Prostate Problems

National Institute on Aging

It seems that most of the men I know are having problems with their prostate. A few even have cancer and the rest are worried about what's in store for them. What's going on?

It's true that prostate problems are very common after age 50. And the older men get, the more likely they are to have such problems. Most prostate problems are not cancer. Still, prostate cancer does affect a lot of men.

The prostate is a gland. It makes fluid that becomes part of semen, the white fluid that contains sperm. The prostate lies low in the body - in front of the rectum and below the bladder (where urine is stored). It surrounds the tube that carries urine away from the bladder (urethra).

When you're a young man, your prostate is about the size of a walnut. It slowly grows larger as you get older. If the prostate gets too large, it can cause urinary problems. Infection or cancer in the prostate can also cause urinary and other problems. Often, men notice symptoms themselves, and sometimes their doctor finds something during a routine check-up.

There are several different kinds of prostate problems. Only a doctor can tell one from another. That's why you need to see your doctor if something doesn't seem right to you.

Common Problems

These problems are not cancer.

Acute prostatitis is an infection of the prostate caused by bacteria. It usually starts all of a sudden. It can cause fever, chills, or pain in the lower back and between the legs. It can cause pain when you urinate. If you have these symptoms, see your doctor right away. Antibiotic drugs can kill the bacteria and help you feel better.

Chronic prostatitis is an infection of the prostate that keeps coming back time after time. This problem can be hard to treat. Sometimes, taking antibiotics for a long time may work. Talk with your doctor about other things you can do to help you feel better.

Benign prostatic hyperplasia, or BPH, is very common in older men. The prostate is enlarged, but it is not cancerous. Over time, an enlarged prostate may press against the urethra, making it hard to urinate. It may cause dribbling after you urinate or a need to urinate often, especially at night. Your doctor will do a rectal exam to check for BPH. And you may need to have special x-rays or scans to check your urethra, prostate, and bladder.

Treatments for BPH include:

• Watchful waiting. If your symptoms are not too bad, your doctor may suggest that you wait before starting any treatment. You will need regular checkups. Treatment can start later on if your symptoms get worse.
• Alpha-blockers. These medicines can ease your symptoms. Side effects may include headaches, dizziness, or feeling lightheaded or tired.
• Finasteride (Proscar®). This medicine lowers the amount of the male hormone (testosterone) in the body. The result is that the prostate shrinks and urinary problems get better. Side effects can include less interest in sex and problems with erection or ejaculation.
• Surgery. An operation can improve the flow of urine but it can also cause other problems. Usually, men have surgery only if medicine hasn't worked. Surgery does not protect against prostate cancer. Regular check-ups are important after BPH surgery. Talk with your doctor about this treatment choice. There are three kinds of surgery. All are done with anesthesia:
• Transurethral resection of the prostate (TURP) is the most common type of surgery. The doctor takes out part of the prostate through the urethra.
• Transurethral incision of the prostate (TUIP) may be used when the prostate is not too large. The doctor makes a few small cuts in the prostate near the opening of the bladder.
• Open surgery is used only when the prostate is very large. The doctor removes the prostate through a cut in the belly or behind the scrotum.
• Other treatments. Other ways to relieve the symptoms of BPH use radiowaves, microwaves, or electrical current.

Prostate Cancer

Prostate cancer is a common type of cancer among American men. It is most common among African American men. Treatment for prostate cancer works best when the disease is found early.

Diagnosing Prostate Cancer. Early prostate cancer does not usually cause symptoms. As the cancer grows, it may cause trouble urinating. Also, you may need to urinate often, especially at night. Other symptoms can be pain or burning during urination, blood in the urine or semen, pain in the back, hips, or pelvis, and painful ejaculation.

To figure out if these symptoms are caused by prostate cancer, your doctor will ask you questions about your past medical problems. He or she will perform a physical exam. In the exam, the doctor will put a gloved finger into your rectum to feel your prostate through the wall of the rectum. Hard or lumpy areas may be a sign of cancer.

Your doctor may also do a test to check the prostate-specific antigen (PSA) level in your blood. PSA levels may be high in men who have an enlarged prostate gland or prostate cancer. You may also need to have an ultrasound exam. In this procedure, a probe that produces sound waves is put into the rectum. Sound waves bounce off the tissues, and a computer uses the echoes to make a picture of the prostate

A biopsy is almost always needed to diagnose prostate cancer. This can be done in a doctor's office using a local anesthetic. The doctor takes out tiny pieces of the prostate and sends them to a laboratory to be checked for cancer cells under a microscope.

Prostate Cancer Treatment. There are many ways to treat prostate cancer. The choice of treatment depends on the stage of the cancer (whether it affects part of the prostate, involves the whole prostate, or has spread to other parts of the body). It also depends on your age and general health. How you feel about the benefits and side effects of the various treatments is also very important.

The following are three standard treatment choices for cancer that has not spread beyond the prostate:

Watchful waiting. If the cancer is growing slowly and not causing problems, you may decide not to have treatment right away. Instead, your doctor will check you regularly for changes in your condition. Older men with other medical problems often choose this option.

Surgery. The most common type of surgery is a radical prostatectomy. The surgeon takes out the whole prostate and some nearby tissues. Side effects may include loss of sexual function (impotence) or problems holding urine (incontinence). Sometimes incontinence goes away within a year of surgery. But some men continue to have problems and have to wear a pad. An operation called nerve-sparing surgery gives some men a better chance of keeping their sexual function.

Radiation therapy. This treatment uses high-energy x-rays to kill cancer cells and shrink tumors. There are two kinds of radiation therapy. External radiation therapy is beamed into the prostate from a machine outside the body. Internal radiation therapy (brachytherapy) uses radioactive "seeds" that are placed in the prostate, into or near the tumor itself.

Like surgery, radiation therapy can cause problems with impotence. Radiation is not as likely to cause urinary incontinence as surgery. But it can cause rectal problems such as pain and soreness, rectal urgency, and trouble controlling bowel movements (fecal incontinence).

In addition, after radiation therapy, some men are treated with hormone therapy. This is used when chances are high that the cancer will come back. Hormone therapy is also used for prostate cancer that has spread beyond the prostate. Side effects of hormone treatments include hot flashes, loss of sexual function, and loss of desire for sex.

You can get more information on these treatment choices by calling the National Cancer Institute's Cancer Information Service at 1-800-422-6237. Or you can go to the NCI's website at www.cancer.gov to chat online with a cancer information specialist - Click on "Need Help?" Then click on "LiveHelp". You can also find information at www.cancer.gov/prostate.

PSA Testing. Some doctors think that men should have regular PSA tests, and others do not. Here's why: We know that this test can catch a cancer before it causes symptoms, but we aren't sure that PSA tests save lives. Also, PSA tests find small cancers that would never grow or spread. When that happens, a man may have surgery or other treatments that he does not need. Researchers are studying ways to improve the PSA test so that it catches only cancers that need treatment.

Protecting Yourself

The following can be signs of prostate cancer. Keep in mind that they are much more likely to be caused by benign diseases than by cancer.

• Frequent urge to urinate
• Blood in urine or semen
• Painful or burning urination
• Difficulty in urinating
• Not being able to urinate
• Painful ejaculation
• Frequent pain or stiffness in lower back, hips or upper thighs
• Dribbling of urine

If you have any of these symptoms, see your doctor right away.

For More Information

Visit NIHSeniorHealth.gov (www.nihseniorhealth.gov), a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This simple-to- use website features popular health topics for older adults. It has large type and a 'talking' function that reads the text out loud.

National Institute on Aging U.S. Department of Health and Human Services National Institutes of Health October 2005

Web page last updated: January 13, 2006