may already have advanced.
At 50 years of age, very few men have symptoms of prostate cancer, but some precancerous or cancerous cells may be present. More than half of all American men have some cancer in their prostate glands at 80 years of age. Many of these cancers never present problems. They can never cause symptoms or become serious threats to health.
Frequent urge to urinate, especially at night
A weak stream of urine or with interruptions
Pain or burning when urinating
Blood in the urine or in the semen
Annoying pain in the back, hips or pelvis.
Prostate cancer can spread to the lymph nodes in the pelvis. Or it can spread throughout the body. It tends to spread to the bones. So the pain in the bones, especially in the back, can be a symptom of advanced prostate cancer.
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of getting a disease. Having one or several risk factors does not mean that you will have prostate cancer. It only means that your risk of the disease is greater.
Age: Men who are 50 years old or older have an increased risk of prostate cancer.
Race:African-American men have the highest risk of the prostate cancer-the disease tends to start at younger ages and grow faster than men of other races. After African-American men, prostate cancer is more common in white men, followed by Hispanics and Native American men. Asian American men have lower rates of prostate cancer.
Antecedents of family: Men whose parents or siblings have had prostate cancer have a 2 or 3 times higher risk of prostate cancer than men without a family history of the disease. The man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who has no family history of prostate cancer. The younger the man’s relatives are when they have prostate cancer, the higher their risk of developing the disease. The risk of prostate cancer also seems to be slightly higher for men in families with a history of breast or breast cancer.
Diet: The risk of prostate cancer may be higher for men who eat high-fat diets.
Screening tests mean having cancer tests before you have symptoms. A screening test can help find cancer at an early stage , when it is less likely to spread and can be treated more easily. When the symptoms appear, the cancer may have started to spread.
The most useful screening tests are those that have been proven to lower a person’s risk of dying from cancer. Doctors still do not know if screening for prostate cancer lowers the risk of dying from prostate cancer. This is why large research studies are now being conducted, with thousands of men, to study prostate cancer screenings. The National Cancer Institute is studying the combination of the PSA test with the digital rectal exam in order to obtain more accurate results.
Although some think it is better to treat whatever cancer is found, including cancers that are found by screening, the treatment of prostate cancer can cause serious and sometimes permanent side effects. Some doctors worry that many men whose cancer has been detected through screening have received treatment when it was not necessary-and have experienced side effects. Ask your doctor about your risk of prostate cancer and your need to have screening tests.
Large research studies are evaluating how prostate cancer can be prevented. Studies have shown that inhibitors of 5-alpha reductase, finasteride and dutasteride may reduce the risk of prostate cancer, but it is still unclear whether they can decrease the risk of dying from prostate cancer.
Ask your doctor about your risk of prostate cancer and your need to have screening tests.
This first step allows your doctor to hear and understand the “history” of your prostate concerns. They will ask you if you have symptoms, for how long you have had them, and to what extent they affect your lifestyle. Your personal medical history also includes any risk factors, pain, fever, or problems urinating. You may be asked to give a urine sample to analyze.
The digital rectal exam is
This exam reviews:
The size, firmness and texture of the prostate
Any hard areas, balls or tumors that extend outside the prostate, and
Any pain caused by touching or squeezing the prostate
The digital rectal exam allows the doctor to feel only one side of the prostate. A PSA test is another way that helps your doctor check the health of your prostate.
The Administration Food and Drug Administration of the United States ( Food and Drug Administration, FDA ) has approved the use of the PSA test along with a digital rectal exam to help detect prostate cancer in men 50 years and older. PSA is a protein produced by the cells of the prostate. Normally it is secreted in the ducts of the prostate where it helps to form the semen, but sometimes it leaks into the blood. When the PSA is in the blood, it can be measured with a blood test called prostate-specific antigen analysis.
In prostate cancer, more PSA than normal enters the blood. However, a high PSA level in the blood is not proof that there is cancer, and many other things can cause a false positive result of the test. For example, PSA levels in the blood often increase in men with prostatitis or with BPH. Even things that alter the prostate gland – like riding a bicycle or motorcycle, or having a digital rectal exam, an orgasm in the last 24 hours, a biopsy of prostate or surgery in the prostate – may increase PSA levels.
Also, some prostate glands naturally produce more PSA than others. PSA levels increase with age. African-American men, in general, tend to have higher PSA levels than men of other races. And other drugs, such as finasteride and dutasteride, can cause the concentration of PSA in man to decrease.
Prostate-specific antigen tests are often used to monitor men after prostate cancer treatment to check for signs of cancer recurrence. It is not yet known with certainty whether prostate-specific antigen tests to detect prostate cancer can reduce a man’s risk of dying from that disease.
Researchers are working to learn more about the ability of the PSA test to help doctors distinguish between prostate cancer and benign prostate problems, and the best that can be done if a man has a high PSA level. For now, men and their doctors use PSA results as a guide to see if there is a need for more follow-up.
PSA concentrations are measured in terms of the amount of PSA per volume of fluid analyzed. Doctors often use a value of 4 nanogram (ng) or more per milliliter of blood as a sign of the need to do more tests, such as a prostate biopsy. Your doctor can monitor the speed of your PSA, which means the rate of change in your PSA concentration over time. Rapid increases in PSA results may suggest that there is cancer.
If you have a slightly elevated PSA level, you and your doctor can choose to perform prostate-specific antigen tests on a scheduled basis and pay attention to any change in PSA velocity.
This test is used for men who have higher PSA levels. The regular PSA test measures the total PSA, which includes both the PSA that is attached, or bound, to other proteins and the PSA that is free or unattached. The free PSA test measures only free PSA. Free PSA is related to benign prostate conditions, such as BPH, whereas the linked PSA is related to cancer. The percentage of free PSA can help tell what kind of problem you have in the prostate.
If both total PSA and free PSA are greater than normal (high percentage of free PSA), this suggests BPH instead of cancer.
If the total PSA is high but the free PSA is not (low percentage of free PSA), there is a higher probability of cancer. More tests should be done, such as a biopsy.
You and your doctor should discuss your personal risk and the results of the free PSA. Then they can decide together whether follow-up biopsies will be done and how often.
If your symptoms or test results suggest there is prostate cancer, your doctor will refer you to a specialist (a urologist) for a prostate biopsy. For a biopsy, small samples of tissue are taken directly from the prostate. Your doctor will take samples from various areas of the prostate gland. This can help to lower the chances of omitting any area of the gland that might have cancer cells. Like other cancers, prostate cancer can be diagnosed only when the tissue is viewed under a microscope. Most men who have biopsies after screening tests do not have cancer.
A positive test result after a biopsy means there is cancer present. A pathologist will check your biopsy sample for cancer cells and give you a Gleason score. The Gleason score ranges from 2 to 10 and describes the likelihood of the tumor spreading. The smaller the number, the less active the tumor will be and the less likely it will spread. Treatment options depend on the stage (or extension) of
Reaching a decision about the treatment of your prostate cancer is a complex process. Many men realize that it is useful to talk with their doctors, with their family and friends, and with other men who have faced similar decisions.
Different kinds of doctors and other health professionals take care of prostate health. They can help you find the best treatment, answer your questions and address your concerns. These health care professionals are:
Family doctors and internists
Medical assistants and nurse practitioners
Urologists , who are experts in diseases of the urinary tract and the male reproductive system
Oncologist urologists , who are experts in treating cancers of the urinary tract and the male reproductive system
Radiation oncologists , who use radiotherapy to treat cancer
Medical oncologists , who treat cancer with medications such as hormone therapy and chemotherapy
Pathologists , who identify diseases by studying cells and tissues under a microscope.
Consider these professionals as your partners – expert counselors and aides to take care of your health. By speaking frankly with your doctors, you can help them learn more about their prostate changes and the tests they should expect.
What kind of problem do I have in the prostate?
Do I need to do more tests? What can you tell me?
If I decide to wait vigilantly, what changes in symptoms should I monitor and how often should I have tests?
What kind of treatment do you recommend for my prostate problem?
For men like me, has this treatment worked?
How soon should I start the treatment and how long will it last?
Do I need medicine and for how long should I take it before I see an improvement in my symptoms?
What are the side effects of the medicine?
Are there other medicines that could interfere with this medicine?
If I need surgery, what are the benefits and risks?
Will I have side effects from surgery that can affect my quality of life?
Are these temporary or permanent side effects?
How long is the recovery time after surgery?
Will I be able to return to a completely normal life?
How will this affect my sex life?
How often should I visit the doctor to monitor my situation?