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Men: Begin Today to Manage Your Health
Khaled Fareed, M.D.
Glickman Urological and Kidney Institute
Cleveland Clinic Beachwood Family Health & Surgery Center
Appointments: 216.839.3000
Common Prostate Problems: Early Detection and Management
What is the prostate?
The prostate is a muscular, walnut-sized gland that surrounds part of the urethra, the tube that
transports urine and sperm out of the body. The prostate is part of the male reproductive system. It secretes seminal fluid, a milky substance that combines with sperm produced in the testicles to form semen. The muscles in the prostate push semen through the urethra and out of
the penis during sexual climax.
Where is the prostate located?
The prostate is located directly beneath the bladder and in front of the rectum. The upper portion of the urethra passes through the prostate; if the prostate becomes enlarged, it can
obstruct the passage of fluid through the urethra.
There are three different types of prostate
disease: benign prostatic hyperplasia, pro statitis, and prostate cancer. Although
these diseases have different causes, they
have similar symptoms. Because of this,
it’s important to be checked for prostate
cancer as part of your yearly physical
examination, and to see a urologist (a doctor who specializes in diseases of the urinary tract and the male reproductive system) if you experience symptoms of any of
the following diseases.
Benign Prostatic Hyperplasia
Commonly called BPH, benign prostatic
hyperplasia is a noncancerous enlargement of the
prostate gland that affects approximately half of
all men before the age of 50, and 80 percent of
men over age 60.
Prostatitis
Prostatitis is an inflammation of the prostate that
can be caused by bacterial infection. This condition can affect men of all ages and can occur in
any sized prostate.
Symptoms of BPH include:
Symptoms of prostatitis include:
· Difficulty urinating
· An urge to urinate even when the bladder is
empty
· Frequent urination, especially at night
· A weak or intermittent stream of urine and a
sense of incomplete emptying when urinating
How is BPH treated?
Patients with mild symptoms may not require
treatment other than continued observation to
make sure their condition doesn't worsen. There
are a number of treatment options available if
your symptoms are severe:
Medication
Urologists generally use two types of medications
to treat BPH: “inhibitors” that reduce the
prostate’s size, and “blockers” that relax the
gland’s smooth muscle (to reduce the tension on
the urine tube). Proscar (finasteride) was one of
the first inhibitor-type drugs used to treat BPH. It
appears to be most beneficial for men with larger
prostates. “Blocker” drugs that relax the muscle
in the prostate are more commonly used. These
include Hytrin, Cardura, and Flomax. The most
common side effects are light-headedness and
weakness.
Surgery
A number of surgical procedures have been used
to remove the prostate tissue blocking the flow of
urine. The most common procedure is called
transurethral resection of the prostate (TURP). It
involves removing the tissue blocking the urethra
(urine tube) with a special instrument.
In the TURP procedure, a thin, lighted instrument called a resectoscope is inserted through
the urethra. A cutting instrument is guided
through the scope to the prostate to remove parts
of the tissue.
· Difficulty urinating
· Frequent urination, especially at night
· Pain or burning during urination
· Chills and fever accompanied with urinating
problems
What is the treatment for prostatitis?
Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct
diagnosis is crucial because each type of prostatitis is treated differently, and it’s important to
make sure your symptoms are not caused by urethritis (inflammation of the urethra) or another
condition that might lead to permanent bladder
or kidney damage.
Treatments generally include the following:
· Taking anti-inflammatory medicines along
with warm sitz baths (sitting in 2-3 inches of
warm water) is the most conservative treatment for chronic prostatitis.
· Antibiotic medicine for infectious prostatitis
are not effective treatments for non-infectious
prostatitis. For acute infectious prostatitis,
patients usually need to take antibiotic medicine for 2-4 weeks. Almost all acute infections
can be cured with this treatment.
· For chronic infectious prostatitis, antibiotic
medicine is taken for a longer period of time,
usually 4 to 12 weeks. About 60 percent of all
cases of chronic infectious prostatitis clear up
with this treatment. For cases that don't
respond to this treatment, taking antibiotics
at a low dose for a long time might be recommended to relieve the symptoms.
· Pain medicines might be use to relieve pain.
· Surgical removal of the infected portions of
the prostate might be advised for severe cases
of chronic prostatitis or for men whose
swollen prostate is blocking the flow of
urine.
· Supportive therapies for chronic prostatitis
include stool softeners and prostate massage.
Other treatments for chronic non-infectious prostatitis include the use of the drugs Proscar,
Hytrin, and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine
flow and decrease symptoms.
Prostate cancer
Prostate cancer, in its early stages, may not cause
any symptoms. But as it progresses, symptoms
often appear.
Symptoms of prostate cancer include:
· A need to urinate frequently, especially at
night
· Difficulty starting urination
· Inability to urinate
· Weak or interrupted flow of urine (dribbling)
· Painful or burning urination
· Painful ejaculation
· Blood in urine or semen
· Frequent pain or stiffness in the back, hips,
or upper thighs
How is prostate cancer treated?
The traditional approaches to treating prostate
cancer are surgery, radiation therapy, watchful
waiting, and hormonal treatment.
Surgery
Complete removal of the prostate is one of the
most common treatments for prostate cancer.
Today, most of the procedures are done in ways
that attempt to spare the nerves controlling your
bladder and erections. These nerve-sparing surgeries reduce, but do not eliminate, the risk of
incontinence and impotence.
Radiation therapy
Radiation is about as effective as surgery to pre-
vent cancer from spreading over a 10-year period.
There are two types of radiation therapy – external beam radiation and brachytherapy.
External beam radiation: This form of radiation
therapy uses powerful x-rays to attack the cancer.
Body scans and computer technology are used to
pinpoint the exact location of the cancer to which
the radiation beam is applied. Treatments take
only about 15 minutes but are time-consuming in
that you will likely need to go to the hospital daily
for about two months of treatments.
Brachytherapy: In this form of radiation therapy,
radioactive pellets -- each the size of a grain of
rice -- are implanted into the prostate. The number of pellets implanted (up to 200) depends on
the size and location of the cancer. This therapy
may work best in small- to medium-sized cancers
and may not be a good option for men with larger
tumors, more aggressive forms of prostate cancer, or cancer that has spread just outside the
prostate. The implant procedure takes about 1
hour and is done on an outpatient basis.
Although the pellets deliver a higher dose of radiation than the external beam procedure, the radiation travels only a few millimeters and therefore
is unlikely to extend beyond the prostate.
Watchful waiting
Watchful waiting, now more commonly called
“active surveillance,” requires no treatment for a
discovered prostate cancer until your doctor
detects signs that the cancer is growing more
aggressively. This option is reserved for patients
who have a cancer that is confined to the prostate
gland and have a cancer that is defined as low to
medium in aggressiveness. It is most often
offered as an option to older men who are in poor
health because it avoids the risks and side effects
of treatment. Most of these men will die of some
other cause before the cancer would become a
problem. Active surveillance can be an option for
younger men who want to avoid the side effects of
treatment or postpone it as long as possible. The
debate on the risk associated with this approach
in younger men is ongoing.
Hormone therapy
Hormone therapies can’t kill prostate cancer but
can be given alone or in combination with other
forms of treatment in the hopes of improving the
quality of life or extending survival. Research on
the value and effects of hormonal therapies is
ongoing. The most common form of hormone
therapy is drug therapy. Drugs such as leuprolide
(Lupron, Eligard, Viadur) and goserelin (Zoladex)
block the effect of testosterone, the male sex hormone. By blocking testosterone, the rate of
growth of the cancer is slowed. Another class of
drugs, the antiandrogens flutamide (Eulexin),
bicalutamide (Casodex), and nilutamide
(Nilandron), work by preventing your body – and
thus the cancer cells -- from using testosterone.
This information is not intended to replace the medical
advice of your doctor or health care provider. Please
consult your health care provider for advice about a
specific medical condition.
BEACHWOOD FAMILY HEALTH AND SURGERY
CENTER
26900 Cedar Road
Beachwood, OH 44122
..........
216.839.3000
www.clevelandclinic.org/fhc
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