Many men aren't sure what their prostate is, what it does, or when to call a doctor if they think they might have a problem. So, information is the best tool you have in dealing with this aspect of men’s health.
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What Does My Prostate Do?
It is a small gland that is
part of the male reproductive
system. It's supposed to be about the shape and size of a walnut.
It rests below your bladder and
in front of your rectum. It surrounds part of the urethra, the tube in your penis that
carries pee from your bladder.
The prostate helps make
some of the fluid in semen, which carries sperm from
your testicles when you ejaculate.
This Gland Can Grow
As you age, your prostate can become larger. It’s a normal part of aging
for most men.
By the time you reach age 40, your prostate might have
gone from the size of a walnut to the size of an apricot. By the time you reach
60, it might be the size of a lemon.
Because it surrounds part of the urethra, the enlarged prostate can
squeeze that tube. This causes problems when you try to pee. Typically, you
won’t see these problems until you’re 50 or older, but they can start earlier.
You might hear a doctor or nurse call this condition benign prostatic hyperplasia, or BPH for short. It is not cancerous.
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Who Might Get an Enlarged Prostate?
BPH is
common and cannot be prevented. Age and a family history of BPH are two things
that increase the chances you might get it. A few stats on that:
- Some
8 out of every 10 men eventually develop an enlarged
prostate.
- About
90% of men over the age of 85 will have BPH.
- About
30% of men will find their symptoms bothersome.
Symptoms
If you have trouble
starting to urinate or have to go a lot, especially at night, these could be
signals that you have an enlarged prostate. Other signs and symptoms include:
- Your
bladder doesn’t empty completely after you pee
- You
feel the need to go out of the blue with no sensation of build-up
- You
may stop and start several times
- You
have to strain to get any flow going
It’s important that you see
your doctor if you have early symptoms of BPH. Although rare, it can lead to
serious problems such as kidney or
bladder damage.
A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues. But your doctor should be aware either way.
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Treatments
How your doctor handles your condition depends on the details of your
case -- your age, how much trouble it’s causing, and more. Treatments may
include:
Watchful waiting. If you have an enlarged prostate but are not
bothered by symptoms, you may be advised merely to get an annual checkup, which
might include a variety of tests.
Lifestyle changes. This includes cutting back on how much you drink
at night and before bedtime,
especially drinks with alcohol or caffeine.
Medicine. Common
treatments for BPH are alpha-blockers, which ease BPH symptoms, and what’s
called 5-alpha reductase inhibitors, or 5-ARIs, which help shrink the prostate.
Many men may take them together.
The FDA now requires labels
on the 5-ARIs to include a warning that they may be linked to an increased
chance of a serious form of prostate cancer.
These medications are dutasteride (Avodart)
and finasteride (Propecia and Proscar).
The combination pill Jalyn also contains dutasteride as one of its ingredients.
Surgery. Men
with severe symptoms who haven't been helped by other treatments might have to
turn to surgery. Talk to your doctor about possible risks and outcomes.
Prostatitis
This is an infection or inflammation of
the prostate; it’s not the same thing as BPH, though some of the symptoms are
similar.
It can affect men from
their late teens well into old age. Symptoms include:
- Trouble
passing urine
- Chills
and fever
- Sexual
problems
Treatment usually includes antibiotics.
If you have recently had a catheter or other medical instrument put into your urethra, you have a higher chance of getting bacterial prostatitis. Some sexually transmitted diseases, such as chlamydia, may also cause ongoing infection and inflammation.
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Prostate Tests
Your doctor can use a
variety of tests to check on the condition of your prostate. A few of them include:
Digital rectal exam: Your doctor puts on a glove and gently inserts
one finger into your rectum to check the size and shape of your prostate. They
check for things such as size, firmness, and any lumps.
Prostate-specific antigen test: This blood test
checks the amount of a protein called PSA that
is produced by prostate cells. Higher levels may be a sign of cancer. By themselves, they are not proof you
have prostate cancer.
Higher levels could also
point to an enlarged prostate or prostatitis. But, levels may be low even with
men who have prostate cancer, so discuss the results with your doctor.
Prostate biopsy: Men with high PSA results or other symptoms of cancer may
have a tissue sample taken of their prostate to determine whether cancer is
present.
Screening for Cancer
Screening for prostate
cancer is controversial. You may read different kinds of advice and guidance
from various sources. Talk to your doctor about what is best for you.
The American Cancer Society: It says men should talk to their doctors about
the benefits, risks, and limits of prostate cancer screening before deciding
whether to be tested. This discussion should take place:
- At
age 50 for men with an average chance for prostate cancer
- At
45 for men with a higher chance for the condition: this includes
African-Americans and men who have a father, brother, or son who has been
diagnosed with prostate cancer at 65 or younger
- At
age 40 for men who have more than 1 first-degree relative (father,
brother, or son) diagnosed with prostate cancer at an early age
The American
Urological Association: It recommends that men ages 55 to 69
who are considering screening should talk with their doctor about the risks and
benefits of testing and make the decision based on their personal situation and
needs.
The group does not suggest screening for:
- Men 39 and younger
- Men who are 40 to 54 and have only an average chance
of getting cancer
A routine interval of 2 years or more may be preferred over yearly tests
in those men who have decided on screening after talking with their doctor.
Compared with annual screening, it is expected that 2-year intervals
give you most of the benefits and reduce false positive results.
Routine PSA screening is not recommended for men older than 70 or for
any man who is expected to live only 10 to 15 more years.
The U.S. Preventive
Services Task Force: It recommends that men ages 55
to 69 who are considering screening should talk with their doctor about the
risks and benefits of testing and make the decision based on their personal
situation and needs.
Routine PSA screening is not recommended for men older than 70.
Medically Reviewed by Carmelita Swiner, MD on
November 18, 2020
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