Prostate Gland: Enlarged Symptoms, Cancer & Treatments
Author: Donald Saunders
Published: 2010-07-21 : (Rev. 2015-10-30)
Synopsis and Key Points:
Information on the male prostate gland including enlargement and prostate cancer.
The vast majority of men will suffer from prostate problems at some stage during their lives and all too many men will die from prostate cancer.
Indeed, with the sole exception of skin cancer, prostate cancer or prostatitis kills more men than any other form of cancer. It may come as something of a surprise to learn therefore that, although things are beginning to change slowly, most men have little or no idea about just what this very important part of our anatomy does.
The prostate gland is located in the lower abdomen and sits just below the bladder and between the pubic bone and the rectum. A healthy prostate is roughly the size of a walnut and weighs about one ounce in a fully grown man. One important point to note is that the prostate gland is shaped something like a donut and partially surrounds the urethra, which is the tube that carries urine from the bladder to the penis and on out of the body.
The prostate gland has a very important role to play as one part of the male reproductive system. Attached to the prostate are a number of seminal vesicles which produce a protein and this is then mixed with a clear liquid produced by the prostate, and referred to as prostatic fluid, to form the male semen. Sperm produced in the testes are carried through connecting tubes to the prostate and are then mixed with the seminal fluid before being ejaculated during orgasm through ejaculatory ducts which are connected to the urethra.
The prostate gland grows rapidly during puberty and is essentially fully formed in most men by about the age of twenty five.
However, at this stage it does not stop growing as you might imagine but continues growing very slowly throughout the remainder of your life. Later in life however, and typically at some point after the age of about forty-five, hormonal changes which are part of the normal aging process can result in a slight 'speeding up' in the growth of the prostate gland.
As a result, once you pass the age of forty-five you begin to run the risk of your now enlarging prostate beginning to cause a series of problems. For most men sufficient enlargement to cause symptoms does not occur until after the age of sixty and some men will never experience a problem at all. Nevertheless, all men are at risk of developing problems after the age of about forty-five.
The first signs of a problem are normally seen when urinating as, because the prostate gland partially surrounds the urethra, its enlargement slowly starts to pinch and thus narrow the urethra interfering with the free flow of urine out of the body. As the prostate continues to grow and enlarge further so it squeezes more and more on the urethra and urinary problems worsen over time.
This enlargement is simply a normal part of the aging process and for most men the problems which it causes are nothing more than a nuisance and do not require treatment. For other men however urinary problems will become sufficiently annoying to warrant treatment and there are several treatment options available today. Overall though this problem is really nothing to worry about and is certainly not a life-threatening condition.
The real problem however lies in the fact that, alongside this normal growth, you may well also be developing prostate cancer and one reason why this remains such a killer today is that most men are unaware of a developing cancer and simply put any symptoms down to normal prostate enlargement.
Unfortunately there is no way to tell whether or not you have a developing prostate cancer without being medically tested for the condition and so, prostate problems should never simply be ignored and, at the first sign of any difficulty, you should consult your physician.
Spotting Developing Prostate Problems
For most men passing the age of forty-five is not only a sign of the dreaded 'middle' age but is also the point at which they might well expect to see the arrival of prostate problems at any day. Enlargement of the prostate (also referred to as benign prostatic hypertrophy, or BPH) is a normal part of the aging process and, as its name suggests, it is not a life-threatening condition.
In the vast majority of cases the symptoms of an enlarged prostate will be relatively mild and, although most men are aware of them, they simply choose to live with them as something of a nuisance and merely a sign of getting old. In some cases however symptoms can be become more than a simple nuisance and then you will need to consult your physician and seek one of the many different treatments available today.
The prostate gland, which is an important part of the male reproductive system, partly surrounds the urethra, which is the tube that caries urine out of the body from the bladder. This means that, as the prostate grows it will start to press on the urethra gradually narrowing it and interfering with the normal flow of urine. It is here therefore that the first signs of a problem usually become evident.
It is common for example to begin to experience difficulty in starting the flow of urine and this will be seen as a need to strain in order to start passing water. Once the flow of urine does start it may be weak and tend to stop and start. You may well also experience a dribbling or urine after you have finished and will often feel that you have not emptied your bladder.
It is also very common for people with an enlarged prostate to visit the bathroom more frequently and often with a sense of urgency, feeling that you can no longer 'hold on' as you used to do. Many men also find that they increasingly have to get up during the night to visit the bathroom.
Interference with the process of emptying the bladder can also lead in some men to an increased risk of urinary track infection and this is often felt as a burning sensation when urinating. In these cases you should always seek treatment from your physician or an urologist.
But should you consult your doctor when the symptoms of an enlarged prostate start to appear or, since it is simply a part of the normal aging process, ignore it unless it becomes too much of a nuisance
The simple answer is that you should always consult your physician for two reasons. The first is that prostate enlargement can lead to other problems such as damage to the bladder and kidneys which can be serious. The second is that, in addition to an enlarged prostate, many men will also develop prostate cancer and the symptoms of an enlarged prostate may well mask this until the cancer is too far advanced to treat it effectively.
About one in six men will contract prostate cancer and well over ninety percent of these cases can be effectively treated if they are caught early enough. See how to keep a healthy prostate.
Is Prostate Specific Antigen (PSA) Testing For Prostate Cancer Worthwhile
Many people will have heard of the prostate specific antigen test (or more commonly PSA test) for prostate cancer, but do you know just what it is and whether or not it is something which you should consider having
The PSA test was considered a major breakthrough when it was approved for use by the FDA in the mid 1980s and today it remains one of the best tests available for detecting the possible presence of prostate cancer.
PSA testing is quick and easy as it is a simple blood test looking for the presence in the blood of a specific protein produced by the prostate gland. In a normal prostate gland the quantity of this protein produces a level in the blood of about 4 nanograms per milliliter and this is assigned a normal PSA score of 4. As with most things of course this level will vary from one individual to another and so a slightly higher or lower level is not necessarily an indication of a problem and many men will have a normal PSA score of as high as 8 or 9.
In the presence of cancer production of this protein rises and, as the cancer progresses, so the level of the prostate specific protein in the blood increases. Accordingly, once a PSA score reaches 10 your doctor will want to monitor PSA levels carefully as this is an initial indicator of a possible developing problem. If your PSA score continues to rise then additional and more specific tests will normally be recommended. As an indicator, a PSA score of 50 is considered to be very high and the level at which not only is the presence of cancer very likely, but such cancer will probably have already spread beyond the prostate gland itself.
Prostate specific antigens appear in two forms within the blood. In the first form antigens attach themselves to the blood proteins, while in the other the antigens are simply free floating. Today it is possible to test for both by measuring the total amount of PSA in the blood and by measuring only free PSA in the blood. Being able to separate out the two different forms of PSA is thought by many doctors to produce a more accurate test and in a study published in the Journal of the American Medical Association in 1995 it was said that the ability to measure free PSA had led to a twenty percent fall in the number of unnecessary follow-up tests following PSA tests.
Perhaps the biggest controversy today is not over whether men should undergo regular (annual) PSA testing which almost all physicians today recommend, but at what age such testing should begin.
Both The American Cancer Society and The American Urological Association recommend testing for all men over the age of 50 and testing for men in 'at risk' categories from the age of 40 onwards. There are several 'at risk' categories, the most important of which is men with a family history of prostate cancer.
Unfortunately, these recommendations probably have more to do with resources and cost than with anything else and it is not uncommon for men to develop prostate cancer in their forties, or even in their thirties. So, where do we go from here
Well, this must of course be a personal decision but an increasing number of men are now asking to be tested at quite young ages (typically when they reach 40) to provide a benchmark and then decide on the frequency of follow-up testing depending on their initial result. For example, if a 40 year old man has a normal initial PSA score of 4 then he may decide to leave further testing for 2 or 3 years. However, if his initial test score comes in at 8, he may decide to have a follow-up after six months and, if it remains the same or has fallen, to then have tests annually.
When you start testing and how often you have follow-up testing is very much a personal decision to be taken in consultation with your physician. What is important is that every man should be tested regularly and you should not put off testing for too long.
Testing For The Presence Of Prostate Cancer
About one in every six men will develop prostate cancer which, apart from skin cancer, is the number one cause of cancer deaths in men. For this reason it is vitally important for men to monitor the health of their prostate with regular testing. Some of the prostate health tests available today include:
The Digital Rectal Exam (DRE)The digital rectal exam has been the benchmark of testing for both benign prostate enlargement and prostate cancer for many years and is a simple examination in which your physician can feel the prostate gland with a gloved finger to assess its size and condition.
The Prostate Specific Antigen (PSA) TestThe PSA blood test was approved for use by the FDA in the mid 1980s and is now widely in use. This test looks for the presence of a prostate specific protein in the blood and it is recommended that all men over the age of 50, together with 'at risk' men over the age of 40, have an annual PSA test.
Urine TestingUrine testing can not only check for diabetes and liver and kidney disease but can also check the condition of the prostate by looking for signs of infection in the blood.
Hyperplasia Intrvenouspyelogram (IVP)This test is a form of x-ray examination in which a dye is injected into the bloodstream and monitored as it passes through the body's vital organs. As far as the prostate is concerned this test follows the flow through the kidneys, bladder and ureter tubes which drain the kidneys and thus looks for any possible restriction caused by an enlargement of the prostate gland interfering with the flow or urine out of the bladder.
Bladder UltrasoundThis simple non-invasive procedure which can be carried out in the doctor's office can detect whether or not the bladder is emptying fully following urination and thus whether or not an enlarged prostate is narrowing the urethra.
Prostate UltrasoundA prostate ultrasound is useful for estimating the size of the prostate gland and is also important if further testing using a biopsy is recommended.
UroflowA uroflow is another very simple test in which the patient urinates into a container and the strength of the flow of urine is measured.
CystoscopyA cystoscopy allows the doctor to make a visual examination of the urethra and the bladder using an instrument which is inserted through the urethra.
In general your doctor will normally recommend PSA screening and will also usually carry out a digital rectal examination as these two tests together are without doubt the best way to detect the presence of possible prostate cancer or of other developing prostate problems. One or more or the other tests mentioned here (or indeed several which we have not listed) may also be ordered but, at the end of the day, the only sure way to confirm the presence of prostate cancer is by carrying out a biopsy.
A prostate cancer biopsy take a number of very small tissue samples from different areas of the prostate for microscopic examination and can not only definitively confirm the presence of prostate cancer, but can also give an indication of the size and type of any cancer.
A Biopsy Is The Only Certain Way To Diagnose Prostate Cancer
Although there are a number of excellent tests to indicate the possible presence of prostate cancer, such as the digital rectal examination and the prostate specific antigen (PSA) blood test, the only certain way to diagnose the presence of prostate cancer is to carry out a prostate biopsy.
A biopsy will normally be conducted by a urologist and can be done as an 'office' procedure. There are various different ways in which a biopsy can be taken but it is common to start by taking a trans-rectal ultrasound. Here an instrument is inserted through the rectum and sound waves are used to produce a computer image of the prostate gland. With this image to hand the doctor can then use a hollow needle to take several small samples of tissue from the prostate for examination under the microscope. Most patients would say that the biopsy is not an especially painful procedure, but you will probably feel a stinging sensation.
The areas from which samples are taken, and the number of samples removed for testing, will depend upon the reason for the biopsy. For example, if the biopsy is simply in response to rising PSA levels then half a dozen or more samples may be taken from different areas of the prostate. However, if the biopsy is being done to examine a particular abnormal area of the prostate then only two or three samples may be collected.
Once the samples have been collected they will be examined by a pathologist. Normal prostate cells are typically of a standard size and neatly arranged in a recognizable pattern. However, prostate cancer cells normally vary in size and are irregular in shape.
If the pathologist determines that cancer is present then he will go on to grade the cancer to indicate whether it is a low grade cancer which is likely to be slow growing, or a high grade cancer which may well be aggressive and spread quickly.
In 1977 the pathologist Donald Gleason devised a scale for categorizing prostate cancer and this scale is now widely used today. The Gleason scale ranges from 1 to 5 (with 1 representing a low grade cancer and 5 a high grade cancer) and a grade is assigned to each of two samples from the largest areas of cancer with the grades being added together to produce a final Gleason score.
A Gleason score of 2 to 4 is considered to be low and indicates a cancer which, depending on the age of the patient, may now pose a significant threat during the patient's lifetime. A score of between 5 and 7 is an intermediate grade for which treatment can often halt the disease in its tracks. Once a Gleason score reaches 8 the cancer is said to be aggressive and is likely to spread outside of the prostate gland, if indeed it has not already done so.
Testing for the possible presence of prostate cancer is recommended for all men over the age of 50 and for those men over the age of 40 who fall into a high risk category. It is important however that once prostate cancer is suspected a biopsy is carried out to confirm its presence so that treatment can be given.
ProstateProblemCenter.com provides detailed information about the prostate gland including just what a prostate exam entails and information on a wide range of prostate problems and their solutions, including the therapeutic use of prostate milking.
- 1 - Male Prostate Exam: PSA, DRE and PVR Tests : Dr. David Samadi (2015/10/30)
- 2 - Genetic Testing Identifies Males at Risk of Prostate Cancer : Institute of Cancer Research (2014/09/15)
- 3 - Digital Rectal Exam Vs. PSA Test For Prostate Cancer : Dr. David Samadi Prostate Cancer Center (2016/09/27)
- 4 - Urine Test for Prostate Cancer : RoboticOncology.com (2011/08/14)
- 5 - Prostate MRI Reveals More Treatable Cancers and Reduces Overdiagnosis : European Association of Urology (2018/03/19)
- 6 - Male Prostate Specific Antigen (PSA) Levels and Chart : Disabled World (2015/02/14)
- 7 - Noscapine for Prostate Cancer : MedInsight Research Institute (2010/03/19)
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