Factsheet
Prostate Problems
Date 20 April 2004
The prostate is a walnut sized gland, through which the urethra (urine passage) passes. It is found just under the bladder and it produces about half the fluid found in semen (cum). There are three main kinds of prostate problems:
- Enlarged prostate - for which the medical name is Benign Prostatic Hyperplasia or BPH.
- Prostatitis - which is inflammation of the prostate gland.
- Prostate cancer.
BENIGN PROSTATIC HYPERPLASIA
HOW COMMON IS THIS?
As a man ages his prostate tends to increase in size. BPH affects 55% of men aged between 60-70 years of age and 80% of men aged 70-80 years of age. This condition is more common than prostate cancer. The problem is that the enlarging prostate can begin to block the urine outlet so that about 50% of men older than 60 will have some problems passing urine.WHAT SORT OF SYMPTOMS MIGHT I GET IF MY PROSTATE IS ENLARGED?
The following symptoms are common as the prostate enlarges. If you get any of these symptoms (and especially if you have a number of them) you should see your doctor for advice.- Incomplete emptying. Do you ever have the feeling that you have not completely emptied your bladder after you finish passing urine?
- Frequency.Do you often feel that you have to pass urine again, less than two hours after you have been?
- Intermittency. Do you find that you stop and start several times when you pass urine?
- Urgency. Do you find it difficult to delay passing urine?
- Weak stream. Have you ever noticed that you cannot pass urine as far and as fast as you used to be able to?
- Straining. Do you ever feel that you have to push or strain when you begin to pass urine?
- Nocturia. Do you have to get up during the night? If you do how often does this happen?
WHAT MIGHT HAPPEN WHEN I VISIT THE DOCTOR?
You will probably have a digital rectal examination. With this examination, the doctor can feel the size, shape and outline of the prostate by gently putting their finger in your back passage (the rectum). You might feel that this is embarrassing but it should not be painful.The doctor might also suggest a blood test called a 'Prostatic Specific Antigen (PSA) test' to check that you do not have prostate cancer. Since this test is not 100% accurate, ask your doctor what other tests you might need if it comes back positive.
The doctor might also ask you to provide a urine sample for testing or send you to a pathologist for the test. Most doctors will also ask you to keep a 'voiding diary'. This means you will measure and record how much fluid you take in each day, how often you pass urine, and if you have to get up to go during the night.
HOW IS BPH TREATED? ARE THE TREATMENTS LIKELY TO HAVE ANY SIDE EFFECTS?
Once prostate cancer has been ruled out, many men and their doctors are happy to wait and see if symptoms get any worse. But even if the doctor does not suggest any specific treatment, they will usually advise that you see them for regular checkups.There are some drugs which can help with the symptoms, but they can sometimes cause side effects such as nausea, headache and dizziness. Some men try natural therapies such as the herbal remedy saw palmetto. Doctors are unsure of the benefits of this treatment and there have been no long-term studies done on potential side effects.
In more severe cases surgery may be recommended. This usually means surgically removing some of the prostate tissue that is blocking the urine flow. Other options are laser or microwave treatment, or special splints designed to keep the urine outlet clear. All forms of treatment may have side effects and these should be fully discussed with your doctor before you go ahead.
IS THERE ANYTHING I CAN DO MYSELF TO HELP WITH THE SYMPTOMS OF BPH?
- Drinking less fluids might help, particularly later in the day if getting up at night is a problem.
- Try to pass urine more frequently.
- Take your time when you are passing urine - don't rush it .
- Exercise regularly and keep fit.
- Limit your intake of alcohol - and also of coffee and other drinks that contain caffein (including Cola).
- Avoid spicy foods and citrus juices.
- Keep warm in cold weather.
- Avoid constipation.
- Have warm baths which will help relax the pelvic muscles and make it easier to pass urine.
- Watch your blood sugar levels if you are a diabetic.
- Always check with the chemist before taking over-the-counter medications eg medication for colds,or to calm you down. Some of these can make it very hard (or even impossible) to pass urine.
PROSTATITIS
WHAT IS PROSTATITIS?
This refers to inflammation of the prostate gland. It is fairly common, with about one in three men having symptoms of prostatitis between the ages of 20 and 50 years. The most common type of prostatitis is caused by an infection within the millions of tiny glands that make up the prostate. This can be caused by a virus or fungus, but bacterial infections are much more common. These can be sexually transmitted infections such as gonorrhoea and chlamydia, but prostatitis can also be caused by intestinal bacteria, which make their way up the urethra (urine outlet) and into the prostate.Prostatitis is 'acute' when symptoms strike suddenly, or 'chronic' when symptoms go on for some time despite treatment or when they return after a short time. The term Prostatodynia, describes the situation where a man gets prostate pain or other prostate symptoms but no infection or inflammation is seen in the gland.
HOW WOULD I KNOW IF I HAD ACUTE PROSTATITIS?
You would feel generally unwell, and have a fever or chills and some pain. The pain can be felt anywhere from the lower back to the thighs, the scrotum or around the anus. Some men experience pain when they cum, and others when they pass urine.WHAT WILL HAPPEN WHEN I VISIT THE DOCTOR?
The prostate gland will feel hot, swollen and tender when the doctor examines it by gently inserting a finger in the back passage. Most doctors will also arrange for you to have some urine tests and tests for sexually transmitted infections.HOW IS IT TREATED?
Once diagnosed, a course of antibiotics is prescribed, usually for a few weeks, though symptoms will often improve after only a couple of days. It is important to finish all the antibiotic tablets even if you are feeling better, since this reduces the chances of any infection persisting and causing chronic prostatitis.It is best to avoid sex during any treatment. If a sexually transmitted infection is found to be the cause, all sexual partners will need to be treated at the same time (even if they have no symptoms at all) or the infection will just keep coming back. Some men find painkillers useful, at least for the first few days.
Occasionally the prostate will swell up and block the urine flow completely - this needs a visit to hospital to unblock the bladder.
WHAT CAN I DO TO PROTECT MYSELF AGAINST PROSTATITIS?
A common causes of prostatitis is a sexually transmitted infection, so the best protection is to use safer sex practices.PROSTATE CANCER
Prostate cancer is a common cancer in men, with the risk increasing as a man gets older. Prostate cancer also seems to run in families. If a man's father or brother has prostate cancer his risk is almost three times greater than the average.WHAT ARE THE SYMPTOMS OF PROSTATE CANCER?
There are usually no symptoms in the early stages of prostate cancer. If the cancer is large and starts to press on the urine outlet, a man may notice some symptoms similar to the ones described with BPH. When the cancer has spread to other parts of the body a man may lose weight, feel tired, have pain in the bones or notice some swelling in the glands in the groin.WHAT SORT OF TESTS DO I NEED FOR PROSTATE CANCER?
All men over 50 should ask their doctor whether they would recommend a yearly digital rectal examination. Men who have a family history of prostate cancer, in their father or brother, should probably begin these checks at 40. If a prostate cancer is present, the doctor can usually feel it as a small, hard lump on the outside of the gland. A small piece of the prostate can then be taken and examined under the microscope to check for cancer cells.Some doctors suggest other routine screening for prostate cancer as well as the yearly digital rectal examination. They might advise a blood test (the PSA test discussed above under BPH) and a prostate ultrasound. However, there are probably just as many doctors who are not convinced that this screening is worthwhile.
There is not a lot of convincing evidence that early detection and treatment of prostate cancer makes much difference to long-term survival. One in ten men is diagnosed with prostate cancer but only about one in 70 die from it. A lot depends on your own history and risk factors, so discuss the pros and cons of further tests for prostate cancer with your doctor.
HOW DO YOU TREAT PROSTATE CANCER AND WHAT ARE THE SIDE EFFECTS?
There is no one recommended treatment for prostate cancer. It depends on the size of the cancer and whether it has spread to other parts of the body. Many doctors believe that the smaller the cancer is when it is diagnosed the better the chances of complete recovery - but even this is controversial since many small cancers may never have caused any problems in the first place.In older men or those with other health problems sometimes a 'wait and watch' approach is advised. If the tumour is small and a decision to treat is made, the prostate gland is usually removed along with the cancer. Such surgery will interfere with normal ejaculation and maycause problems with erection and urine control in some men. In other men radiotherapy is recommended. Radiotherapy can irritate the skin and the lining of the bladder and back passage.
Since the growth of the prostate cancer depends on the presence of male hormones, sometimes doctors recommend treatments designed to reduce hormone levels in the blood stream. This can be done by removing the testes or by prescribing drugs that block male hormones made by the testes. Side effects include loss of libido, impotence and hot flushes.
Often the decisions about the type of treatment required are quite complex, and a man needs to get advice from all the specialists involved in looking after him, before he can decide the best form of treatment in his particular case.
IS THERE ANYTHING I CAN DO TO PROTECT MYSELF AGAINST PROSTATE CANCER?
- Lose any excess weight. Fatty tissues secrete hormones and this seems to increase the risk of prostate cancer.
- Eat less fat and less red meat.
- Eat more fish, fruit and vegetables (especially red, green and yellow vegetables).
- Eat more soy and whole grain products.
- Eat more fibre. This seems to mop up the excess male hormones found in the bile.
USEFUL WEBSITES
www.prostatehealth.org.auwww.urosoc.org.au
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- Contact the Healthline on 1300 658 886.
