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The Prostate:
A Healthy Gland is a Happy Gland

By Bridget Avila

For men of a certain age, the word prostate seems to be an increasingly common topic of conversation. Yet many of us would be hard-pressed to say exactly what and where the prostate is, much less how to maintain its health. It can be an embarrassing topic—a little gland involved in both sex and urination—but prostate problems are as common as gray hair and something all men should know about.

The Gland

When BPH is found in its earlier stages, there is a lower risk of developing such complications. Doctors urge men to consult their physician at the first sign of urination problems.

In case you were busy giggling with embarrassment through your high school anatomy lesson, here's another chance to learn. The healthy prostate is a walnut-sized gland, with two lobes (or regions), enclosed by an outer layer of tissue. It is located in front of the rectum and just below the bladder and is part of the male reproductive system. The prostate also surrounds the urethra, the canal through which urine passes out of the body. While scientists do not know all the prostate's functions, they do know that one of its main roles is to add important fluids to the semen to help sustain the sperm during ejaculation.

With the anatomy lesson out of the way, you might wonder why we hear so much about the prostate. As men enter and pass beyond their 40s, they are increasingly likely to encounter problems with their prostates—everything from enlargement, to inflammation, to cancer.

Enlargement

A condition known as benign prostatic hyperplasia (BPH), or an enlarged prostate, commonly occurs in men over age 40. The prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH, putting pressure on the urethra, causing thickening and irritation of the bladder wall. These are common symptoms of BPH:

• A hesitant, interrupted, weak stream while urinating
• Urgency and leaking or dribbling
• More frequent urination, especially at night

Severe BPH can cause serious problems over time, such as urinary tract infections, bladder or kidney damage, bladder stones, and incontinence. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications, so doctors urge men to consult their physicians at the first sign of urination problems, which can also be symptomatic of other serious conditions.

The cause of BPH and its risk factors are not well understood, but research generally points to fluctuating hormone levels as men age as the likely culprit.

Men who have BPH with symptoms usually need some kind of treatment—eventually. However, a number of researchers have questioned the need for early treatment when the gland is just mildly enlarged, as the condition may clear on its own. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk. Treatments vary widely, from a number of medications to relieve symptoms, to minimally invasive procedures, to surgery.

Inflammation

Prostatitis is another condition men face. It accounts for up to 25 percent of office visits by young and middle-aged men for complaints involving the genital and urinary systems. The term prostatitis actually encompasses four disorders:

•  Acute bacterial prostatitis is the least common but most easily treated form of prostatitis. Symptoms include chills, fever, pain in the lower back and genital area, urinary frequency and urgency (often at night), burning or painful urination, body aches, and evidence of a urinary tract infection, which is treated with an appropriate antibiotic.

•  Chronic bacterial prostatitis, is also relatively uncommon. In this form of the disease, an underlying defect in the prostate becomes a focal point for bacterial persistence in the urinary tract. The defect must be removed before treating the infection with antibiotics.

•  Chronic prostatitis/chronic pelvic pain syndrome is the most common but least understood form of prostatitis. Found in men of any age, its symptoms are persistent yet fickle. In the inflammatory form, infection-fighting cells are increased, but an infecting organism is not found. In the noninflammatory form, no evidence of inflammation is present. Treatments for this condition vary with the individual, but antibiotics will not cure it.

•  Asymptomatic inflammatory prostatitis is the diagnosis when the patient does not complain of pain or discomfort but has infection-fighting cells in his semen. Diagnosis can be made when doctors are looking for causes of infertility or testing for prostate cancer.

Cancer

Of all cancers, prostate cancer is the second-biggest killer (behind lung cancer) of American men and it is estimated that 30 percent of men in the Western world will develop microscopic prostate cancer in their lifetime. It is often said that men are more likely to die with prostate cancer than to die of it. That is because, while so many men will have the cancer present in their bodies, the cancer grows slowly. There is only an 8 percent risk of developing clinically significant prostate cancer and only a 3 percent chance of dying from it. In fact, the postmortem prevalence of the disease is 80 percent by the age of 80.

Screening for prostate cancer involves the ever-dreaded digital rectal exam and a prostate-specific antigen (PSA) blood test. Medical advice regarding who should be screened and when varies. Some doctors encourage yearly screening for men over age 50 and some advise men who are at a higher risk for prostate cancer to begin screening at age 40 or 45. Others voice concerns as to the cost and benefits of routine screening. Some counsel on an individual basis and encourage men to make personal decisions about screening based on health and family history. Currently, Medicare provides coverage for an annual PSA test for all men age 50 and older.

Several risk factors increase a man's chances of developing prostate cancer. When a doctor recommends screening he or she may consider these factors. Age is the most common risk factor. Other risk factors for prostate cancer include family history, race, and possibly diet. Men who have a father or brother with prostate cancer have a greater chance of developing prostate cancer. African American men have the highest rate of prostate cancer, while Asian and Native American men have the lowest rates. In addition, there is some evidence that a diet higher in fat, especially animal fat, may increase the risk of prostate cancer.

If the cancer is caught at an early stage, watchful waiting may be recommended. While surgical removal of the prostate is appropriate in cases where the cancer has not grown beyond the prostate itself, radiation and hormone therapy are used when the cancer has grown outside the prostate wall or metastasized to other organs.

Good News About Treatment

Many men fear the effects of treating prostate disease, namely, impotence and incontinence. Fortunately, more precise imaging and surgical techniques and even “seed” radiation have helped alleviate these problems. These side effects can sometimes be corrected surgically and according to a recent study often decrease or diminish with time.

Prevention

Research on preventing prostate illnesses is ongoing, and few specific recommendations are made by the medical community at large. Doctors offer a few general guidelines for maintaining prostate health:

•  Diet: Most doctors recommend a diet high in vegetables and fruits and low in animal fats (especially beef) for preventing prostate cancer. Avoiding sugar and excessive alcohol consumption is also advised. Some studies suggest that eating foods that have tomatoes in them may help protect men from prostate cancer. Lycopene is an antioxidant found in tomatoes and some other fruits and vegetables. Research is in progress to see whether lycopene can help prevent prostate cancer. A diet low in fat is also under study.

•  Dietary supplements: The Selenium and Vitamin E Cancer Prevention Trial (SELECT), started in 2001 and projected to end in 2013, with 32,000 participants, is studying these two supplements. The goal of the study is to learn whether these supplements can reduce the risk of developing prostate cancer, something suggested by previous nutritional research. Doctors urge patients to ask their physicians before taking any nutritional supplements or herbal medicines.

•  Drugs: Two drugs that are used to treat BPH appear to also prevent prostate cancer. In one study, Proscar (finasteride) reduced overall rates of prostate cancer by 25 percent, and dutasteride also seems to have properties that prevent prostate cancer. A large, international study to further test this finding is now under way. Finally, nonsteroidal anti-inflammatory drugs (NSAIDS) might prevent prostate cancer. These drugs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). NSAIDS inhibit an enzyme called COX-2, which is found in prostate cancer cells. More studies are needed to confirm whether NSAID use actually results in lower rates of prostate cancer or reduced deaths from the disease.

The advice isn't Earth-shattering, but it's worth heeding. If you want to keep your prostate healthy, see your doctor regularly and take care of yourself, and don't be embarrassed to voice your concerns. Your little gland—and your loved ones—will thank you.

Most doctors recommend a diet high in vegetables and fruits for preventing prostate cancer.

Advance in prostate cancer diagnosis

A new urine test developed by San Diego-based Gen-Probe can tell prostate cancer from an enlarged prostate. The test, approved for clinical trials in Europe but not the U.S. , detects genetic material (RNA) from prostate cancer gene 3, or PCA3.

Currently, prostate cancer screening involves a blood test for prostate specific antigen (PSA), which is elevated by prostate cancer but also by non-cancerous conditions such as prostatitis. This can lead to invasive procedures such as biopsies and even surgery.

While research indicates that the PCA3 test can more accurately identify prostate cancer than PSA levels, it is unlikely the PSA test would be replaced entirely. PCA3 may be better at telling whether cancer is present, but PSA levels indicate the severity of the disease, an important piece of knowledge for patients and medical providers deciding on a course of treatment.