Prostate Problems

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The prostate is a walnut-sized gland that surrounds the male urethra-the tube that transports urine from the bladder through the penis. Its primary function is to produce an essential portion of the seminal fluid that carries sperm; the prostate also controls the outward flow of urine from the bladder. Because of this dual role, signs of prostate trouble can include both urinary and sexual difficulties.

Prostate Problems Occur in Two Principal Forms:

Enlargement of the prostate, called BPH (for benign prostatic hyperplasia); and prostatitis, a bacterial infection, which may be either sudden and severe (acute prostatitis) or milder but persistent or recurrent (chronic prostatitis). A chronic infection may follow an acute one.

The signs of prostate enlargement generally appear after the age of 45. Typically, the first indication is a need to urinate at night, with the urge gradually increasing over time.

Other Urination Problems may Develop:

A difficulty or hesitancy in initiating the urine stream; an inability to empty the bladder completely; and dribbling at the end of urination. These signs all have a common origin-the narrowing of the urethra because of growth of the glandular tissue surrounding it. Although the problem varies in severity, few men escape it altogether: Prostate enlargement affects 50 per cent of those over 50 and a some-what astonishing 90 per cent of those over 80.

Prostatitis is less common and can occur in younger men or without symptoms of enlargement. While some of the signs resemble those of BPH, others are more typical of infection. Acute prostatitis may produce fever, chills, and lower back pain. Chronic prostatitis generally brings milder versions of those symptoms and may also cause painful ejaculation, urethral discharge, or sexual dysfunction.

Many men are reluctant to seek treatment for BPH or prostatitis, especially if their discomfort is minor. If either condition progresses toward severe symptoms, the danger can increase sharply.

With prostatitis, the infection may reach the testicles and epididymis (a long, coiled tube behind each testicle through which sperm is transported from the testicles). It can also spread to a sexual partner. With BPH, the bladder may eventually be unable to empty itself, and the lingering pools of urine become sites of infection or stone formation. Such urine retention is very painful and should be treated as a medical emergency. If the outflow of urine is blocked, pressure within the bladder may back up to the kidneys, eventually leading to permanent damage.

As the average age of the population in a country rises, so does the number of men who seek relief from prostate problems. But with BPH, some aspects of the condition, including the chances of its worsening, are still poorly understood. As a result, the field is alive with controversy over when to take medical action and also over the relative merits of standard surgery and newer forms of medical treatment.

Causes

Although the molecular mechanisms underlying prostate enlargement remain uncertain, the condition seems to stem from age-related changes in hormone balance that begin when a man is in his forties. Testosterone levels in the blood decrease, while other hormone levels rise; the net effect is the increase of a testosterone derivative that stimulates cell growth in the prostate. This results in enlargement and consequent stricture of the urethra within the gland. Prostatitis is usually the result of a urinary tract or bladder infection that has spread into the prostate gland. The infection can be sexually transmitted.

Diagnostic and Test Procedures

If symptoms indicate prostate enlargement, a physician will want to determine whether the growth of the gland is benign (BPH) or malignant (prostate cancer). The physician will insert a gloved finger into the rectum to feel the prostate for hardness or nodules, which can indicate malignancy. A urine sample is taken to detect infection and/or chemical indicators of cancer cells. (In 10 to 20 per cent of benign cases, the prostate also harbors such cells.) Ultrasound imaging of the bladder and prostate is usually performed, and the bladder may be examined with a cystoscope. If symptoms suggest prostatitis, a urine test will identify the infectious agents. A rectal exam will find the prostate to be very tender and sensitive and will provide a check for coexisting conditions.

Treatment

For prostate enlargement, be sure that you and your doctor consider the whole range of treatment options. Just a few years ago, many physicians felt that surgery was the only solution; today, researchers are proposing an array of new treatment choices, from hormone-blocking drugs to lasers that can remove prostatic tissue without hospitalisation.

Conventional Medicine

Enlarged prostate: When BPH symptoms are mild to moderate, medication may be the appropriate therapy. Two recently approved prostate drugs, terazosin and prazosin, relax the smooth muscles at the bladder neck and urethra, easing urination. Another new medication, finasteride, has shown some ability to gradually reduce prostate size and symptoms, though noticeable improvement may take three to six months.

When symptoms are severe or there is evidence of cancer, surgery is usually recommended. About 85 per cent of patients experience marked relief of symptoms. In the most common surgery, the patient is placed under anesthesia, but no incision is needed. A small cutting instrument called a resectoscope (resect means to remove part of an organ) is passed through the penis and into the prostate by way of the urethra. Using an electrical apparatus at the end of the scope, the surgeon carves away the inner prostate, leaving a hollow shell through which the urine can flow. This procedure is known as TUR, or transurethral resection.

In about 15 per cent of cases, TUR can have complications, including possible impotence and urinary incontinence; some patients experience infection or bleeding, and others require a second operation to reopen the urinary tract. For these reasons, and because of the desire of patients to avoid surgery, there is much enthusiasm for nonsurgical resectioning methods. Several kinds of laser resecters, which can be used for outpatients, have shown good results. The instrument is passed through the urethra, as in TUR; the laser is then fired, and the heat quickly coagulates and vaporizes excessive prostate tissue.

Microwave devices, similarly inserted, have been widely employed in Europe, US and Canada for nearly a decade. Like laser resections, they can be done in an outpatient setting.

If the prostate is too large for TUR or other methods, the surgeon may recommend open prostatectomy, the removal of the prostate gland via surgical incision.

Prostatitis:

A prolonged course of antibiotics is usually successful in eliminating the infection. Stool softeners, sitz baths, and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for discomfort. If an infection is neglected too long, antibiotics may not be effective-and it may be difficult to remove the infection even by surgery without causing further complications.

Alternative Choices

Ayurvedic Medicine

A practitioner may prescribe herbal remedies and exercises to increase circulation and relieve congestion in the prostate.

Chinese Medicine

Prostatitis and urethritis are considered conditions of damp heat and would be treated accordingly by a practitioner.

Herbal Therapies

An extract of the berries of the saw palmetto (Serenoa repens), a scrubby tree of the American Southeast, is said to shrink an enlarged prostate and relieve symptoms. Other remedies include Asian ginseng (Panax ginseng), flower pollen, horsetail (Equisetum arvense), nettle (Urtica dioica), true unicorn root (Aletris farinosa), and the powdered bark of pygeum (Pygeum africanus), an evergreen tree.

For prostatitis, pipsissewa (Chimaphila umbellata) and horsetail are used to treat chronic infection. Thuja (Thuja occidentalis) and pasque-flower (Anemone pulsatilla) are also suggested for inflammation of the prostate.

Homeopathy

Numerous medications are available to the homeopathic practitioner for treating prostatic enlargement and prostatitis, among them Berberis vulgaris and Staphysagria.

Nutrition and Diet

Prostate enlargement may respond to nutritional support. In addition, if surgery is elected, good nutrition afterward will speed recovery.

Zinc, which is involved in many aspects of hormonal metabolism, is thought to promote prostate health and reduce inflammation; rich sources of zinc are oysters, wheat bran, whole oatmeal, pumpkinseeds, and sunflower seeds. Vitamins C and E may promote prostate health. The amino acids glycine, alanine, and glutamic acid are said to alleviate symptoms. The prostate may also benefit from large amounts of essential fatty acids, as found in flaxseed oil, walnut oil, sun-flower oil, soy oil, and evening primrose oil.

Prevention

To prevent a recurrence of chronic prostatitis and promote prostate health:

Take warm sitz baths.
Drink more water; dehydration stresses the prostate.
Avoid prolonged bicycle riding, horseback riding, or. other exercises that irritate the region below the prostate.
Take supplements of zinc and Vitamin C.

Symptoms

For an Enlarged Prostate:

Difficulties in urination, including a weak or intermittent stream, unusual frequency (especially at night), straining, dribbling, or inability to empty the bladder.

For Acute Prostatitis :

frequent, difficult urination.
a burning sensation when urinating.
sudden fever, chills.
pain in the lower back and the area behind the scrotum.
blood in the urine.

For Chronic Prostatitis:

frequent, difficult urination.
pain in the pelvis and genital area.
painful ejaculation, bloody semen, or sexual dysfunction.

Call Your Doctor If:

your symptoms lead you to suspect an enlarged or infected prostate. If allowed to progress, prostate problems can lead to bladder stones, generalized infection, or kidney failure.

In addition, an enlarged prostate can be a sign of cancer.

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