Prostate Disease

The prostate is a gland in the male reproductive system that is located just below the bladder and in front of the rectum. The urethra, the tube that transports urine from the bladder to the tip of the penis, passes through the prostate gland. The purpose of your prostate is to produce fluid for semen which transports sperm during the male orgasm. As a man grows older, the prostate gland is frequently a source of problems. The three most common prostate problems include inflammation (prostatitis), enlargement (benign prostatic hyperplasia/BPH), and prostate cancer.

Benign prostatic hyperplasia is a non-cancerous growth in the prostate that can cause significant difficulties with urination. Some of the problems include initiating a urine stream, feeling a powerful urge to urinate without warning, frequent urination and the annoying sense that the bladder is never completely empty. In the most serious cases, complete obstruction of the urine flow may occur. This is a medical emergency that requires catheterization (a tube placed into the penis to the bladder to allow urine to escape). Treatment of BPH may be medical or surgical. Although the popularity of surgery for this problem has diminished since more effective drug therapy became available, operations for BPH are still among the most common surgical procedures performed on American men. The tissue removed from this type of surgery is examined under a microscope by a pathologist to confirm the presence of prostatic hyperplasia and to make sure no other disease process, such as cancer, is present.

Prostate cancer is the most common non-skin cancer in American men. Approximately 190,000 men will be diagnosed with prostate cancer each year and approximately 3000 men will die of their disease. About 75% of prostate cancers are diagnosed in men over 65 years old. However, men who are considered at high risk may develop cancer at a much younger age. These high risk groups include men with a family history of prostate cancer and African-American men. Many men are screened for prostate cancer by using a blood test referred to as PSA which is the abbreviation for prostate specific antigen. A high level of PSA in the blood is a warning sign that prostate cancer may be present. However, other prostate diseases may cause a rise in PSA; thus, PSA testing by itself can not confirm the presence of prostate cancer. Conversely, a low PSA value does not completely exclude the possibility that prostate cancer is present. Therefore, the PSA test result should be interpreted in the context of other factors including a digital rectal exam in order to more accurately evaluate the status of your prostate. Guidelines recommend that all men over age 50 and men at high risk over age 40 should have a PSA blood test every year.

If the results of your prostate evaluation is abnormal, your physician may recommend a prostate biopsy. This involves taking several needle biopsies of the prostate in a systematic fashion. The tissue is then examined under a microscope by a pathologist. Only microscopic evaluation of a biopsy can definitively confirm the diagnosis of prostate cancer. Keep in mind, however, that there may still be cancer in the prostate even when the biopsies are negative. This typically occurs when the prostate cancer is so small that it is not sampled by the biopsies. Thus, follow up with your physician and repeat PSA measurements is important. If prostate cancer is diagnosed by the pathologist, the information will be relayed to your physician who will then discuss the various treatment options with you.

Resources (Links will open in a new window):

www.cancer.org
www.urologyhealth.org
www.webmd.com