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Getting Control of Prostate Health
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How to handle BPH and Prostatitis
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By Beth Howard
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MediZine's Healthy Living Fall 2009
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Age may improve a man’s judgment and enrich his wisdom. But it’s no friend to his prostate, the walnut-size gland that sits below the bladder and manufactures seminal fluid.
As men age, the prostate grows larger and more prone to inflammation, which can cause troublesome symptoms. At any age men may develop infections that affect the prostate. Here we explain two of the most common prostate problems.
Some prostate conditions have subtle signs or none at all. So whether
or not you have symptoms, it’s important to talk with your doctor about
your prostate health.
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In men with BPH, the prostate enlarges, gradually constricting the urethra, the tube through which urine passes. “Men frequently complain they don’t have the stream they used to,” says Cy Stein, M.D., head of the medical genitourinary oncology program at the Montefiore-Einstein Cancer Center in NYC.
Men with BPH also may experience frequent urination, an urgent need to urinate and a burning feeling. In addition to such annoyances, BPH can eventually cause a backflow of urine, triggering bladder or kidney infections, urine blockage or even kidney failure—so seek treatment early.
An enlarged prostate usually begins to bother men after age 50; almost all men are affected by the time they reach 80. Luckily, having BPH does not increase your risk for prostate cancer.
Help is available, but you need to be open with your doctor. “Unfortunately, men are often hesitant to disclose urination problems to their doctor,” notes Muta Issa, M.D., associate professor of urology at the Emory Clinic and chief of urology at the Atlanta VA Medical Center. “They consider it part of aging,” he observes, “and tend to tolerate these symptoms for too long.”
• Treatment For many men, the first step is to change behaviors that may worsen symptoms, such as drinking too much liquid before bedtime. In addition, “many patients don’t realize that some medications exacerbate symptoms,” Dr. Issa says. These include over-the-counter cold and sinus medications as well as certain antidepressants, tranquilizers and blood-pressure medications.
Two classes of drug therapies can help if the condition becomes more bothersome. Alpha-blockers help relax the muscles in the prostate, relieving the pressure and allowing urine to flow more freely. Medications called 5-alpha reductase inhibitors retard prostate growth and actually shrink the prostate to reduce symptoms. They work by blocking enzymes that act on testosterone, a hormone that promotes organ growth.
When symptoms can’t be managed with medication, your doctor may recommend removing or destroying excess prostate tissue. Surgical techniques may involve trimming the tissue or destroying it with lasers, radio-frequency energy, electrical currents or microwave energy. These procedures carry a small risk of incontinence and sexual dysfunction.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, 10 to 12 percent of men experience prostatitis-like symptoms. The term prostatitis means inflammation of the prostate, but doctors use the word to describe the following four distinct disorders:
• Chronic prostatitis Also called chronic pelvic pain syndrome, this is the most common form of the disorder. It causes pain or discomfort in the groin or bladder area. Treatment may include anti-inflammatory drugs, antibiotics, analgesics for pain or alpha-blockers to relax the muscles in the prostate.
• Acute bacterial prostatitis This appears as a sudden infection triggered by bacteria. Symptoms include fever, chills and blood in the urine and warrant an immediate trip to the doctor. Treatment is an initial high dose of antibiotics, followed by several weeks at a lower dose.
• Chronic bacterial prostatitis This condition, also caused by bacteria, results in recurring bladder infections. A 4- to 12-week course of antibiotics is usually prescribed to clear up the problem, but a longer-term, low-dose antibiotic may be needed for cases that don’t respond.
• Asymptomatic inflammatory prostatitis Because it has no symptoms, you may learn you have this condition when a doctor evaluates you for another problem, such as prostate cancer or infertility. Often a blood test revealing an elevated prostate-specific antigen (PSA) level triggers an investigation. Men with the condition usually go on antibiotics for four to six weeks and then repeat the PSA test.
Current guidelines advise that all men have an annual prostate exam
beginning at age 50 (40 if you are African-American and/or have a
family history of prostate cancer). Your doctor should perform a
digital rectal exam (DRE) to search for prostate enlargement and
irregularities associated with BPH or prostate cancer. Your physician
should also give you a blood test to measure your PSA level; when
elevated, this protein produced in the prostate may be a marker for
prostate cancer. (Some doctors advise that all men have their first PSA
test in their early 40s.) Urinalysis may be performed as well, to
detect prostate inflammation or infection. —Sid Kirchheimer
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