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Each year, more than 120,000 new cases of prostate cancer occur in the U.S., and more than 30,000 deaths are caused annually by this disease. Approximately one of every 10 men will develop this form of cancer -- it is second only to lung cancer as the leading cause of cancer death in men -- and the likelihood of developing it increases with age.
Every man over age 40 should know that he is at risk for prostate cancer. African Americans have the highest risk of developing this disease. Having a father or brother with prostate cancer also greatly increases a man's likelihood of developing it. In addition, studies have shown that a diet high in fat may contribute to the development of this cancer.
Most prostate cancers begin in the outer part of the prostate. The cancer must grow fairly large before it presses on the urethra and interferes with urination. In the early stages, prostate cancer is curable. With prompt treatment, the percentage of men who survive longer than 10 years is roughly equal to that of men who have never had prostate cancer.
If prostate cancer is allowed to develop without treatment, it may spread to other organs, causing disability and sometimes death. Advanced prostate cancer is more likely to cause symptoms, which may lead a man to see a doctor for diagnosis. Unfortunately, by the time prostate cancer has reached this stage, it is less responsive to treatment.
If the results of the digital rectal examination suggest the presence of a cancer, your doctor may recommend that other tests be performed which help detect prostate cancer or indicate the extent of the cancer's growth. To confirm the presence of cancer, the urologist may also perform a biopsy -- obtaining a small sample of the suspected cancer for examination.
Prostate Cancer Graph
If a diagnosis of prostate cancer is made, the doctor will generally recommend treatment. Various treatments are employed; these include surgery, radiation therapy, hormonal therapy, and occasionally chemotherapy. The doctor will advise on the treatment most appropriate for each particular case. Treatment of early-stage prostate cancers may not be necessary in some patients who are very old or very ill.
Enlarged Prostate
After a man reaches the age of 40, his prostate frequently begins to enlarge, a condition known as benign prostatic hyperplasia (BPH). The likelihood of developing BPH also increases with age. Eventually about 80 percent of men have enlarged prostates, but many will never have any symptoms.
It is important to note that BPH is not cancer nor does it lead to cancer, although a man can have both BPH and prostate cancer.
BPH usually affects the innermost part of the prostate first, so the enlargement frequently results in a gradual squeezing of the urethra where it runs through the prostate, sometimes causing difficulty in urinating or other urinary problems.
Although BPH may exist without creating any problems, this condition can cause bothersome urinary tract symptoms that may interfere with the quality of your life. And, BPH may sometimes progress to the point at which it blocks the flow of urine from the bladder. Inability to completely empty the bladder may eventually result in bladder and kidney malfunction.
When the symptoms of BPH are bothersome or when obstruction of the urinary tract causes a serious kidney or urinary problem, further diagnostic studies and treatment are called for.
If the digital rectal examination indicates the presence of BPH and you are experiencing symptoms that may be caused by prostate enlargement, several other diagnostic tests may be performed. A urine flow study, which measures the strength and speed of the urine stream, can help determine the extent of urinary tract blockage.
The amount of urine left in the bladder after urination -- an indication of bladder obstruction -- may be determined by other methods. In addition, a blood test may help to establish whether your kidneys are functioning normally.
The specific tests necessary vary from patient to patient. Your doctor will recommend those needed in your particular case.
If you have bothersome BPH symptoms, you may decide with your doctor to choose treatment. Surgery is the most frequently recommended choice in such cases. Other forms of treatment are currently emerging as well. You should discuss the options with your doctor.
Prostatitis
Prostatitis is an inflammation of the prostate. There are three types of prostatitis:
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acute infectious
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chronic infectious
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noninfectious
Symptoms of prostatitis vary and may include:
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chills and fever (in acute infections)
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urinary difficulties, including frequent urge to urinate, difficulty urinating, pain or burning on urination, or blood or pus in the urine
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pain in the lower back and perineum (the area between the scrotum and the anus)
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joint or muscle pain
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tender or swollen prostate
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painful ejaculation
Acute and chronic infectious prostatitis are caused by bacteria and need to be treated with an antimicrobial medication. Although these types of prostatitis are infections, they are not contagious. Your sexual partner cannot catch your infection.
Because noninfectious prostatitis is not caused by bacteria -- its cause is unknown -- antimicrobial medications are not effective treatment for this type. Muscle relaxants or other treatments may be helpful.
Prostatodynia (painful prostate) is a condition that mimics prostatitis when prostatitis is not present. Patients have pain in the pelvis or in the perineum but no bacteria in the urine. This condition may be due to muscle spasms along the pelvic floor or other factors rather than to actual prostate disease.
In order to prescribe the correct treatment, your doctor needs to know whether bacteria are present in your prostatic fluid and your urine. Two tests are helpful in identifying the presence of bacteria: a urinalysis and an analysis of a sample of prostatic fluid, which may be obtained by pushing on the prostate during the digital rectal examination.
Sometimes, BPH may lead indirectly to the development of a bladder infection as bacteria grow in the stagnant urine that remains when the bladder cannot empty completely. Occasionally, this infection may spread to the prostate.
Will Prostate Disease Affect My Life -- and My Lifestyle?
The good news is that early diagnosis of the most serious prostate disease -- prostate cancer -- increases the chances of a cure. Early treatment may not only be life-saving but lifestyle-saving. In many cases, treatment for prostate cancer need not affect your sex life or your ability to control urination.
Other good news: An increasing number of treatment options for BPH, including medications and new surgical techniques, are on the way. If you have bothersome BPH symptoms, ask your doctor about these options.
The message is clear:All men over age 40 should be sure to have a digital rectal examination for prostate disease every year. And, you should see your doctor promptly if urinary symptoms appear or worsen.