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Prostate Disorders
What Every Man and Woman Should Know About Prostate Disorders...
What's all the hoopla about the prostate gland? For a small structure about the size of a walnut, it has certainly catapulted its way into the forefront of medicine and male health issues. According to the American Cancer Society, it is the second most common site of cancer in men, and it is estimated that more than 200,000 men will develop prostate cancer this year. Even more heartbreaking, the American Cancer Society projects approximately 40,000 men will die this year from prostate cancer. Chances are if you're male, sooner or later you'll become familiar with the prostate gland. Today, an estimated 12 million American men have some problem with their prostate. By age 60, 50 percent of all men suffer from prostate problems. And by the time a man reaches 85, he has a 90 to 95 percent chance of having to cope with an enlarged prostate, referred to as benign prostatic hypertrophy (BPH).
Q: What is the prostate gland?
Dr. Green: The prostate gland is a small gland that is part of the male reproductive system. The prostate muscles surrounding the gland squeeze it to secrete fluid into the urethra that helps transport and nourish the sperm. Problems arise not because of the gland itself, but because of its location. Just below the bladder, next to the rectum, the urethra runs through the middle of the prostate and penis and out of the body. Sometimes the prostate swells or enlarges, which squeezes the urethra like a pinched straw. This squeezing action cuts off the flow of urine, causing backup that can damage the kidneys. Other times, bacteria can flow up the urethra, under the prostate, and cause painful inflammation.
Q: What are the most common prostate problems?
Dr. Green: The three most common prostate problems are prostatitis, benign prostate hypertrophy (BHP), and prostate cancer.
Q: What can I do to prevent prostate problems?
Dr. Green: Most experts agree that there is very little men can do to prevent the "big 3" prostate problems. However, what you can do is beware of the problems when they first develop and try to treat them before they get out of hand.
Q: How does one treat prostatitis?
Dr. Green: The mainstay of treatment is antibiotics. Other treatments in conjunction with antibiotics are:
- Anti-inflammatory medications
- Muscle relaxants
- Stress management
- Ejaculatory management
- Prostatic massage
- Warm baths
- Alcohol dietary changes (for example the avoidance of caffeine, alcohol, and spicy foods)
Q: What is BPH and why does it occur?
Dr. Green: BPH is benign prostatic hypertrophy, or enlargement. Although there is no precise reason for prostatic enlargement, experts think that the stimulation produced by male sex hormones plays a key role. As a man grows toward middle age his prostate grows. It continues to grow in size as long as the man is alive. The prostate is a very little gland in young boys. It grows to the size of a nickel in diameter as boys turn into adults. Normally it remains stable for the next 25 to 30 years, and then begins to enlarge, sometimes to the size of an orange. This enlargement is believed to be due to hormonal changes. The specific cause is still being debated. Whatever the reason for BPH, it is an inevitable result of aging -- there are currently no measures to take to prevent it. Symptoms of BPH are the same as those discussed in the prostate cancer side bar. The problem with BPH is that the enlarged prostate can press on a man's urethra, causing difficulty in urinating. Some men wake up two or three times during the night just to urinate, but are unable to empty their bladders. Some may strain so hard that they give themselves a hernia (rupture). A very serious problem occurs when a man is totally unable to void urine (retention) and it builds up in the bladder.
Q: What are the treatment options for BPH?
Dr. Green: The most common means for treating BPH is with a transurethral resection of the prostate (TURP). In this procedure, a urologic surgeon inserts a catheter into the urethra and then uses a tiny looped wire to shave excess prostate tissue from the blocked portion of the urethra in the center of the gland.
Recently a number of non-surgical options have been introduced, namely:
- The shrinking agent PROSCAR (finesteride), a drug that shrinks the prostate by interfering with the conversion of the male hormone testosterone into a hormone that causes prostate enlargement. Early studies report that it can shrink the prostate in most men by about 25 percent to 30 percent. However, it is too new to know how long the results will last.
- Blocking agents, such as Hytrin and Cardura, can relax the smooth muscle areas lining the urethra, which can go into spasms when the prostate enlarges. Those drugs benefit some BPH patients with mild to moderate symptoms so long as there is no sign of cancer.
- Hyperthermia, laser, and prostatic stents are investigational and may prove to be useful in the future.
- Balloon dilation of the prostate has not provided the lasting results that we anticipated, and therefore is being used infrequently and in select cases only.
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