What Is The Prostate?
The prostate is a small gland about the size of a walnut which is a part of male reproductive system that produces fluids that protects and provides nutrients to sperm.
The prostate surrounds part of the urethra which is located in between the base of the penis and the rectum and sits deep inside the groin. Thus, all urine and semen flowing through the urethra will pass through the prostate.
Does the prostate change with age?
Yes, it grows larger as you get older. If the prostate gets too large, it may squeeze the urethra and cause problems in passing urine and other symptoms.
It happens even to men as young as 30s to have these urinary symptoms which may require medical attention. For some, symptoms may not even appear until much later in life.
Prostate disease
The risk of prostate problems rises as you grow older. Besides ageing, infection or a tumour can also increase the size of the prostate. It is also important for you to know that it is possible for you to have more than one condition at the same time. Here are the examples of non-cancer prostate problems:
1) Benign prostatic hyperplasia or BPH
2) Prostatitis
Benign Prostatic Hyperplasia
It’s a non-cancerous enlargement of the prostate gland. BPH affects men 50% before the age of 50 and more than 75% over the age of 60. Symptoms include :
- Difficulties urinating,
- An urge to urinate even when the bladder is empty (urgency),
- Frequent urination, especially at night
- Weak or intermittent stream
- Feeling of incomplete emptying of the bladder
- Dribbling of urine.
Prostatitis
It is an inflammation of the prostate that may result from a bacterial infection or others. It affects at least half of all men at some time during their lives. It can occur in any prostate whether small or enlarged and may affect men of any age. You should see a doctor if you have one or more of these symptoms:
- Frequency (urge to pass urine, even when there is only a small amount of urine)
- Urinary retention (inability to urinate)
- Burning pain when passing urine (dysuria)
- Urinary hesitancy (trouble starting to urinate or maintaining urine flow)
- Dribbling at the end of urination post-void dribbling)
- Unable to empty your bladder completely
- Blood in urine
- Fever, or body aches
- Pain in your penis or scrotum
- Loss of sex drive
- Painful ejaculation/climax (orgasmalgia)
Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. Thus several tests can be done to get the right diagnosis.
Next read: Prostatitis
Types of Prostatitis
- Acute bacterial prostatitis: The symptoms will come sudden onset such as severe chills, fever with blood in the urine which is usually caused by a bacterial infection. In most cases, it can be cured with CIPROFLOXACIN/MOXIFLOXACIN daily for 2-4 weeks.
- Chronic bacterial prostatitis: Recurrent infection that comes back repeatedly and hard to treat and requires antibiotic treatment over a longer period of time up to 12 weeks.
- Chronic prostatitis or chronic pelvic pain syndrome: This disorder is the most common type of prostatitis. It could occur at any age from late teens to the elderly, and its symptoms include pain or discomfort in the groin or bladder area and can come and go without warning.
- Asymptomatic inflammatory prostatitis: You don’t have symptoms with this condition. If you have this form of prostatitis, your PSA test may show a higher number than normal. Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.
Prostate cancer
Prostate cancer occurs when abnormal cells in the prostate gland grow more quickly and form a malignant tumour. However, most prostate cancers grow slower than other types of cancer.
Men are at higher risk for prostate cancer if you have a strong family history of prostate or breast cancer, those who are obese and older age group.
What are tests that can be done to confirm if you have a prostate problem?
In the clinic, there are a few other things that can be done after we take your medical and family history which include :
- A physical exam, including a digital rectal exam of your prostate
- Other tests :-
- Urine test : to look for signs of infection.
- Blood test: to look for signs of infection and serum PSA level.
- Ultrasound : The pictures can show the size and shape of your prostate.
- If required, we will refer you to a tertiary centre for :
- Urodynamic tests: The tests can show signs of blockage in your urethra due to prostate enlargement.
- Cystoscopy: to see blockage in urethra and problems in the bladder.
- Prostate biopsy : is a test that involves taking small pieces of tissue from your prostate to look at with a microscope.
Prostate Cancer Screening
Primarily, men who are above 50 are at average risk of prostate cancer. Most prostate cancer cases in Malaysia were discovered after the age of 65 (late age in men). 60% out of all these cases were detected already at late stages (Stage 3 & 4).
Thus, early detection of prostate cancer is easier to treat when it is less likely to have spread. There is one test which is specific for prostate problems and prostate cancer called serum prostate screening antigen(PSA) test.
Serum PSA test
In men who report prostate symptoms, PSA testing (along with digital rectal examination) can help determine the nature of the problem. The blood level of PSA is often elevated in men with prostate cancer. The PSA test also can be used to see if the cancer has come back in men who have been treated for prostate cancer. However, yearly PSA testing in men without symptoms is generally not recommended.
FREE PSA TEST
The free PSA test is used for men who have higher PSA levels. The standard serum PSA test measures total PSA, which includes both PSA that is attached to other proteins and PSA that is free in the blood. This free PSA test measures free PSA only. The percentage of free PSA can help determine the specific prostate conditions. Free PSA is linked to benign prostate conditions (example BPH) whereas attached PSA is linked to cancer.
- If the total PSA is high and the free PSA is also high (high percentage of free PSA), this suggests BPH rather than cancer.
- If total PSA is high but the free PSA is low (lower percentage of free PSA), cancer is more likely. More testing will be required such as a biopsy.
What are the treatment options for prostate problems?
Treatment depends on the type of prostate problem you have.
Prostatitis
Treatment depends on the type of prostatitis.
- Chronic prostatitis. Warm baths, relaxation exercises, and physical therapy may help in reducing the symptoms. A medicine called an alpha-blocker such as Tamsulosin or Silodosin can be used to relax the muscles in your prostate and part of your bladder this in turn lessen pain, discomfort, and inflammation. In addition, electroshockwave therapy can also be helpful in treatment of chronic prostatitis.
- Bacterial prostatitis. If you have bacterial prostatitis, you will need an antibiotic, a medicine that kills bacteria such as MOXIFLOXACIN or CIPROFLOXACIN for 2-4 weeks depending on its severity. As part of treatment, you might need to drink more liquids to help cleanse the bacteria.
Benign Prostatic Hyperplasia
Treatments for BPH include
- Watchful waiting: If your symptoms don’t bother you too much, you may choose to live with them rather than take medicines or have surgery. However, regular follow-ups are still needed to make sure your condition isn’t getting worse.
- Lifestyle changes : Your symptoms may get better if you
- Drink fewer liquids before going out or before going to sleep
- Avoid or reduce caffeine or alcohol intake
- Healthy lifestyle
- Medicines : We may prescribe you with finasteride (Proscar). These medicines can stop prostate enlargement men. Tadalafil (Cialis) can also help relax the prostate and bladder muscles and Alpha-blockers like Tamsulosin might be added in some cases to improve your symptoms.
- Surgery : In some cases, we may recommend removing your prostate and this has to be done in a tertiary centre
