Prostate Health

The symptoms of prostate problems vary depending on the cause and severity of the condition. However, the most common signs of prostate problems include:

• Weak urine stream
• Difficulty starting urination
• Stopping and starting while urinating
• Dribbling at the end of urination
• Frequent or urgent need to urinate
• Increased frequency of urination at night, for example, if you often need to go again two hours after urinating
• Straining while urinating
• Not being able to completely empty the bladder
• Urinary tract infection
• Formation of stones in the bladder
• Reduced kidney function
• Pain or burning sensation during urination
• Pain during ejaculation (orgasm)
• Problem getting or keeping an erection
• Blood in your urine or semen
• Pain in the abdomen, groin or lower back
• Pain in the area between the scrotum and rectum
• Pain or discomfort of the penis or testicles
• Flu-like symptoms (with bacterial prostatitis)

What is the prostate?

The prostate is a gland forming part of the male reproductive system. It is located in front of the rectum and below the bladder. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body. The main function of the prostate gland is to produce fluid which protects and enriches sperm.

In young men, the prostate is about the size of a walnut and continues to grow with age due to changes in the balance of sex hormones as men grow older. Its position near urinary and sexual organs means that certain prostate problems, as well as a number of treatments of those problems, can affect urination and sexual function. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow.

What are the most common prostate problems?

According to Prostate Cancer UK , the three most common prostate problems are:

• Enlarged prostate: Also known as benign prostatic hyperplasia (BPH), an enlarged prostate is the most common cause of urinary problems in men as they get older, mainly affecting those over 50 years. Untreated prostate gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney problems. Medications or surgery can treat an enlarged prostate. Having an enlarged prostate does not increase your risk of getting prostate cancer.
• Prostatitis: Prostatitis is inflammation of the prostate, sometimes caused by infection. In other cases, the cause is never identified. Symptoms of prostatitis usually include painful or difficult urination. Depending on the cause, prostatitis may come on gradually or suddenly. It may get better quickly, either on its own or with treatment. Some types of prostatitis, such as chronic prostatitis, last for months or more or keep recurring.
• Prostate cancer: After skin cancer, prostate cancer is the most common form of cancer in men. Prostate cancer occurs when some of the cells in the prostate reproduce far more rapidly than in a normal prostate, causing a growth or tumor. Prostate cancer cells can then spread by breaking away from the prostate tumor and invading other parts of the body, producing secondary tumors. Most of the time, it is a slow-growing cancer, causing some men to choose to delay treatment, which is called watchful waiting. Surgery, radiation, hormone therapy, and chemotherapy can also be used to treat prostate cancer. For a comprehensive overview of this topic, go to Prostate Cancer.

If a prostate condition or disease is suspected, there are several tests to help your doctor identify the problem and decide on the best treatment. These include:

• Digital rectal exam: This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the prostate, which sits directly in front of the rectum. This exam gives the doctor a general idea of the size and condition of the prostate and can sometimes detect an enlarged prostate, lumps or nodules of prostate cancer, or tenderness from prostatitis. The drawback to this test is that the doctor can feel only part of the prostate, so may miss abnormalities beyond reach.
• Prostate Specific Antigen (PSA) test: The PSA is a blood test that measures the blood level of PSA, a protein that is produced by the prostate gland. If PSA is high, prostate cancer is more likely, but an enlarged prostate can also cause an elevated PSA level. Also, some men who have prostate cancer do not have elevated PSA.
• Imaging: The doctor may want to use imaging tests, such as x-rays or a sonogram, to get a picture of your prostate. An intravenous pyelogram (IVP) 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 test: This test involves urinating into a machine that measures the speed of your urine flow. If you are urinating slowly, it may mean that you have an enlarged prostate.
• Cystoscopy: During a cystoscopy, a thin tube with lenses like a microscope (cystoscope) is inserted into the bladder through the urethra while the doctor looks through the cystoscope. This is another way to see the problem from the inside.
• Biopsy: A biopsy is a surgical procedure to remove a small sample of tissue from the prostate gland using a spring-loaded needle. The biopsy samples are then analysed by a pathologist to check for prostate cancer.

Several treatments are available for prostate problems, including treatment for prostate cancer. The best treatment choice for you depends on a number of factors, including your diagnosis, how much your symptoms affect you, your age, other health conditions you may have, as well as your preference. Treatment options include:

• 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.
• Medications: Mayo Clinic states that medications are the most commonly prescribed treatment for both prostatitis and an enlarged prostate. If prostatitis is caused by a bacterial infection, then antibiotics will need to be taken, either orally or intravenously. For those suffering from an enlarged prostate, medications like alpha-blockers and 5-alpha-reductase inhibitors can shrink or relax the prostate to keep it from blocking the bladder opening.
• Prostate massage: Prostate massage may be used to relieve swelling caused by prostatitis. This is done by your physician using a lubricated, gloved finger — a procedure similar to a digital rectal exam. This technique may provide some symptom relief, but doctors disagree about how effective it is.
• Nonsurgical procedures: To help treat an enlarged prostate, a number of devices have been developed that allow doctors to remove parts of the prostate during nonsurgical procedures.
  • Photoselective vaporisation of the prostate (PVP): destroys excess prostate tissue interfering with the exit of urine from the body by using a controlled laser beam inside the prostate.
  • Transurethral incision of the prostate (TUIP): widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
  • Transurethral microwave thermotherapy (TUMT): destroys prostate tissue by using a probe in the urethra to deliver microwave energy. This generates heat and destroys the inner portion of the enlarged prostate gland causing it to shrink and ease urine flow. 
  • Transurethral needle ablation (TUNA): destroys excess prostate tissue with electromagnetically generated heat by using a needle-like device in the urethra.
• Surgical treatment: Usually, medications resolve symptoms of an enlarged prostate, but some men require surgery to improve symptoms and prevent complications. 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. The most common surgery is called transurethral resection of the prostate (TURP). In TURP, the surgeon inserts a thin tube up the urethra and cuts away pieces of the prostate with a wire loop while looking through a cystoscope. 

There is currently no known way to completely prevent prostate conditions and disease. However, a person's risk of developing prostate problems can be reduced by maintaining a healthy, low-fat diet that includes plenty of fruits, vegetables, and whole grains.  Incorporating phytochemical-rich foods, such as tomatoes (which contain lycopene) and soy products (which have isoflavones), may also help reduce risk. 

Maintaining a healthy weight through exercise is another key way to reduce the risk of prostate disease. According to Harvard Health , evidence is accumulating that losing extra pounds, or avoiding weight gain in the first place, might help keep a prostate tumor in check. 

Other than diet and exercise, the best prevention of prostate disease is regular check-ups. Prostate cancer is more easily cured when caught early. After the age of 40, regular prostate check-ups are highly recommended for all men. A yearly examination can help to avoid major complications with prostate cancer later in life.