4 Common Prostate Conditions

The prostate is a small organ with a big role in male reproductive health. It is a small gland located at the base of the penis near the rectum. The prostate’s primary purpose is to supply part of the seminal fluid, which allows sperm, produced in the testes, to travel and survive. The rest of the seminal fluid is produced in other glands including the seminal vesicles. The part of the seminal fluid produced in the prostate contains enzymes, minerals, and sugar compounds that help the sperm function while protecting sperm from bacteria and other organisms that could attack them.

Prostate gland functions

The prostate gland is normally around one ounce. It has muscles that forcefully push the seminal fluid outwards during ejaculation. It also helps prevent sperm and seminal fluid from moving into the bladder and seminal vesicles during ejaculation. The urethra, the tube that carries urine from the bladder out of the body, runs through the prostate gland. This helps divide the prostate into its three zones:

• The transition zone is the inner 10% of the prostate which surrounds the urethra between the bladder and upper third of the urethra.
• The central zone is around the transition zone and is about 25% of the urethra. The ejaculatory duct and seminal vesicles are in this area.
• The peripheral zone is the largest part of the prostate gland.

The third and final job of the prostate is to transform testosterone into its biologically active form dihydrotestosterone or DHT. It does this using an enzyme called 5-alpha reductase.

Several common conditions can affect the prostate gland. Benign prostatic hypertrophy, prostatitis, and prostate cancer are the three most common conditions.

Benign prostatic hypertrophy

The most common condition that can affect the prostate is benign prostatic hypertrophy or BPH. BPH is estimated to affect at least 14 million men and the incidence of the disease increases as you age. We don’t know exactly what causes BPH, but there are many theories. Men who had their testicles removed before puberty do not develop BPH, so researchers theorize that the testicles and aging play a role in the development of this condition. Other theories include higher proportions of estrogen relative to testosterone, which occurs naturally with aging, affecting the substances that promote cell growth. Researchers have also noted that men who do not have DHT do not develop BPH, so it is thought that a relatively higher proportion of DHT as men age may contribute to the condition.

BPH is more common in men over age 40 and rarely develops in men younger than 40. It is also more common in men who have a family history of the condition. Obesity, lack of physical exercise, heart and vascular disease, and diabetes also increase the risk of developing the condition. Men who struggle with erectile dysfunction are also at an increased risk of BPH.

With BPH, the prostate grows and enlarges. As it enlarges, it can press on the urethra and make it more narrow. The narrowing of the urethra affects the urinary stream and causes:

• Increased nighttime urination
• Urinary urgency and frequency
• Urinary hesitancy
• Feeling of incomplete bladder emptying
• Straining to urinate
• Decreased urinary stream and dribbling

After taking a history regarding your symptoms, your healthcare provider may order additional testing. This includes a urinalysis and urine culture to rule out infection, basic bloodwork to evaluate things like your hydration and kidney status, or a prostate-specific antigen (PSA). Your healthcare provider may also do a digital rectal exam which involves putting a finger inside your anus to feel the back side of the prostate gland.

Treatment for BPH depends on the severity of the symptoms. In mild cases, the symptoms can just be monitored if the symptoms aren’t causing a significant disturbance in your life. Moderate symptoms can be treated with lifestyle and dietary changes. If you are wondering about supplements for BPH and prostate symptoms, a few supplements have shown some potential for improvement. Beta-sitosterol extract, Pygeum africanum, Saw palmetto, or cerniton all have limited supporting evidence for their use for this condition. Supplements aren’t regulated by the FDA and the risks are not always well known. Before starting any supplement, you should discuss it with your healthcare provider.

Several medications can be prescribed by your healthcare provider to treat BPH. Alpha-blockers work by relaxing the muscles of the prostate and bladder neck to allow urine to flow more easily. Phosphodiesterase inhibitors are more commonly used for erectile dysfunction but in low doses can be used as daily medications to treat the symptoms of BPH. Alpha-reductase inhibitors are designed to stop prostate growth and hopefully shrink it. Any medication can potentially cause side effects, so they should only be taken with the supervision of your healthcare provider.

In more extreme cases surgery may be necessary. One procedure called transurethral resection of the prostate (TURP) involves going through the urethra and boring out a larger opening to allow for better urine flow. In extreme cases, the prostate may be completely removed.

Prostatitis

Prostatitis is inflammation of the prostate. This condition is generally painful and comes in 2 forms: acute or chronic. These classifications refer to the length of symptoms you’ve experienced.

Acute prostatitis

Acute prostatitis is usually caused by a bacterial infection that comes from the urethra or reflux in the prostate. About a quarter of the time, the infection is the result of instrumentation such as a catheter or a prostate biopsy. The bacteria that usually cause prostatitis are usually either bacteria associated with urinary tract infections or those associated with sexually transmitted diseases.

Acute prostatitis usually presents with the sudden development of urinary symptoms such as pain with urination, urinary frequency, difficulty voiding, or a weak stream. Pain with ejaculation, fevers, chills, and body aches are also symptoms that you may experience.

Acute prostatitis is typically treated with antibiotics. If the specific bacteria is not known, an antibiotic with a broad spectrum, one that covers many types of bacteria, is used. Antibiotics are generally prescribed for at least 10 days, and you must complete the full course of antibiotics even if you start to feel better after a couple of days.

Complications of acute prostatitis include abscess requiring surgical drainage, recurrence of infection, or chronic pain and chronic prostatitis.

Chronic prostatitis

Chronic prostatitis is defined by symptoms lasting at least 3 months. The causes of this condition are less clear-cut than acute prostatitis which is almost always bacterial. Chronic prostatitis can be bacterial, in which antibiotics are used for 4-6 weeks. It can also be caused by inflammation, which is not infectious. Inflammatory prostatitis is more likely to recur and can be caused by psychological stress, nerve damage, or trauma.

Treating chronic prostatitis is tricky. Many medications may be tried. The condition is considered a chronic pain condition and chronic pain is frequently difficult to treat. Antibiotics and medications that are used for BPH are frequently tried. Sometimes anti-inflammatory medications are also used. Occasionally, chronic prostatitis can cause recurrent urinary tract infections.

Prostate cancer

Prostate cancer is the third most common condition associated with the prostate. It is one of the most common types of cancer and one of the leading causes of cancer death. With cancer, cells grow out of control and form tumors, which may stay localized in the prostate or may spread to other parts of the body such as bones. The risk of prostate cancer increases with age.

Many times, prostate cancer doesn’t have any symptoms. When it does, you may experience difficulty with urination, pain, or blood in the urine or semen. The challenge with prostate cancer is that even when symptoms occur, they can be the result of many non-cancer conditions. Your healthcare provider may be able to feel a tumor on a digital rectal exam. There is a screening test available for prostate cancer called PSA. As we discussed above, the prostate produces an enzyme called prostate-specific antigen. This level can be elevated with any of the conditions we’ve discussed, but with prostate cancer, it’s generally very high. If the PSA level is elevated, you may be able to just follow the levels to see if they increase over time. If the level is higher, your healthcare provider may recommend a biopsy.

Prostate cancer has many options for treatment. Sometimes your healthcare provider will recommend just monitoring the cancer. Prostate cancer is slow-growing in many cases. More people die of prostate cancer than of prostate cancer. This is one of the reasons that prostate cancer screening is controversial. If treatment is needed then surgery, radiation, or medications may be recommended. Prostate cancer is generally a testosterone-responsive cancer. If you are taking any testosterone replacement medications, your healthcare provider will generally recommend that you stop these. Anti-testosterone medications can be used to shrink the cancer or prevent it from spreading. Other treatments include chemotherapy, immunotherapy, high-intensity ultrasound, and cryotherapy.

Prostate conditions are extremely common, and many people may be reluctant to discuss some of the symptoms with their healthcare provider. It is important to be open with your healthcare provider about any symptoms you may be experiencing and to discuss whether screening is appropriate for you.

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Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.

References:

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