Prostate Health & Disease
The prostate gland has an important job: it produces a thick, milky-white fluid that becomes part of the semen, the liquid ejaculated during sexual activity. The gland isn't big—about the size of a walnut or golf ball—but its location virtually guarantees problems if something goes awry. The prostate gland is located just below the bladder and in front of the rectum. It also wraps around the upper part of the urethra, the tube that carries urine from the bladder out of the body. That means prostate problems can affect urination and sexual function.
The prostate is prone to three main conditions:
Prostatitis: infection or inflammation of the prostate. Prostatitis can cause burning or painful urination, the urgent need to urinate, trouble urinating, difficult or painful ejaculation, and pain in the area between the scrotum and rectum (known as the perineum) or in the lower back.
Benign prostatic hyperplasia: aging-related enlargement of the prostate gland. Benign prostatic hyperplasia (BPH) can make the prostate compress the urethra and slow or even stop the flow of urine, in much the same way that bending a garden hose chokes off the flow of water. BPH affects about three-quarters of men over age 60.
Prostate cancer: the growth of cancerous cells inside the prostate, which may break out of the gland and affect other parts of the body. In the United States, about 1 man in 7 will be diagnosed with prostate cancer during his lifetime. It occurs mainly in older men.
Prostate Health & Disease Articles
Involuntary leakage of urine (incontinence) in men often traces to either damage from prostate surgery or physical changes in the bladder that trigger a sudden, strong need to urinate (urinary urgency) with involuntary loss of urine. After assessing the underlying causes, a doctor can suggest strategies to reduce leakage incidents. This may include strengthening the muscles beneath the bladder, in the pelvic floor. Medication may also help.
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Many American men 65 and older continue to have routine prostate specific antigen (PSA) tests to look for hidden cancer, despite expert recommendations that discourage the practice, according to national survey findings.
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The medications dutasteride (Avodart) or finasteride (Proscar) are used to treat symptoms of noncancerous enlarged prostate, or benign prostatic hyperplasia (BPH). The drugs slightly lower the chance of low-risk prostate cancer while slightly increasing the risk of aggressive prostate cancer. Men must weigh the small long-term cancer risk associated with these drugs against the value of immediate relief of bothersome urinary symptoms caused by BPH.
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There is no good evidence that bicycling worsens existing prostate conditions, but prolonged biking may cause numbness in the genital area and possibly erectile dysfunction. Wider, softer seats can help to reduce numbness and discomfort.
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Fewer men are being screened for prostate cancer since the 2012 recommendation against routine PSA screenings from the United States Preventive Services Task Force.
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Taking extra vitamin E or selenium every day can raise the risk of prostate cancer, and the risk is substantially higher if the amount of selenium from your diet is already pretty high.
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Routine PSA testing to check for prostate cancer is no longer recommended for most men. Guidelines specifically discourage routine testing for men 70 and older. But despite what the experts suggest, many men and their doctors continue to opt for regular PSA tests. This includes a surprisingly large number of men in their 70s. Older men stand less to benefit from PSA testing because of a shorter life span. Having any chronic health conditions also reduces the potential benefit. Those who choose to continue testing anyway should be aware of the potential risks. The risks include the chance of serious complications of treatment, which most men choose after diagnosis with low-risk, early-stage prostate cancer.
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Researchers may know more about connections between diet and prostate cancer, but increased risk of testicular cancer has been linked to diet as well.
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A number of new tests combine measurements of prostate-specific antigen (PSA) with other cancer markers in blood and urine to more accurately identify men who should have a prostate biopsy to look for prostate cancer. New gene-based tests provide information to help decide whether a man should have a repeat biopsy when the previous one found no cancer, yet PSA remains high. Gene-based tests can also help men and their doctors assess how likely the cancer is to spread and progress. A slow-growing, low-risk cancer may not demand immediate treatment. In that situation, a man could choose to closely monitor the cancer and move forward with treatment only when the cancer shows signs of spreading. This strategy is known as active surveillance or watchful waiting.
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Some men with mild-to-moderate symptoms of noncancerous enlargement of the prostate gland, called benign prostatic hyperplasia (BPH), can try a conservative approach called watchful waiting. This involves monitoring the symptoms over time until a man feels it is time to consider additional treatments, such as medications or surgery. In the meantime, behavior changes can help control symptoms. These include restricting fluids, modifying the use of prescription or over-the-counter medications that worsen symptoms, and changing the timing and manner in which the bladder is emptied.
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