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THE PROSTATE

The prostate is a walnut-sized gland which forms part of the male reproductive system. It is located in front of the rectum and just below the bladder, and surrounds the urethra, thus affecting the normal flow of urine. Scientists are still researching the prostate’s complete function, however it is known that its main role is to squeeze fluid into the urethra as sperm move through it during sexual climax. This prostatic fluid, which forms part of the semen, provides energy for the sperm and reduces the acidity of the vaginal canal. The prostate is controlled by hormones. These hormones affect its growth, the way it works and ongoing health – they are important in maintaining a system of balance in the prostate.

Prostate Enlargement

An enlarged prostate is a non-cancerous condition in which the narrowing of the urethra makes the elimination of urine more difficult. It most often occurs in men over age 50. A non-cancerous condition that affects many men past 50 years of age, enlarged prostate makes eliminating urine more difficult by narrowing the urethra, a tube running from the bladder through the prostate gland. It can effectively be treated by surgery and, today, by certain drugs.

Causes & symptoms
When the enlarging prostate gland narrows the urethra, a man will have increasing trouble starting the urine stream. Because some urine remains behind in the bladder, he will have to urinate more often, perhaps two or three times at night (nocturia). The need to urinate can become very urgent and, in time, urine may dribble out to stain a man’s clothing–to his embarrassment. Other symptoms of BPH are a weak and sometimes a split stream, and general aching or pain in the perineum (the area between the scrotum and anus). Some men may have considerable enlargement of the prostate before even mild symptoms develop.

PROSTATITIS

This is the most-neglected male disease in the U.S. It strikes more men than either prostate cancer or prostate enlargement. It can be one of the most miserable diseases inflicted on men. It strikes them at younger ages.

It lasts longer. Urologists estimate that one in every four men who see a doctor about a problem involving the penis, urethra, testicles, prostate, bladder, or kidneys is suffering from one of three types of this disease. But prostatitis is not a threat to life, and for all practical purposes research of prostatitis does not exist.

Symptoms
These mimic the symptoms of prostate growth, such as: Frequent urge to urinate, Difficult start, dribbling, Nighttime trips to the bathroom . The symptom that sets prostatitis apart from prostate growth is pain. This varies from mild to so severe it renders a man helpless. Indeed, some people refer to a man in severe prostatitis pain as a “prostate cripple.”

BENIGN PROSTATIC HYPERPLASIA (BPH)
NON-CANCEROUS PROSTATE GROWTH

This condition is normally identified by its symptoms. The most common include:
1- Getting up nights to go to the bathroom
2- Sudden, almost irresistible need to urinate
3- A weak, start-stop stream
4- Problems getting the stream to start.

The prostate begins to enlarge in all men usually starting in their 40′s. Once growth starts, it does not stop as long as life goes on. Effects of this growth vary from almost unbearable misery to minor annoyance, and points in-between. The general rule is that one man in four over age 60 will become so aggravated by BPH he will need physical relief.

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What are the possible prostate enlargement treatments?

1. Drugs

Common medications for prostate enlargement treatment are Finasteride and Dutasteride which can help in preventing the further enlargement of the prostate. On the other hand, alpha blockers such as Terazosin and Doxazosin try to alleviate the signs and symptoms caused by benign prostatic hypertrophy

2. Minor Surgeries

The two most common minor surgeries for Benign Prostatic Hypertrophy are Transurethral Microwave Thermotherapy and transurethral Needle ablation. These two procedures are considered minimally invasive which makes use of recent up to date equipments. The good thing about these surgeries is that yopu do not have to suffer much of the post operative complications.

3. Major Surgical Treatments

Transurethral resection of the prostate is the most common prostate enlargement treatment. In this procedure, a physician makes use of a resectoscope that is inserted in a man’s penis. This resectoscope removes the enlarged part of the prostate into pieces and is then removed from the body through urination.

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How can benign prostatic hypertrophy be diagnosed?

1. Digital Rectal Exam

In digital rectal exam, the physician is able to palpate whether or not a patient has an abnormally enlarged prostate

2. Prostate Specific antigen

The PSA level of a patient is measured through a blood smear and elevated amounts may mean the possibility of prostate cancer or benign prostatic hypertrophy. Definite diagnosis can only be done after a biopsy

3. Urine Flow Study

The urine flow study measures how quickly you can empty your bladder and increased results would mean a possibility of benign prostatic hypertrophy.

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A few questions to ask yourself:

* How severe are your symptoms?
* Do symptoms prevent you from doing things you enjoy?
* Do they seriously affect your quality of life?
* Are they getting worse?
* Are you ready to accept some small risks to get rid of your symptoms?
* Do you know the risks associated with each treatment?
* Is it time to do something?

Deciding on Treatment for an Enlarged Prostate

A range of treatments can relieve enlarged prostate symptoms — medications, minimally-invasive office procedures, and surgery. The best one for you depends on your symptoms, how severe they are, and whether you have other medical conditions.

The size of your prostate gland, your age, and your overall health will also factor into treatment decisions. What’s best for a man in his 50s might not be optimal for an 80-year-old. An older man may want immediate symptom relief through drugs or surgery, whereas a younger man may lean toward a minimally invasive treatment. According to the American Urological Association, surgery often does the best job of relieving symptoms, but it also has more risks than other treatments.

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The enlargement of the prostate can be due to so many diagnoses but the most common reason for such is benign prostatic hypertrophy. Benign prostatic hypertrophy is a disease that goes as a man ages. In this disease, the cells in the prostate continue to grow to the point that it impedes the functioning of the organs near it such as the urinary bladder and the urethra.

What are the signs and symptoms of prostate enlargement?

1. Urinary incontinence
2. Urinary hesitancy or having a slow start in urination
3. Dysuria or painful urination
4. Hematuria or blood in the urine
5. Urinary urgency or a strong urge to urinate at once
6. Nocturia or frequent urination at night.

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Alpha blockers: These drugs don’t reduce the size of the prostate, but they are very effective at relieving symptoms. They work by relaxing the muscles around the prostate and bladder neck, so urine can flow more easily. These drugs work quickly, so symptoms improve within a day or two. They are most effective for men with normal to moderately enlarged prostate glands.

The drugs: Flomax (tamsulosin), Uroxatral (alfuzosin), Hytrin (terazosin), and Cardura (doxazosin).

Alpha blockers were originally created to treat high blood pressure; dizziness is the most common side effect; other side effects are generally mild and controllable. Possible side effects: headache, stomach irritation, and stuffy nose. These drugs are not for men with significant urine retention and frequent urinary tract infections.

5-Alpha reductase inhibitors: These drugs can partially shrink the prostate by reducing levels of a male hormone — dihydrotestosterone (DHT) — which is involved in prostate growth. These drugs take longer to work than alpha blockers, but there is urine flow improvement after three months. These drugs can reduce risk of acute retention (inability to urinate) — and also reduce the need for prostate surgery. You may need to take them for six to 12 months to see if they work.

The drugs: Proscar (finasteride) and Avodart (dutasteride).

Possible side effects: erection problems, decreased sexual desire, and reduced amount of semen. These side effects are generally mild and may go away when you stop taking the drugs — or after the first year of taking the drugs.

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Symptoms of enlarged prostate can include: * A weak or slow urinary stream * A feeling of incomplete bladder emptying * Difficulty starting urination * Frequent urination * Urgency to urinate * Getting up frequently at night to urinate * A urinary stream that starts and stops * Straining to urinate * Continued dribbling of urine * Returning to urinate again minutes after finishing

When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine, incontinence, and acute urinary retention (an inability to urinate).

A sudden and complete inability to urinate is a medical emergency; you should see your doctor immediately. In rare cases, bladder and/or kidney damage can develop from BPH.
Time to Do Something About Your Enlarged Prostate?

Most men put up with an enlarged prostate for months, even years, before seeing a doctor, says Slawin. “When they’re getting up several times a night, and have trouble falling asleep again, that’s when they come in,” he tells WebMD.

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Watchful Waiting With an Enlarged Prostate

When the symptoms of an enlarged prostate gland are mild, with low scores on the BPH Impact Index (less than 8), it may be best to wait before starting any treatment — what’s known as “watchful waiting.”

With regular checkups once a year or more often, doctors can watch for early problems and signs that the condition is posing a health risk or a major inconvenience. That’s where the BPH Index is especially helpful, Westney tells WebMD. “It lets us know how high the symptom score is … when to start treatment.”

The “driving force in treatment,” she explains, is whether the symptoms are affecting your quality of life — and whether a blockage is causing serious complications, such as inability to urinate, blood in the urine, bladder stones, kidney failure, or other bladder problems.

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It’s not always obvious what’s going on, Slawin adds. “When men start having urinary problems, it’s hard to know the reason. They should see a doctor when anything changes, because there can be bladder cancer, stones, prostate cancer. BPH is often a diagnosis of exclusion … after we make sure nothing more serious is going on.”

Urologists use the BPH Impact Index, a symptom questionnaire developed by the American Urological Association to determine if a man’s symptoms from BPH require treatment. “It helps us understand how severe the problem is,” says Slawin. Higher scores indicate more severe symptoms.

Prostate growth — and the trouble it causes — varies greatly from person to person, says O. Lenaine Westney, MD, division director of urology at The University of Texas Medical School at Houston. “Some people have more growth than others. Some people with very large prostates don’t have trouble with voiding. It’s a very individual thing.

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In men, urine flows from the bladder through the urethra. BPH is a benign (noncancerous) enlargement of the prostate that blocks the flow of urine through the urethra. The prostate cells gradually multiply, creating an enlargement that puts pressure on the urethra — the “”chute”" through which urine and semen exit the body.

As the urethra narrows, the bladder has to contract more forcefully to push urine through the body.

Over time, the bladder muscle may gradually become stronger, thicker, and overly sensitive; it begins to contract even when it contains small amounts of urine, causing a need to urinate frequently. Eventually, the bladder muscle cannot overcome the effect of the narrowed urethra so urine remains in the bladder and it is not completely emptied.

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