Prostate Problems

Do you know your odds of developing a prostate problem? Do you know what you can do about it? ishonest has assembled the following information to help you improve your chances of avoiding prostate trouble.

What Are the Most Common Prostate Problems?

For such a little gland, the prostate seems to cause a lot of concern. Like a troubled, war-torn country, it's in the news all the time and something always seems to be going wrong there, but you don't really know where it is or why it's important.

All men are at risk for prostate problems. That's because all men have a prostate. Take a look at this overview of prostate problems to assess your risk for trouble with your prostate.

Benign prostatic hyperplasia (BPH).BPH, also known as an enlarged prostate, is growth of the prostate gland to an unhealthy size. A man's chances of having BPH go up with age:

• Age 31-40: one in 12
• Age 51-60: about one in two
• Over age 80: more than eight in 10

However, only about half of men ever have BPH symptoms that need treatment. BPH does not lead to prostate cancer, although both are common in older men.

Prostate Cancer. Prostate cancer is the most common cancer in men (besides skin cancer). About one man in six will be diagnosed with prostate cancer in their lifetime. Let's keep these numbers in perspective, though. Because prostate cancer is usually slow growing, only about one in 35 men will die of prostate cancer.

Like BPH, the risk for prostate cancer increases with age. About two out of every three men with prostate cancer are over age 65. No one knows exactly what causes prostate cancer, but risk factors associated with it include:

• Family history. Having a father or brother with prostate cancer more than doubles your risk.
• Race. African-American men are more likely to get prostate cancer than Caucasians, and the cancer is usually more advanced when discovered.

African-American men and men with a family history of prostate cancer usually begin prostate cancer screening at an earlier age than Caucasian men who do not have prostate cancer in their family history.

Prostatitis. Unlike most prostate problems, prostatitis -- inflammation or an infection of the prostate -- occurs more often in young and middle-aged men. Only 5% to 10% of men develop prostatitis in their lifetime.

The Prostate and Its Symptoms

The prostate is a walnut-sized gland found only in men. It sits just below the bladder and surrounds the urethra, the tube that carries urine through the penis. The prostate's job is to make fluid for semen.

The prostate grows naturally with age, usually without problems. In some men, the enlarged prostate compresses the urethra, making urination difficult and causing benign prostatic hyperplasia (BPH). BPH symptoms include:

• Urinating frequently, especially at night
• Difficulty getting a urine stream going
• Feeling as if you are unable to get all the urine out

Prostatitis is an inflammation of the prostate, often caused by bacteria. Think of prostatitis as a type of men's urinary tract infection. Prostate infection is rarely serious, but if you have symptoms of prostatitis, see your doctor. Possible symptoms include:

• Pain urinating or ejaculating
• Fever and chills
• Pelvic pain
• Needing to urinate more often
• Cloudy urine

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.

How Can I Prevent Prostate Problems?

In some ways, prostate problems, particularly BPH, are a natural part of growing older. Still, there are specific steps you can take to keep your prostate healthy.

• A diet low in saturated fat and high in fruits and vegetables may lower your risk of developing BPH. Research is ongoing to identify who might benefit from early treatment to prevent BPH.
• According to the American Cancer Society, most cases of prostate cancer can't be prevented. This is because prostate cancer's causes are still unknown. As with BPH, however, experts recommend eating a healthy diet with lots of fruits and vegetables.
• No herbal supplements have been proven to prevent prostate cancer. Studies of selenium, a mineral, have had mixed results, but the majority of the evidence shows no real benefit. Trials for drugs to prevent prostate cancer are also ongoing.
• No activity or drug is known to prevent prostatitis. Experts recommend good hygiene, including keeping the penis clean. Most men will never develop prostatitis.

How Are Prostate Problems Treated?

Treatment depends on which kind of prostate problem you develop.

Benign prostatic hyperplasia needs treatment only if the urinary symptoms become bothersome. BPH often responds to drugs that either:

• Relieve the tension around the urethra (Cardura, Flomax, Hytrin, and Uroxatral)
• Reduce the size of the prostate itself (Avodart and Proscar)

The FDA is revising labels on several BPH drugs -- Proscar, Avodart, and Jalyn (a combination of Flomax and Avodart) -- to include a warning that the drugs may be linked to an increased risk of prostate cancer.

If medication does not relieve the symptoms, surgery may be required. Several herbs showed promise as treatment for BPH in some studies, but results are incomplete or conflicting. These include saw palmetto, beta-sitosterol, and Pygeum africanum.

Prostate cancer treatment is complex. When designing a prostate cancer treatment plan, doctors consider a man's age, overall health, and how aggressive or widespread the prostate cancer is. All men's cancer is unique, and their treatment will be unique. Some treatment options include:

• No treatment (watchful waiting)
• Surgery
• Radiation (either external-beam or implantable "seeds")
• Chemotherapy
• Active surveillance
• A combination of these

Prostatitis is usually a bacterial infection. Prostatitis is most often treated with antibiotics, usually for at least four weeks.

Should I Be Screened for Prostate Cancer?

Prostate cancer screening is controversial. Some doctors and organizations recommend regular screening while others don't.

The American Cancer Society says men should talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested. The group's guidelines make it clear that prostate- specific antigen (PSA) blood testing should not occur unless this discussion happens. The discussion about screening should start at age 50 for most men with average risk for prostate cancer and earlier for men at higher risk.

The American Urological Association recommends that men ages 55 to 69 who are considering screening should talk with their doctors about the risks and benefits of testing and proceed based on their personal values and preferences. The group also adds:

• PSA screening in men under age 40 is not recommended.
• Routine screening in men between ages 40 and 54 at average risk is not recommended.
• To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have decided on screening after a discussion with their doctor. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over diagnosis and false positives.
• Routine PSA screening is not recommended in men over age 70 or any man with less than a 10-15 year life expectancy.

The U.S. Preventive Services Task Force, however, doesn't recommend routine PSA screening for men in the general population, regardless of age. They say the tests may find cancers that are so slow-growing that medical treatments -- which can have serious side effects -- would offer no benefit.

If prostate cancer screening is done, it involves a blood test and possibly a prostate exam by your doctor. Whether or not you test is something you and your doctor must decide together.

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