Prostate disease

What is prostate gland?

In the male reproductive system, the prostate is a tiny, muscular gland. It is a small gland positioned between the bladder and the penis. The prostate is located just in front of the rectum. The urethra connects the bladder to the penis and travels through the middle of the prostate, allowing urine to exit the body. Your prostate surrounds your urethra and produces the majority of the fluid in your sperm. During sexual climax, the prostate's muscular movement helps drive fluid and sperm into your penis.

The prostate's principal role is to supply prostatic fluid to sperm. The prostate contributes 20-30% of the fluid to the overall amount of sperm. The remaining is derived from seminal vesicles (50-65%) and testicles (5 percent).

Prostatic fluid includes enzymes, zinc, and citric acid, which make semen an optimal environment for sperm cells to survive in. Prostate-specific antigen (PSA) is an essential enzyme that helps make the sperm thinner and more fluid.

The fluid in sperm helps it go through the urethra and survive its journey to an egg, which is required for reproduction. Although prostatic fluid is slightly acidic, the other components of sperm make it alkaline in general. This is done to neutralize the vaginal acidity and protect the sperm from harm.

The prostate contracts and squirts prostatic fluid into the urethra during ejaculation. It subsequently combines with sperm cells and fluid from the seminal vesicles to form semen, which the body then excretes.

When the prostate contracts during ejaculation, it seals the hole between the bladder and urethra, allowing semen to pass quickly through. This is why, in most anatomical conditions, it is difficult to urinate and ejaculate at the same time.

The prostate of a young guy is roughly the size of a walnut. It gradually expands with age. It might pose issues if it grows too big. This is rather prevalent beyond the age of 50. The older men become, the more probable it is that they may have prostate problems.

How the Prostate Changes with age?

Because the prostate gland enlarges with age, it may compress the urethra and induce urinary incontinence. Men in their 30s and 40s may experience these urine symptoms and require medical treatment. Others do not discover symptoms till much later in life. A tumor or infection can also cause the prostate to enlarge.

Growing older increases your chances of developing prostate issues. Prostatitis, enlarged prostate (BPH, or benign prostatic hyperplasia), and prostate cancer are the three most prevalent prostate diseases.

One disorder does not imply another. Prostatitis or an enlarged prostate, for example, do not enhance your risk of prostate cancer. It is also possible to have many conditions at the same time.

What happens when a man has Prostate problems?

Urination and bladder control issues are common in prostate disorders. The following are examples:

• Inadequate bladder control, resulting in frequent toilet visits
• Urinary urgency, sometimes with only a tiny volume of pee
• Difficulty initiating or terminating the urine stream when urinating
• A weak or thin urine stream

Prostate issues can also lead to sexual dysfunction, urinary tract infections, bladder stones, and, in severe situations, kidney failure. If a person is unable to urinate at all, they should seek emergency medical treatment.

If a person notices any of the following symptoms, they should consult a doctor:

• Urinary or post-ejaculatory pain
• Pain in the penis, scrotum, or the area between the scrotum and anus
• Urine containing blood
• Abdominal discomfort that is excruciating
• A dribble or weak urine stream towards the end of urinating
• Fever, chills, or body aches
• Issues with bladder control, such as halting or postponing urinating
• Inability to completely empty the bladder
• Urine with a unique odor or color

What are the tests used to check for the Prostate diseases?

This initial stage allows your doctor to understand and evaluate your prostate issues. You'll be asked if you have symptoms, how long you've had them, and how much they interfere with your daily life. Your personal medical history should also include any risk factors, such as pain, fever, or difficulty passing urine. You may be requested to provide a urine sample for testing purposes.

Digital Rectal Exam (DRE)

DRE is a common method of checking the prostate. Your doctor will feel the prostate from the rectum with a gloved and lubricated finger. The test lasts around 10-15 seconds.

This exam evaluates for:

• The prostate's size
• Hardness, and texture
• Any hard regions, lumps, or growths expanding beyond the prostate
• Any pain produced by touching or pushing the prostate

PSA (Prostate-Specific Antigen) Test

The FDA has authorized the use of the PSA test in conjunction with a DRE to aid in the detection of prostate cancer in males aged 50 and older. PSA is a protein that prostate cells produce. It is generally produced into ducts in the prostate, where it aids in the production of sperm, although it occasionally spills into the blood. PSA levels in the blood can be determined via a blood test known as the PSA test.

PSA levels in the blood are elevated in prostate cancer patients. A high PSA blood level, however, is not proof of cancer, and many other factors might result in a false-positive test result. Other conditions that can elevate PSA level include: prostatitis, BPH, activities that stress the prostate gland, such as riding a bicycle or motorbike, a prostate biopsy, or prostate surgery.

PSA tests are frequently used to monitor men following prostate cancer therapy for evidence of disease recurrence. It is unclear if PSA testing to screen for prostate cancer can lower a man's chance of dying from the illness.

PSA levels are expressed as the quantity of PSA present per liter of fluid examined. A number of 4 nanograms (ng) or greater per milliliter of blood is frequently used by doctors to indicate that more testing, such as a prostate biopsy, are required. Your doctor may monitor your PSA velocity, which is the pace at which your PSA level changes over time. Rapid spikes in PSA levels may indicate malignancy. If you have a slightly high PSA level, you and your doctor may decide to perform PSA testing on a regular basis to monitor any changes in PSA velocity.

Prostate Biopsy

If your symptoms or test findings point to prostate cancer, your doctor will recommend you to a urologist for a biopsy. Small tissue samples are obtained straight from the prostate for a biopsy. Your doctor will extract prostate gland samples from several locations. This reduces the possibility of missing any parts of the gland that may contain cancer cells.

A positive test result following a biopsy indicates the presence of prostate cancer. A pathologist will examine your biopsy sample for cancer cells and assign a Gleason score to it. Treatment choices are determined on the stage (or extent) of the cancer (stages 1–4), Gleason score, PSA level, age, and overall health. Your doctor will have this information, and it will be mentioned on your pathology report.

Making a treatment decision for your prostate cancer is a difficult process. Many men find that talking with their physicians, family, friends, and other guys who have faced similar situations is beneficial.

Prostatitis

Prostatitis is a prostate gland inflammation caused by a bacterial infection. At some point in their lives, at least half of all men will be affected by it. This issue does not enhance your chance of developing any other prostate illness.

Symptoms of Prostatitis:

• Trouble passing urine
• A burning or stinging feeling or pain when passing urine
• Strong, frequent urge to pass urine, even when there is only a small amount of urine
• Chills and high fever
• Low back pain or body aches
• Pain low in the belly, groin, or behind the scrotum
• Rectal pressure or pain
• Urethral discharge with bowel movements
• Genital and rectal throbbing
• Sexual problems and loss of sex drive
• Painful ejaculation (sexual climax)

A Digital Rectal Examination (DRE) and a urine test can be used to determine whether you have prostatitis. The correct diagnosis of your specific kind of prostatitis is critical to receiving the best therapy.

Types of Prostatitis and Treatments

1. Acute bacterial prostatitis:

• This condition is caused by a bacterial infection and appears acutely. Severe chills and fever are among the symptoms. Urine frequently contains blood. Your PSA level may be higher than usual. You must get care at a doctor's office or an emergency room. It is the least prevalent of the four forms, yet it is the simplest to detect and cure.
• The majority of cases may be healed with a high dose of antibiotics for 7 to 14 days, followed by lesser doses for many weeks. You may also require medications to alleviate pain or discomfort. If your PSA level was elevated, it will most likely revert to normal once the illness is resolved.

2. Chronic bacterial prostatitis:

• This form of prostatitis, which is also caused by bacteria, does not appear quickly, although it can be troublesome. The only sign you may have is recurring bladder infections. The cause might be a prostate abnormality that allows bacteria to accumulate in the urinary system.
• This sort of infection responds well to long-term antibiotic therapy. The duration of treatment ranges from 4 to 12 weeks. This form of therapy is effective in around 60% of instances. In situations when symptoms do not resolve, long-term, low-dose antibiotics may assist.

3. Chronic prostatitis or chronic pelvic pain syndrome:

• This is the most frequent variety of prostatitis, but it is also the least understood. It affects males of all ages, from late teens to the elderly, and its symptoms can appear and disappear without notice. There may be groin or bladder pain or discomfort. Even when no germs are present, infection-fighting cells are frequently present.
• Depending on your symptoms, there are various potential therapies for this disease. Anti-inflammatory drugs and other pain-relieving therapies, such as warm baths, are examples. Other medications, such as alpha-blockers, may also be used. Alpha-blockers relax muscular tissue in the prostate, making it simpler to pass urine. If the symptoms are caused by an undiagnosed infection, some men are given antibiotics.

4. Asymptomatic inflammatory prostatitis:

• You have no symptoms of this illness. It is frequently discovered when conducting tests for other diseases, such as determining the reason of infertility or searching for prostate cancer. If you have this type of prostatitis, your PSA level may be higher than normal.
• Men with this disease are normally not treated, but if the PSA level is high, a second PSA test is routinely performed.

Enlarged Prostate (BPH)

BPH is an abbreviation for benign prostatic hyperplasia. Benign refers to "not cancerous," whereas hyperplasia refers to improper cell proliferation. As a result, the prostate grows in size. Although BPH is not connected to cancer and does not raise your chance of developing it, the symptoms of BPH and prostate cancer can be similar.

Symptoms of BPH:

• Trouble starting a urine stream or making more than a dribble
• Passing urine often, especially at night
• Feeling that the bladder has not fully emptied
• A strong or sudden urge to pass urine
• Weak or slow urine stream
• Stopping and starting again several times while passing urine
• Pushing or straining to begin passing urine

At its worst, BPH can cause: a weak bladder, backflow of urine resulting in bladder or kidney infections, a total blockage of urine flow, and kidney failure.

When a person is in his twenties, his prostate gland is roughly the size of a walnut. It may have gotten somewhat larger by the time he is 40, to the size of an apricot. It might attain the size of a lemon by the age of 60. The enlarged prostate can put pressure on the bladder and urethra. This can delay or stop urine flow. Even if they sense the need to pee, some men may find it difficult to start a urine stream. It may be difficult to halt the pee stream once it has begun. Other men may experience the constant urge to pass pee, or they may be aroused during sleep by the abrupt desire to pass urine. Early BPH symptoms take many years to turn into bothersome problems.

Treatments for BPH

Some men with BPH have symptoms that are uncomfortable enough to require therapy. Although BPH cannot be cured, medications or surgery can typically alleviate its symptoms. Consult your doctor about the best option for you. Your symptoms may alter over time, so notify your doctor of any new developments.

1. Watchful waiting

Men with minor BPH symptoms who do not find them unpleasant frequently select this strategy. Annual checks are required for watchful waiting. Only when symptoms become unbearable is treatment initiated.

If you choose to watchful waiting, the following easy measures may help alleviate your symptoms:

• Limit alcohol and caffeine-containing beverages in the evening.
• When passing pee, empty your bladder completely.
• Use the restroom often. Don't go for long periods without passing urine.

Some drugs can exacerbate BPH symptoms, so inform your doctor or pharmacist about any medications you are taking, such as:

• Over-the-counter cold and cough medicines (especially antihistamines)
• Tranquilizers
• Antidepressants
• Blood pressure medicine.

2. Drug Therapy

There are two sorts of medications utilized. One kind relaxes the muscles around the prostate, while the other shrinks the prostate gland. Some data suggests that using both medicines simultaneously may be the most effective way to prevent BPH symptoms from worsening.

• Alpha-blockers are medications that relax the muscles around the prostate to alleviate pressure and allow urine to flow more easily, but they do not shrink the prostate. These medications can increase urine flow and lessen BPH symptoms in many men within days. Dizziness, headache, and tiredness are all possible adverse effects.
• 5 alpha-reductase inhibitors are medications that aid in prostate shrinkage. They alleviate symptoms by inhibiting the functioning of an enzyme called 5-alpha reductase. This enzyme converts testosterone, the male hormone, into dihydrotestosterone (DHT), which increases prostate development. When 5-alpha reductase activity is inhibited, DHT synthesis decreases and prostate development slows. This aids in prostate shrinkage, reduces obstruction, and reduces the need for surgery.

These medications can help enhance urine flow and alleviate your discomfort. To avoid recurrence of symptoms, you must continue to take these medications. In a small number of males, 5-alpha reductase inhibitors can induce the following negative effects: reduced desire in sex, difficulty attaining or maintaining an erection, and a lesser volume of semen with ejaculation.

3. Surgery

The number of prostate procedures has decreased over time. However, BPH procedures remain among the most common surgeries performed on American men. Surgery is done when the symptoms are severe or medication treatment has failed.

BPH surgical options include:

• TURP (transurethral resection of the prostate). TURP is the most frequent BPH procedure, accounting for 90% of all BPH surgeries. The doctor inserts a device into the urethra and cuts away any excess prostate tissue. The tissue is transported to a laboratory to be tested for prostate cancer. In general, TURP avoids the two major risks associated with another form of surgery known as open prostatectomy, which include incontinence and/or impotence. TURP, on the other hand, might have major adverse effects, such as hemorrhage. Furthermore, males may be required to stay in the hospital and use a catheter for a few days following surgery.
• TUIP (transurethral incision of the prostate). This procedure, similar to TURP, is used to treat mildly enlarged prostate glands. One or two tiny incisions are made in the prostate by the surgeon. This lowers pressure while preserving tissue. It poses little danger of negative effects. This therapy, like TURP, improves urine flow by expanding the urethra.
• TUNA (transurethral needle ablation). Radio waves are utilized to burn away extra prostate tissue. TUNA improves urine flow, reduces symptoms, and may have fewer side effects than TURP. Most men require a catheter to drain urine for a period of time following the treatment.
• TUMT (transurethral microwave thermotherapy). Excess prostate tissue is destroyed using microwaves delivered through a catheter. This may be a possibility for men who should avoid major surgery due to other medical issues.
• TUVP (transurethral electroevaporation of the prostate). Prostate tissue is vaporized using an electrical current.
• Laser surgery. Using a cystoscope, the doctor inserts a laser fiber into the urethra and then administers numerous bursts of laser radiation. The laser radiation damages prostate tissue while also increasing urine flow. Laser surgery, like TURP, necessitates anesthesia. One advantage of laser surgery over TURP is that it results in less blood loss. Laser surgery may also result in a quicker recovery period. Laser surgery, on the other hand, may not be successful on bigger prostates.
• Open prostatectomy. this may be the sole alternative in exceptional circumstances, such as when the blockage is severe, the prostate is very big, or other treatments are not possible. A catheter is left in place for 3 to 7 days following the procedure. This procedure has the highest risk of complications. The tissue is transported to a laboratory to be tested for prostate cancer.

Prostate cancer

Cancer cells develop in the prostate tissues, resulting in prostate cancer. In comparison to most other malignancies, prostate cancer grows slowly. Cell alterations can begin ten, twenty, or even thirty years before a tumor becomes large enough to produce symptoms. Cancer cells may eventually spread (metastasize). The malignancy may be progressed by the time symptoms arise.

By the age of 50, very few men develop signs of prostate cancer, but some precancerous or cancerous cells may be present. By the age of 80, more than half of all American males have prostate cancer. Most of these tumors never cause any problems. They may never cause symptoms or pose a major hazard to health.

Symptoms of Prostate Cancer:

• Trouble passing urine
• Frequent urge to pass urine, especially at night
• Weak or interrupted urine stream
• Pain or burning when passing urine
• Blood in the urine or semen
• Painful ejaculation
• Nagging pain in the back, hips, or pelvis

Prostate cancer can spread to the pelvic lymph nodes. It might also spread throughout the body. It has a tendency to spread to the bones. As a result, bone discomfort, particularly in the back, can be a sign of advanced prostate cancer.

Risk Factors for Prostate Cancer

Some risk factors for prostate cancer have been identified. A risk factor is something that increases your chances of getting a disease. The presence of one or more risk factors does not guarantee the development of prostate cancer. It simply indicates that your chances of contracting the condition are higher.

• Age. Men over the age of 50 are at a greater risk of developing prostate cancer.
• Race. African-American men had the highest risk of prostate cancer, with the illness starting at a younger age and progressing quicker than men of other races. After African-American males, white men are the most likely to have prostate cancer, followed by Hispanic and Native American men. Asian-American males have the lowest prostate cancer rates.
• Family history. Men who have dads or brothers who have had prostate cancer have a 2 to 3 times higher chance of developing the illness than men who do not have a family history of the disease. A guy who has three direct family members with prostate cancer is around ten times more likely than a man who does not have a family history of prostate cancer. Prostate cancer risk appears to be somewhat greater in males from families with a history of breast cancer.
• Diet. Men who consume a high-fat diet may be at a higher risk of developing prostate cancer.

Prostate Cancer screening

Screening is the process of checking for cancer before you notice any symptoms. A screening test may aid in the early detection of cancer, when it is less likely to spread and may be simpler to cure.

Screening tests that have been shown to reduce a person's chance of dying from cancer are the most beneficial. Doctors are unsure if prostate cancer screening reduces the likelihood of dying from the disease. As a result, major research studies involving thousands of men are currently being conducted to investigate prostate cancer screening. The National Cancer Institute is researching the use of PSA testing in conjunction with DRE to obtain more accurate findings.

Although some individuals believe that it is best to treat any cancer that is discovered, including tumors discovered during screening, prostate cancer therapy can have substantial and often lasting negative effects. Some physicians are concerned that many men whose cancer is found by screening are being treated inappropriately and suffering from negative effects.

Large research projects are being conducted to determine how prostate cancer might be avoided. Although studies have demonstrated that the 5-alpha reductase inhibitors finasteride and dutasteride can reduce the chance of acquiring prostate cancer, it is uncertain if they can reduce the risk of dying from prostate cancer.

Conclusion

In men, the prostate is a gland aids in the production of sperm-containing fluid, known as semen. The prostate encircles the tube that transports urine from the bladder and out of the body. The prostate of a young guy is roughly the size of a walnut. It gradually expands with age. It can cause issues if it grows too large. This is rather prevalent beyond the age of 50. The older men become, the more probable to have prostate problems.

The prostate naturally grows with age, typically without incident. The enlarged prostate pinches the urethra in certain men, making urination difficult and causing benign prostatic hyperplasia (BPH). Symptoms of BPH include:

• Frequent urination, especially at night
• Difficulty starting a urine stream
• Feeling as though you can't get all of the urine out

Prostatitis is a prostate inflammation that is frequently caused by bacteria. Prostate infection is seldom serious, but if you have symptoms of prostatitis, consult your doctor. Among the possible symptoms are:

• Pain on Urination or ejaculation.
• Chills and fever
• Pelvic discomfort
• Urinating more often
• Urine that is cloudy

Prostate cancer often has no symptoms. It is often discovered after screening with a lab test called prostate specific antigen (PSA). Occasionally, prostate cancer can cause obstruction of urine flow, like BPH. This symptom usually suggests more advanced prostate cancer.