Lately, you've been leaving the bathroom light on when you go to bed. You're hardly afraid of the dark. It's just that you're pretty sure you'll be headed to the bathroom--yet again--sometime in the night.
Or perhaps you're having other problems when you urinate or have noticed some rather uncomfortable feelings in your very personal zone.
“Urinary symptoms--and many other signs and symptoms you shouldn't ignore--often do signal a prostate problem,” says Jens C. Carlsen, DO, a Watson Clinic urologist. “Since such problems can be bothersome, it's good to know treatments are available. And because a prostate condition can also be quite serious, it's always important to let your doctor know about your symptoms.”
Your prostate gland is located in your lower pelvis, below the bladder. As part of the reproductive system, it helps make semen. It also surrounds the urethra, the tube through which semen and urine flow. That helps explain why some prostate problems can make it difficult to urinate or can cause frequent urination.
When you were younger, you probably never had an issue with your prostate--and probably gave it little thought. But as you age, things can start to go wrong.
In his early years, a man's prostate is about the size of a walnut. But by the time he reaches 60, the gland may be nearly the size of a lemon, according to the National Institutes of Health (NIH). “As it grows, the prostate can push against the bladder and urethra, slowing or stopping urine flow--a condition called benign prostatic hyperplasia, or BPH,” says David L. Bowers, MD, a urologist with Watson Clinic.
You might have BPH if you:
• Have trouble starting a urine stream or only dribble when you do go.
• Urinate a lot, often at night.
• Have a strong, sudden urge to go.
• Have a weak or slow urine stream.
• Feel as though your bladder hasn't quite emptied after you urinate.
If your BPH symptoms are only mild, you and your doctor might decide that regular checkups are enough for right now--that you don't need to treat the condition yet.
However, if your symptoms are particularly bothersome or they're severe enough to cause bladder damage or other complications, medicines and surgery can help.
Drugs called alpha blockers relax the muscles near the prostate, making it easier to urinate. Others, called 5-alpha reductase inhibitors, help shrink the prostate.
Surgeries to relieve BPH include:
• Transurethral resection of the prostate (TURP). An instrument passed through the urethra is used to trim away excess prostate tissue and improve urine flow.
• Transurethral incision of the prostate. The doctor makes cuts in the prostate tissue to relieve pressure but doesn't trim the excess tissue.
• Other procedures--such as using radio waves, electrical energy, microwaves or lasers--to remove excess tissue.
“Each procedure has pros and cons, as well as potential side effects,” Dr. Carlsen says. “That's also true for BPH medicines. You and your doctor should discuss these when considering treatment.”
Prostatitis -- an inflammation of the prostate--can affect men of all ages. Sometimes bacteria are to blame, but usually there's no obvious cause.
Three types of prostatitis can cause urinary symptoms or pain:
• Acute bacterial prostatitis is the least common form and the easiest to diagnose and treat. It comes on suddenly, often causing chills, a high fever and blood in the urine.
• Chronic bacterial prostatitis triggers urinary tract infections that go away and return, possibly due to a defect in the prostate that allows bacteria to thrive.
• Chronic prostatitis/chronic pelvic pain syndrome. This is the most common type of prostatitis and the least understood. Often, infection-fighting cells are present in urine and other fluids, yet no bacteria are found, notes the NIH. Symptoms--such as pain in your lower back, groin or penis--come and go.
Bacterial prostatitis is treated with antibiotics, which may need to be taken for several months if you have the chronic form. For nonbacterial forms, you need to work closely with your doctor to figure out the best treatment for you. Medicines to relieve pain or to relax the prostate, along with warm baths and dietary changes, may help you feel better.
Aside from skin cancer, prostate cancer is the most common cancer in American men. Being older than 50 increases your risk, as does being African American or having a father or brother who was diagnosed with the disease.
Prostate cancer often grows slowly and may not cause symptoms for years. Dr. Carlsen says when symptoms do occur, they can include:
• A frequent urge to urinate, especially at night.
• A weak or interrupted urine stream.
• Painful urination or ejaculation.
• Blood in the urine or semen.
• Lingering back, hip or pelvic pain.
It's important to remember that these symptoms are much like those of BPH and prostatitis. Still, if you're having symptoms, it's time to see your doctor.
Your doctor can perform a variety of tests to help diagnose a possible prostate problem--either one you noticed or one found during a routine test or exam. Often, this starts with a medical history followed by a digital rectal exam.
For this brief exam, the doctor inserts a gloved finger into the rectum to check the prostate for abnormalities, such as lumps, enlargement or tender spots.
Other tests may include:
• A blood test to check for elevated levels of prostate-specific antigen (PSA), a protein made by prostate cells. PSA levels can be high because of cancer, BPH or other noncancerous problems.
• Urine tests to check for infections.
• Ultrasound exams to take images of your prostate.
• Cytoscopy--an exam that lets your doctor see inside the urethra and bladder.
• Biopsy. If cancer is suspected, a biopsy may be used to confirm the disease. An ultrasound probe inserted in the rectum is used to guide a needle that removes tiny pieces of prostate tissue so they can be examined under a microscope.
The PSA test may also be used to screen for prostate cancer in men whose age, race or family history puts them at high risk for the disease.
According to Drs. Bowers and Carlsen, it's not clear if PSA screening saves lives or if it might lead to unnecessary treatment of non-life-threatening cancers and the side effects that may result. That's why it's important to talk with your doctor about your prostate cancer risk and the pros and cons of screening.
“Most prostate changes aren't cancer,” says Dr. Bowers. “When men are diagnosed with the disease, deciding how to treat it is complex and involves many factors, including the stage of the cancer and a man's age and overall health.” Options include:
• Watchful waiting--monitoring but not treating a slow-growing cancer unless it starts to cause problems.
• Surgery to remove the prostate along with nearby tissue.
• Radiation therapy aimed from outside the body or in tiny seeds placed near the prostate.
• Hormone therapy--drugs used to help control the cancer or prevent its return.
Watson Clinic’s urology department offers a diverse range of treatments for BPH, urinary incontinence, erectile dysfunction and urologic cancers. Call 680-7300 for more information or to schedule an appointment.