The Prostate: What is it anyway?
Ask a man what the prostate does and he might say it has something to do with ejaculation. But, he's more likely to say, "I don't know." Essential to a man's ability to reproduce, "the prostate's job is to add nutrients and enzymes to semen so that it can become liquefied and be ejaculated. One of these enzymes is prostate specific antigen or PSA," explains
Louis Keeler, III, MD, board-certified urologist and medical director of the Virtua West Jersey Oncology Program.
Where is the prostate?
Symptoms of an enlarged prostate
Prostatitis: inflammation of the prostate gland
Keeping the prostate healthy
The risk of prostate cancer
Where is the prostate?
The prostate, which is an intricate collection of glands encased as one organ, is located in front of the rectum and below the bladder. It surrounds the urethra, the tube that drains urine from the base of the bladder to the penis. It's the position of the prostate that can lead to problems as a man ages. "There is a natural growth pattern to the tissues that make up the prostate. Around age 35, these tissues begin to undergo hyperthrophy or an abnormal rate of growth, which can create an obstruction in the urinary passage," says Dr. Keeler.
Symptoms of an enlarged prostate
Referred to as an enlarged prostate, this is a biologic process that can cause a man to experience more frequent urination, primarily at night; difficulty starting or stopping urination; decreased amount of force and urine stream; dribbling at the end of the stream; hesitancy or straining to empty the bladder. While the prostate grows slowly during the 20s and 30s, it grows faster and gets larger as a man approaches his 40s. "This process generally begins the late 40s and is most prevalent when a man reaches his 50s and 60s," says Neil Phillips, MD, a urologist at Virtua Hospital Marlton.
Symptoms are indeed bothersome and maybe even embarrassing, but they do not increase a man's risk for prostate cancer and there are effective treatments. This includes medications which can relax the muscles around the prostate and the bladder, and those which block the growth of male hormones such as testosterone, resulting in shrinkage of the prostate. Both types of medication improve urination function.
When indicated, physicians may recommend laser surgery to destroy the tissue that is causing the blockage, or a procedure called transurethral resection of the prostate. "We use a fiber-optic instrument to identify the enlarged tissue that is causing the blockage and then remove it piece by piece," says Dr. Keeler.
Prostatitis: inflammation of the prostate gland
Another problem associated with the prostate is prostatitis. Dr. Keeler says, "This is an inflammation of the prostate gland which is categorized as infectious prostatitis because bacteria is present, or non-infectious prostatitis because bacteria is not found. The most notable symptoms are premature ejaculation, an urgency to urinate and uncomfortable voiding. Dr. Phillips adds that although men may experience urinary symptoms of infectious prostatitis, they will not experience the "fever and chills" that are associated with infections.
Treatment involves identifying the cause of the symptoms, which may include bacteria, or scar tissue in the passage to the urethra that has resulted from an injury. This injury may have occurred at any point in a man's life. Dr. Keeler explains: "A boy jumps a fence, bangs his prostate, and scar tissue may develop." As with an enlarged prostate, prostatitis does not cause cancer, and antibiotic treatment or removal of scar tissue generally relives it.
Keeping the prostate healthy
There's been a lot of talk about the ability of zinc, soy and fruits such as grapefruit to enhance the health of the prostate and decrease the risk of prostate cancer and other problems. According to Dr. Keeler, U.S. males already get appropriate levels of zinc in their day-to-day diet, and studies on the effectiveness of grapefruit and soy have not demonstrated a benefit to prostate health. He does, however, recommend vitamin E. "A study was conducted to see if taking vitamin E would reduce lung cancer. It actually showed that taking it reduced the incidence of prostate cancer."
All of this information leads to one critical point. It's vital that men monitor the health of their prostate through regular check-ups, digital rectal exams and PSA or prostate specific antigen testing, which is currently the most accurate tool available to identify prostate cancer. Even though prostate enlargement and infectious prostate may not lead to cancer of the prostate, the fact is that all men are susceptible to prostate cancer.
The risk of prostate cancer
The risk increases as men age, if they are African American, or have a family history of prostate cancer. The latest research shows that a history of maternal or fraternal breast cancer also puts a man at increased risk for prostate cancer. The American Cancer Society recommends that men begin having PSA testing and a digital rectal exam performed at age 50. African American men, or those with a family history should begin at age 40. Dr. Keeler says that his clinical experience shows an increase in prostate cancer among men under 50 without a family history, and recommends a digital rectal exam and PSA testing at 40. "A man of 40 could go undiagnosed for ten years or more without it."
As with all cancers, early diagnosis and treatment are critical to outcome. At Virtua Health treatment approaches range from external radiation therapy to brachytherapy, which involves inserting radioactive seeds around a tumor to nerve-sparing removal of the prostate. Urologists at Virtua are trained to treat all conditions related to the prostate, and have sophisticated technology to identify and treat the full range of problems.
Dr. Keeler sums it up: "Prostate health is an issue that men should consider throughout their lifetime, not just when symptoms appear."