The topic of men’s health continues to make headlines. Never before has such an effort been underway from medical professionals, the media, and pharmaceutical manufacturers to raise awareness of the causes, treatment options, and prevention of health-related conditions in men. Foremost among these issues is the health of the prostate gland.
By Mike Haskew
Prostate problems can negatively impact the quality of life in men of all ages, and the likelihood that a male will experience prostate-related concerns at some point during his lifetime is quite high. However, these problems may range from the simple, easily treated inflammation or infection to the more serious concern of cancer. Understanding the function of this small, walnut-sized gland provides men with insight and options for treatment if, and when, a health issue arises.
The prostate gland itself is a component of the male reproductive system that contributes to the body’s manufacture of semen. It is located below the bladder, in front of the rectum, and surrounds the urethra, which is the narrow tube that carries urine and semen out of the body. The nerves which control erectile function are attached to the sides of the prostate, while two smaller glands, the seminal vesicles, are located above it. These glands produce additional components of the fluid which makes up semen, and treatment of prostate conditions can affect their function.
By far the most prominent prostate-related health concern is the potential for developing cancer. The National Cancer Institute’s SEER (Surveillance, Epidemiology and End Results) program reports that one in six men will be diagnosed with prostate cancer during their lifetime. In 2005, more than 2.1 million American men reported some history of prostate cancer. Prostate cancer appears to be more common among black men than any other group; annually, 248.5 per 100,000 black men are diagnosed versus 156.7 per 100,000 white men.
“They say that over time, if you follow people long enough, every man would develop prostate cancer,” says Dr. Matt Mumber, a radiation oncologist with the Harbin Clinic in Rome, Georgia, and the Fuller Cancer Center at Hutcheson Medical Center in Fort Oglethorpe, Georgia. “Prostate cancer is one of the top four, along with breast, lung, and colon cancer; about 220,000 new cases are diagnosed in the United States each year.”
The general symptoms of prostate cancer are similar to those of other conditions, such as benign prostatic hyperplasia (BPH, enlarged prostate) or prostatitis (inflammation of the prostate). The key to successful treatment is visiting the doctor and determining the cause of the symptoms.
According to the Prostate Cancer Foundation, symptoms that might indicate the presence of prostate cancer include:
• 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.
However, these symptoms are not limited to prostate cancer and can also be associated with other issues, including a narrowing of the urethra, side effects of certain medications, or complications from a neurological problem, such as Parkinson’s disease.
Symptoms of an irritated or enflamed prostate, an infection of the bladder or prostate, a bladder tumor, bladder stone, a thickened bladder due to BPH, or a neurogenic (nerve-related) bladder issue include pain or burning during urination, frequent urination (especially during the night), a strong sense of urgency in urination, sleep interrupted to urinate, and urgency incontinence.
Two reliable preventive screenings can be performed to monitor the potential presence of cancer cells, even when symptoms do not exist. These screenings may also be helpful in detecting other problems with the prostate.
Of the two screenings, the digital rectal exam (DRE) involves feeling the prostate through the rectum. This allows the doctor to detect abnormalities such as bumps or enlargements that could signify prostate cancer or other problems. The prostate specific antigen (PSA) blood test determines the level of PSA present in the bloodstream. Elevated levels may indicate the need for a biopsy to determine any presence of cancer cells. Each patient’s course of treatment for prostate cancer is evaluated individually.
“We have to figure out the stage of disease and determine how risky the disease is for the patient,” says Dr. Mumber. “That involves determining how much disease is in the gland and if it has spread elsewhere in the body. This places the patient in the low, medium, or high-risk category. Depending on the stage the patient is in, surgery, chemotherapy, and radiation are the big three.”
In surgical cases, all or part of the prostate is removed. The most common type of surgery is the radical retropubic prostatectomy, in which the entire gland and surrounding tissue are removed and the urethra is stitched directly to the bladder. Surgical incisions are made either in the abdomen or the perineum. Variations of this surgery include the nerve-sparing prostatectomy, in which erectile nerves are spared to the extent possible. Laparoscopic surgery is less invasive and involves the insertion of instruments controlled by the surgeon through robotic manipulation.
“Robotic surgery is one of those techniques that has improved the tolerance and the morbidity rates among patients and made it easier on them,” continues Dr. Mumber. “It has provided better outcomes, but there are not any specific long-term results yet. It certainly is touted as a very promising technique and has the potential to be a major advance.”
Radiation therapy involves the exposure of cancer cells to radioactivity, which can kill them. External beam radiation therapy is most commonly employed following the targeting of the cells through diagnostic scans such as the CT or MRI. Dr. Mumber is optimistic that radiation oncology is moving forward with even more precise locating of cancer cells within the prostate.
“Intensity modulated radiation therapy (IMRT) is usually combined with some form of image-guided radiation therapy (IGRT), and that means that the tumor is targeted directly every time; this is a major advance within the last 10 years,” he says. “Another well-researched procedure is prostate seed implantation. The radioactive seeds are specific to what the patient needs and are placed using ultrasound guidance.”
Chemotherapy involves the use of chemicals to arrest the growth of cancer cells or kill them. Initially, chemotherapy was utilized as a reliever of symptoms for advanced prostate cancer; however, recent studies indicate that some combinations of drugs may be more effective than originally believed. Clinical studies are ongoing.
Of course, these are only three of the most prominent treatments for prostate cancer. Other treatments include: hormone therapy; cryotherapy or cryoablation, in which prostate and cancer cells are frozen; and high-intensity focused ultrasound (HIFU), in which prostate cells are killed by elevated heat levels. Depending on the aggressiveness of the cancer, the age and general health of the patient, and the treatment preference, another option is active surveillance. For example, slow-growing cancer in a patient of advanced age may best be dealt with in a mode of active surveillance or watchful waiting. Periodic DRE and PSA testing are typically performed.
Treatments on the horizon may include better chemotherapy drugs, interruption of the cycle of cancer cell division through the introduction of substances such as certain proteins or fats, and the suppression of new blood vessel generation (angiogenesis), which occurs when cancer cells spread to a new tumor site. The development of vaccines may actually allow the body’s immune system to recognize certain characteristics of emerging cancer cells and destroy them.
While cancer is potentially life threatening and certainly the most alarming diagnosis for men with prostate issues, the cure rate with early detection and treatment exceeds 90 percent. Risk factors for the disease include age greater than 50, race or ethnicity, family history, a diet high in fat, the presence of obesity, and high levels of the male hormone testosterone.
Other diagnoses also demand attention. Prostatitis, for example, is a painful condition which can include a tender, enflamed, or swollen prostate, along with pain in the joints or muscles and other symptoms. The Prostate Cancer Foundation reports that 25 percent of men who visit their doctor for urological issues exhibit symptoms of prostatitis, which is also the most common cause of male urinary tract infections. These symptoms are treatable, although the condition itself is potentially chronic. Infections involving the prostate may be treated with a course of antibiotics.
Treatment for BPH has developed rapidly since the early 1990s. Medications are available and surgery is an option for those with extreme symptoms. BPH is a benign enlargement of the prostate which constricts the urethra. The incidence of BPH increases beyond the age of 40, with 70 percent of men who have reached the age of 70 experiencing some form of it. More than 350,000 in the U.S. alone are diagnosed with BPH each year.
Maintaining the health of the prostate involves a commitment on the part of the individual to a healthy lifestyle. “It really does go back to how you remain healthy in general,” advises Dr. Mumber. “The first step is an awareness of where you are in terms of your health. I think of health as a three-legged stool. If one of the legs is weak, then it is hard to maintain balance. The three legs are physical activity, nutrition, and stress reduction.”
Dr. Mumber recommends the following steps:
• Exercise. At least 20 to 30 minutes of exercise five days a week at a level intense enough to make you sweat. This can be tailored to a person’s physical abilities and can be mild, like yoga, or active, like jogging.
• Eat a healthy diet. Eat six to seven servings of vegetables a day and avoid processed and sugary food. Limit the intake of red meat to about one serving a week and avoid meat that is overcooked.
• Take a Supplement. Take a decent multivitamin every day and have levels of vitamin D3 checked – these levels are generally low. Also, omega-3 fatty acids, like those found in cold water fish, are beneficial.
• Reduce Stress. Stress reduction is probably one of the least understood and least practiced lifestyle improvements in our society. It is beneficial to learn stress-reducing practices, like listening to music, along with certain types of exercises.
The prostate gland can pose challenges to male health; however, individuals do have a certain measure of control over their own general health. When problems with the prostate arise, there is hope for a positive outcome.