Prostate Gland - FAQs

What is benign prostatic hyperplasia ?

Benign prostatic hyperplasia (BPH) is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through). As men age, the prostate gland slowly grows bigger (or enlarges). As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. "Benign" means the enlargement isn't caused by cancer or infection. "Hyperplasia" means enlargement.

What are the symptoms of BPH ?

Most symptoms of BPH start gradually. One symptom is the need to get up more often at night to urinate. Another symptom is the need to empty the bladder often during the day. Other symptoms include difficulty in starting the urine flow and dribbling after urination ends. The size and strength of the urine stream may decrease.

These symptoms can be caused by other things besides BPH. They may be signs of more serious diseases, such as a bladder infection or bladder cancer. Tell your doctor if you have any of these symptoms, so he or she can decide which tests to use to find the possible cause.

How will my doctor treat my BPH ?

All enlarged prostates do not necessarily need medical treatment.

Options include medicines & various forms of surgery.

What are my chances of getting prostate cancer ?

Prostate cancer is the most common cancer among men and the second leading cause of annual cancer deaths, following lung cancer. One in 10 men will be diagnosed with prostate cancer. More than 70 percent of all prostate cancer cases are diagnosed in men over the age of 65. Black men are in the highest risk group and represent approximately 270 cases per 100,000 men. In addition, prostate cancer has the strongest familial link of all the major cancers.

What are the symptoms of prostate cancer ?

Often, early stages of prostate cancer do not cause any specific symptoms. But, in some cases, men with prostate cancer may present with symptoms of prostate enlargement or those due to widespread disease including blood in urine, bone pain etc:

  • A need to urinate frequently, especially at night;
  • Difficulty starting urination or holding back urine;
  • Weak or interrupted flow of urine;
  • Painful or burning urination;
  • Difficulty in having an erection;
  • Painful ejaculation;
  • Blood in urine or semen; or
  • Frequent pain or stiffness in the lower back, hips, or upper thighs.

You should speak with your doctor immediately if you have these symptoms or if you are over 50 and not had a recent prostate cancer screening. If you have a family history of prostate cancer, or are an African-American male, you should consider screening beginning at age 45.

What are the chances of survival ?

Prostate cancer may be highly curable when detected in its early stages. One in every seven men diagnosed with prostate cancer will die from the disease. In advanced stages of the disease, new data from two large clinical trials suggest chemotherapy extends survival among men who have failed hormone therapy. Your physician can provide you with specific guidance based on the facts and circumstances of your case.

What type of doctor should i visit for prostate cancer screening ?

Screening for prostate cancer is a relatively simple procedure. While others may begin with a visit to the urologist. Urologist will be able to help you learn more about the screening process.

What type of tests will the doctor perform ?

The first analysis many physicians will perform is a

  • PSA test. Prostate specific antigen (PSA) is an enzyme produced in the prostate that is found in the seminal fluid and the bloodstream. To measure the PSA level, a small vial of blood is drawn and sent to a laboratory for evaluation. An elevated PSA level in the bloodstream does not necessarily indicate prostate cancer, since PSA can also be raised by infection or other prostate conditions. Many men with an elevated PSA do not have prostate cancer.
  • The digital rectal exam (DRE) should be performed along with the PSA test. The DRE is performed by a physician who will insert a gloved finger into the rectum to feel the peripheral zone of the prostate where most prostate cancers occur. The physician will be checking for hardness of the prostate or for irregular shapes or bumps extending from the prostate - all of which may indicate a problem. The DRE is particularly useful because the PSA test may miss up to 25 percent of cancers, and the DRE may catch some of these.

How prostate cancer is typically treated ?

  • There are a variety of ways to treat prostate cancer including
  • Surgery to remove the prostate in its entirety, radiation therapy to kill the cancerous tissue in and around the prostate,
  • Hormone deprivation therapy to stop the production of hormones that help prostate cancer cells to grow,
  • Chemotherapy to stop the cancer cells from dividing and multiplying,
  • Active surveillance and/or watchful waiting where patients remains under strict follow up. One or more of these treatment approaches may be used by your doctors at various times and stages of the disease. There are a variety of factors that will be evaluated by your physician to determine the best treatment approach.

What if my prostate cancer progresses or comes back after i receive initial therapy ?

By measuring levels of a substance called prostate-specific antigen in the blood, your physician can measure disease progression. If you are receiving treatment for prostate cancer and your PSA numbers keep rising, it may be a sign that your therapy isn't working and you may need to consider a more aggressive treatment.

Most men whose cancer returns after local treatment or are diagnosed with advanced disease are treated with hormone therapy. However, at some point, hormone therapy may stop working and the PSA levels will begin to rise again. At this point it is particularly important to seek the advice of a medical oncologist who can work with the rest of your healthcare team to determine the best treatment for you at this stage of the disease.

What new treatments are available for advanced prostate cancer ?

If prostate cancer is diagnosed at an advanced stage or if the cancer returns after localized therapy such as surgery or radiation, additional treatment with hormonal therapy is typically initiated.

Recently many additional hormonal & new Chemotherapy options are now available.

How is erectile dysfunction treated ?

How erectile dysfunction is treated depends on what things are causing it. After your doctor checks you for medical problems and medicines that might cause erectile dysfunction, he or she may have you try a medicine to help with erectile dysfunction. Some of these medicines are injected into your penis. Other medicines are taken by mouth. Not everyone can use these medicines. Your doctor will help you decide if you can try them.

What other options do i have ?

If the medicines aren't right for you, you could also try using vacuum pump devices, or you could have surgery. Your doctor may send you to an urologist to talk about these options.

How do i know which treatment for impotency is best suited for me ?

The decision about treatment option should be discussed with your physician. Your choice of treatment will depend on personal preference and economic factors. Both you and your partner should be comfortable with your choice.

Is it necessary for my sexual partner to be included in discussions on my impotence ?

She helps the doctor understand the problem and must agree with the treatment choice.

Can any of these treatment options reverse impotence ?

Most impotence is irreversible. While none of the three treatment options reverse a man’s impotence, they do offer a solution to the problem.

Hope through research

Advances in suppositories, inject able medications, implants, and vacuum devices have expanded the options for men seeking treatment for ED. These advances have also helped increase the number of men seeking treatment. Gene therapy for ED is now being tested in several centers and may offer a long-lasting therapeutic approach for ED.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsors programs aimed at understanding the causes of erectile dysfunction and finding treatments to reverse its effects. NIDDK's Division of Kidney, Urologic, and Hematologic Diseases supported the researchers who developed Viagra and continue to support basic research into the mechanisms of erection and the diseases that impair normal function at the cellular and molecular levels, including diabetes and high blood pressure.

Points to remember

  • Erectile dysfunction (ED) is the repeated inability to get or keep an erection firm enough for sexual intercourse.
  • ED affects 15 to 30 million American men.
  • ED usually has a physical cause.
  • ED is treatable at all ages.
  • Treatments include psychotherapy, drug therapy, vacuum devices, and surgery.