Areas Of Expertise :: Prostate Health

Male Health

Whether or Not You Have Symptoms...

You might think you don't need to be examined because you're young and you feel fine. But you can develop prostate cancer as early as age 40. You nay not have symptoms or you may be so used to symptoms, like having to urinate frequently at night, that they seem normal. You might also be reluctant to speak with your doctor about this personal subject because it makes you feel uncomfortable.

Learning about prostate anatomy can help you better understand how health problems develop. Having a medical evaluation can provide the information your doctor needs to make a diagnosis. Following through with your prostate care can help ensure that you live a health lifestyle.

Learning about where your prostate is located and about age-related changes can help clarify why it may cause a variety of problems ranging from mild to serious, and cause symptoms related to urination. It can also help you understand why you should have an annual screening for prostate cancer, whether or not your're experiencing symptoms.

Prostate Anatomy

Your prostate is located between the pubic bone and rectum. About the size and shape of a walnut, your prostate is a gland that produces a portion of the fluid in which sperm travel. Your prostate surrounds the upper portion of the urethra, the tube that carries urine out of the bladder.

The prostate is found underneath the bladder surrounding the urethra, behind the pubic bone and in front of the rectum. The prostate encircles the urethra tube which can be constricted if it enlarges. The prostate is a gland and consists of many small tubes that produce most of the seminal fluid. A capsule containing muscle fibers surround the prostate and aid in ejaculation. These muscle fibers are controlled by the sympathetic nervous system and may be affected by certain drugs called alpha-blockers (Hytrin, Cardura and Flomax). The prostate rests on the sphincter muscle which maintains urine control. Behind the prostate are two small sacs(the seminal vesicles) which store sperm cells from the testicles. These sacs connect to the urethra by passing through the prostate gland. Directly behind the prostate a number of tiny nerve fibers conduct signals to and from the penis and regulate erections

Function (what does it do?)

The prostate is a gland which produces about 90% of the seminal fluid. Sperm cells require this fluid to survive and they mix with the prostatic fluid at the time of ejaculation. After a vasectomy, semen does not look any different than before because the volume of the total amount of sperm cells is small. A small sphincter (valve) is situated between the bladder and prostate compressing the urethra to prevent the semen going 'the wrong way' (into the bladder). At birth, the prostate is very small. The male sex-hormone (testosterone) induces growth of the prostate during puberty. The prostate continues to grow during later years due to enlargement of the glands as well as the muscle tissue within the prostate. If testosterone is not available in the body, for example after castration (as was common with eunuchs in Turkish harems) the prostate will not grow, or, if castration is done at a later age, it will shrink.

Function (what does it do?)

The prostate is a gland which produces about 90% of the seminal fluid. Sperm cells require this fluid to survive and they mix with the prostatic fluid at the time of ejaculation. After a vasectomy, semen does not look any different than before because the volume of the total amount of sperm cells is small. A small sphincter (valve) is situated between the bladder and prostate compressing the urethra to prevent the semen going 'the wrong way' (into the bladder). At birth, the prostate is very small. The male sex-hormone (testosterone) induces growth of the prostate during puberty. The prostate continues to grow during later years due to enlargement of the glands as well as the muscle tissue within the prostate. If testosterone is not available in the body, for example after castration (as was common with eunuchs in Turkish harems) the prostate will not grow, or, if castration is done at a later age, it will shrink.

Prostate Changes

In younger men, the prostate doesn't usually press on the urethra. Beginning at about age 40 to 45, your prostate enlarges normally as benign (non-cancerous) tumors develop inside it, a condition called benign prostatic hyperplasia or BPH. As your prostate enlarges it squeezes the urethra like a hand pinching a garden hose, so you may have trouble emptying your bladder. Your prostate can also become infected or inflamed (prostatitis), causing symptoms like a burning sensation while urinating. Most malignant (cancerous) tumors develop in theoutere protion of the prostate. Since they don't usually press on the urethra, they don't cause symptoms.

Disease, Signs and Symptoms (what can go wrong?)

Prostatitis (prostatic infection)
An inflammatory process occurring in the prostate because of an infecting bacterium or other non-infectious causes. Usually, prostatitis is a mild disease causing intermittent pain low in the abdomen, around the anus, in the groin, or in the back. There can also be some irritation when passing urine, visiting the toilet more often, difficulty in postponing that visit or a burning feeling during voiding. In some cases, bacteria can get into the vas deferens, causing groin pain or an infection of the epididymis. The prostate may swell, causing a less forceful urine stream. A prostatitis does not cause cancer of the prostate or damage to the kidneys.
Prostatodynia ('prostatic pain')
In some cases the prostate may be sensitive or painful, without an infection. Just like a sensitive stomach or a tension headache, pains during periods of high stress cause pain in the region of the prostate. It is thought that this is due to a 'spasming' of the pelvic muscles. At examination nothing wrong can be found with the bladder or prostate and no evidence of inflammation is present.
Prostate Enlargement
BPH (Benign Prostatic Hyperplasia). In a number of men, the prostate enlarges during later years. Why this happens is unknown but is thought to be related to changing levels of sex hormones in the body. An enlarged prostate does not always produce symptoms because the bladder muscle may compensate to overcome the constriction of the urethral channel The diminished flow occurs over a long period of time, so it often goes unnoticed. Moreover, a lot of men think that a restricted flow comes naturally with age. In time, the enlarged prostate starts irritating the bladder, causing some men to go to the toilet more often, and at night they have to get up several times to pass urine. At a certain point, the bladder may fail to overcome the prostate narrowing and will not be able to empty itself completely and eventually may develop complete retention. Infections, bleeding and back-pressure on the kidneys are more serious complications of BPH.
Prostate Cancer
It is unknown how prostate cancer develops, although testosterone is necessary for its existence. Prostate cancer is found more commonly in men with a family history of prostate cancer and also more commonly in the Western Hemisphere where a high animal fat diet may be responsible. Usually the cancer cells are found at a different location than BPtt, at the outskirts of the prostatic gland closest to the rectum. Of course, it is possible for a man to have both BPH and prostate cancer. In the early stages, prostate cancer causes little or no signs that it is there. Since the cancer usually develops at the outskirts of the prostate, it will only cause a diminished stream late in its course. Prostate cancer hardly ever causes pain whii st it is localized to the prostate; pain usually only arising when it has spread to other parts of the body. The cancer cells spread via the lymph channels or by way of the bloodstream, or both. When it spreads to the lymph nodes, the nodes near to the prostate enlarge and form the starting point for further spreading of the cancer cells throughout the body. The disease usually has a preference to spread to the bones although any site in the body may become involved.

Evaluating Your Prostate Health

No single exam or lab test can provide a complete picture of your prostate health. Your doctor starts with a history and physical exam to make preliminary diagnosis, then fills in the picture with lab tests. This evaluation tells your doctor whether or not additional tests need to be made. It also establishes a baseline of your proste health that your doctor can use as a guide for identifying any future changes.

Evaluating Your Prostate Health

Your doctor is likely to discuss your medical history with you. Answering questions about any history of genital or urinary disease in your family can help your doctor start to put the picture of your health in focus. Your doctor may also ask about any changes in your pattern of urinating.

Examinations (what can we check?)

A Transrectal Prostate Ultrasound (TRUS) is a good study to assess the size of the prostate. The internal anatomy as well as surrounding organs like the seminal vesicles and bladder can also be studied. The ultrasound probe is about the same size as the index finger, so the examination ought not to be painful. If abnormal areas in the prostate are seen, biopsies can be done though the ultrasound probe to obtain tissue for a Pathologist to examine. It is important to be covered with antibiotics as the biopsy is done through the bowel wall.

Cystoscopy means looking into the urethra and bladder using a small telescope. The size of the prostate can be judged, especially whether it is obstructing the urethra or not. An impression of the quality of the bladder muscles can also be made.

A CT or MRI Scan can be used to cut the body into thin slices obtain a clear definition of the prostate and surrounding structures. Although they are sensitive examinations, not all conditions of the prostate are seen.

A Bone Scan can determine if prostate cancer has spread to the skeleton. A radioactive substance is injected into the bloodstream via an arm vein, and will adhere to reactive cells in the bones, indicating a 'hot' spot which can be scanned by a special camera and photographed. This test cannot distinguish arthritis, old bone injuries or bone inflammation from cancerous lesions.

Digital Rectal Exam

A digital rectal exam (performed by inserting a finger into the rectum and feeling the prostate) is an important part of a yearly cancer evaluation for men over 40. Although the entire prostate can't be examined this way, this exam can detect a tumor on the side of the prostate where a tumor is most likely to occur. Whether your doctor asks you to kneel, lie down, or bend over during the exam, you can make yourself more comfortable by relaxing your muscles.

Lab Tests

Urinalysis: Certain substances in your urine can indicate whether you have a urinary tract problem. A sample from the beginning of your stream can give information about possible infection or inflammation of your urethra. A sample from the middle of your stream can provide information about your bladder and kidneys. A routine urinalysis may also show blood cells indicating a disease process of the prostate, however, these findings are not specific to the prostate.

Expressed Prostatic Secretions (EPS): Examination of the urine or the urethral fluid obtained after a rectal examination may show an elevated level of white cells in prostafitis.

Blood Tests: Abnormally high levels of certain substances in your blood can show if your kidneys have been affected by a problem with your prostate. An enlarged prostate can block the normal flow of urine. If urine backs up to the kidneys, they can't do their job as well.

Looking at the Results

If results indicate that your prostate is healthy, your doctor can use this information as a baseline to monitor changes that may occur in the future. If results indicate BPH or prostatitis, your doctor may suggest further tests or treatment options. And if cancer is suspected, additional diagnostic tests will be recommended.

Related Articles for Prostate Health
· The Silent Time Bomb - The Prostate · Eat Better for Your Prostate · Benign Prostatic Enlargement · How to Understand and Interpret Your PSA (Prostate Specific Antigen) · Microwave Thermotherapy - Rational Treatment for Prostate Enlargement · Prostate Cancer: Diagnostic and Treatment Services · Prostatitis

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