A Prostate Primer

Have you ever thought about your prostate? If the answer is no, odds are you’re either female or below the age of 50. There’s no better time than National Prostate Cancer Awareness Month to educate yourself about your prostate, its function, and prostate-related health issues.

What Is The Prostate & What Does It Do?

Your prostate is a walnut-sized gland located just below your bladder around the urethra — the tube that carries urine from the bladder to the penis. The prostate works in conjunction with the seminal vesical and bulbourethral gland to produce the liquid needed to make semen. It contains tiny muscles that forcibly express semen into the urethra during ejaculation.

Benign Prostate Hyperplasia (BPH)

As we age, our bodies change. Some of that change is visible, like a receding hairline or Wrinkles in our skin. Other changes are internal, like the natural enlargement of the prostate known as benign prostate hyperplasia, or BPH. Nearly half of men develop BPH by age 50. For some, BPH does not cause any complications. For others, because the prostate hugs the urethra, enlargement can reduce the flow of urine. This could be the case if you experience:

• Difficulty starting to urinate and/or maintaining a strong, steady flow
• Frequent or sudden urges to urinate
• Waking up in the middle of the night to go to the bathroom
• Pain or burning when urinating and/or ejaculating
• Urine leakage
• The sensation that the bladder is full even after urination

Treating BPH

Because BPH is so common, a variety of treatment options have been developed over the years. Unless the problem is severe, your primary care physician or urologist is likely to start by recommending lifestyle changes. You may be advised to reduce your consumption of caffeine and alcohol and not drink liquids before bed. Your doctor may counsel you to avoid spicy foods, which can irritate the bladder, and to increase your consumption of fiber to prevent constipation, which puts increased pressure on your bladder. Your physician might also advise you to avoid certain medications. If lifestyle changes don’t alleviate your symptoms, your doctor will prescribe one of the following treatment options:

1. Medication: Your doctor may prescribe one or more medications to alleviate your symptoms. Alpha blockers relax the muscles in the prostate and bladder, which facilitates urination. 5-alpha reductase helps reduce the size of the prostate and prevent further enlargement. Anticholinergics reduce urgency and frequency of urination.
2. Non-invasive and minimally invasive procedures:

• The UroLift® is a permanently implanted device that lifts and supports the enlarged prostate, taking pressure off the urethra
• Transurethral resection of the prostate (TURP) involves inserting a scope through the urethra to the prostate, and using electricity to burn off excess tissue
• Transurethral incision of the prostate (TUIP) eases the pressure on the urethra by making a few small cuts in the prostate without removing tissue
• Laser surgery may also be used to reduce prostate tissue

3. Invasive surgery is usually reserved for cases in which the prostate is significantly enlarged, or there is existing damage to the bladder. The procedure usually removes only the enlarged parts of the prostate (partial prostatectomy). This type of surgery can be performed as traditional open surgery, laparoscopically, or robotically.

Prostatitis

Not all prostate inflammation is age-related. The problem could be a bacterial infection or a condition, most common in men between 35 and 50 years of age, known as chronic pelvic pain syndrome. Prostatitis due to infection can be cured with antibiotics. Chronic pelvic pain syndrome is less understood. In this case, doctors may prescribe drugs commonly used to treat BPH, OTC pain meds, and low doses of anti-depressants or anti-epileptic drugs such as gabapentin.

Prostate Cancer

Aside from non-melanoma skin cancer, prostate cancer is the most common cancer in men, affecting one in six U.S. men at some point in their lives. Because prostate cancer is so common, the CDC recommends routine screenings starting at age 55. Your doctor may recommend starting screening earlier if your father, brother, or two or more members of your extended family have been diagnosed with prostate cancer. Screenings are essential because early-stage prostate cancer has no symptoms — by the time a man experiences symptoms his tumor is already advanced.

The initial screening process for prostate cancer involves a digital rectal exam (DRE), a prostate-specific antigen (PSA) test, or both. The PSA test is a blood test that looks for PSA, a protein produced by prostate tissue. Elevated PSA levels can be due to an infection, BPH, or cancer. If PSA levels indicate a possible tumor, the next step is a biopsy — examining a small section of prostate tissue under a microscope to determine how advanced and fast growing the cancer is. This is determined using a one to five grading system known as the Gleason Score. The Gleason Score evaluates how much a biopsy looks like healthy tissue (lower score) vs. abnormal tissue (higher score).

After diagnosing prostate cancer, your doctor will estimate the likelihood of the cancer having spread. This is determined based on the PSA, findings from the rectal exam, and the Gleason Score.

Treating Prostate Cancer

As with all cancers, early detection is key. When the cancer is confined to the prostate itself, men usually have a range of treatment options. Treatment for prostate cancer depends on the type and stage of the cancer as well as factors such as:

• Your age and life expectancy
• The stage and Gleason score of your cancer
• Your general health
• Your potential tolerance for treatment side effects
• Your personal preference regarding a particular care option

Treatment modalities include:

1. Active Surveillance, also known as watchful waiting, is sometimes prescribed if a tumor is low-risk, slow-growing, and not likely to spread. This protocol requires a check-in every six months to make sure there are no changes. Not all men are good candidates for active surveillance and your doctor will discuss the pros and cons of this approach.
2. Radiation damages cancer cells and interferes with their ability to reproduce. Two types of radiation therapy are commonly used for prostate cancer.  External beam radiation therapy targets a tumor with high-energy beams. Brachytherapy involves the placement of tiny radioactive “seeds” inside the body in and around the cancer. This approach minimizes radiation damage on healthy cells surrounding the tumor.
3. Hormone Therapy uses drugs to cut off the body’s supply of testosterone, the male hormone that fuels the growth of prostate cancer cells. Hormone therapy is generally only used for advanced or recurrent prostate cancer.
4. Chemotherapy uses oral and/or intravenous medications to treat prostate cancer.
5. Radical prostatectomy is the surgical removal of the entire prostate gland, attached seminal vesicles, and adjacent lymph nodes. The bladder and urethra are then reattached, and a catheter is left in place to drain urine while healing takes place. Traditionally performed through a large incision, this procedure can now be done using the da Vinci Xi® surgical robot to help preserve continence and sexual function.

When was your last checkup? Have you ever had a PSA test? Don’t wait! If you have a urologist or a primary care provider, give them a call to schedule a prostate exam, or click here to find a doctor who’s right for your needs.