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Prostate Health
Arnold C. Cinman, MD, FACS Fifty to sixty percent of men between the ages of 40 and 60 will develop an enlarged prostate gland, a condition known as benign prostatic hyperplasia (BPH). The U.S. National Institute of Health claims that "more than 80 percent of adult males 50-60 years of age have benign enlargement of the prostate gland," and at least 10 per cent of them will require treatment. Cancer of the prostate causes 42,000 deaths annually in the United States, equivalent to approximately 2-3% of all male deaths. Thousands more suffer from either acute or chronic prostatitis. Prostate problems often cause great frustration, as well as disruption of normal activities, and contribute to several billion dollars a year in health care costs. Although most men anticipate prostate troubles with aging, they are by no means inevitable. Prostate Anatomy and Physiology The walnut-size prostate gland, consisting of three main lobes, lies beneath the bladder surrounding the urethra like a collar. It secretes a thin, milky, alkaline fluid containing substances which neutralize bacteria, citric acid, calcium, acid phosphate, fructose, zinc, enzymes such as prostate specific antigen (PSA) and prostaglandins. The prostatic fluid is normally ejaculated in the first contraction of orgasm, before the bulk of the seminal fluid, to enhance sperm motility and fertility. It also possibly prepares the cervix to receive the sperm by causing slight dilation and provides a more alkaline environment necessary for fertilization. The prostate grows under the influence of testosterone following puberty until production begins to dwindle around the age of forty. By the age of fifty, the conversion of testosterone to dihydrotestosterone (DHT) increases, thought to cause enlargement of the gland. As the enlargement progresses, the prostate pressure squeezes the urethra, causing obstruction of urine flow. Damage to the kidneys, bladder and ureters, as well as infection from residual urine, may occur when the flow backs up. The most common problems associated with the prostate are BPH, prostatitis and cancer. Men over 40 should receive yearly examinations of the prostate, including a digital rectal examination (DRE), a blood test for prostate specific antigen (PSA), urinalysis and other tests (such as ultrasound), if indicated Common Symptoms of BPH Most men know the symptoms of BPH: progressive urinary frequency; urgency, especially at night; hesitancy or lack of control in passage of urine; difficulty in cessation of passage of urine (terminal dribbling); reduced force of urine stream; enlarged non-tender, non-lumpy prostate; possible presence of blood in urine with prolonged obstruction; associated infection of bladder due to stagnant urine (retention); discomfort in lower back or legs when urinating; and possible sexual problems due to urethral obstruction. BPH normally occurs in men over 50. Conventional treatment includes partial removal of the gland, called transurethral resection (TUR or TURP); or pills that either relax the muscles around the urethra and bladder neck (alpha-blockers e.g. Hytrin or Cardura) or block 5-alpha reductase, the enzyme which converts testosterone to DHT (Proscar). Prostatitis Prostatitis refers to infection, inflammation or pain in the prostate. In contrast to BPH, prostatitis usually occur in younger men between 20 and 50 and can be acute or chronic. Bacteria or chlamydia occasionally are found to cause the condition, although autoimmune disorders may also play a part. Symptoms include difficulty, frequency and urgency with a burning sensation or pain during urination, and a discharge from the penis after bowel movements. Untreated prostatitis may lead to bladder outlet obstruction and prostatic stones. Conventional treatment calls for antibiotics and anti-inflammatory drugs. Prostate Cancer This is the most common male cancer in the USA today. At least 80 percent are discovered early when the condition is curable largely due to the PSA blood test. However, if not detected early, spread to the bones or the lymph nodes can occur. Prostate cancer most commonly strikes males over 50 years of age, and may not reveal itself through symptoms until metastasis occurs. Genetics, hormonal factors, high fat diets seem to be associated with prostate cancer. Most physicians select surgery as the treatment of choice for prostate cancer, along with radiation and hormone manipulation. Preventive and Nutritional Support Any condition of the prostate needs attention by a qualified health practitioner. However, the patient must assume responsibility for his nutritional status, since poor nutritional status may significantly and adversely affect the prostate gland. Cultures that consume high-fat diets, particularly with high red meal content, have higher rates of prostate cancer. Decreasing sugar consumption contributes to lower prostate cancer rates. Therefore, preventive measures should emphasize a low-fat, low-sugar and high-fiber diet The patient should also avoid excess caffeine, alcohol and spicy foods as they deplete the prostate of vital nutrients and lower immune function. At Tower Urology we are proud to have a nutritionist (Stacy Macris) "in house", who can give expert advice on diet. |
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What is Urology?