Prostate Disease Treatment

What is prostate disease?

man consulting doctor with clipboard

The prostate gland is about the size of a walnut and located in a man’s pelvic area. The function of the prostate gland is to produce fluids and suspend the sperm during ejaculation. The fluid produced by the prostate gland contains proteins and nutrients that nourishes the sperm and makes up about one-third of the semen volume.

One type of prostate disease is benign prostatic hyperplasia (BPH). Benign prostatic hyperplasia occurs when the prostate gland is enlarged, causing problems with urination. Benign prostatic hyperplasia generally occurs more frequently in older men; in one study, the prevalence of benign prostatic hyperplasia was only 8% in men aged 31 to 40 years, 40 to 50% in men aged 51 to 60 years, and to over 80% in men older than 80 years.¹

It is not clear what causes benign prostatic hyperplasia, but we do know hormone levels (e.g. testosterone and estrogen) and inflammation contributes to benign prostatic hyperplasia.

Another type of prostate disease is prostatitis. Prostatitis occurs when there is inflammation in the prostate gland, most likely from a bacterial infection.

What are the symptoms of prostate disease?

image of male urological system

Benign prostatic hyperplasia can cause problems with urination and symptoms are divided as either a storage or voiding problem.²

1) Storage symptoms – frequent need to urinate during daytime, overnight urination, and urinary incontinence

2) Voiding symptoms – slow urinary stream, splitting or spraying or urinary stream, intermittent urinary stream, hesitancy, straining to void, and dribbling of urine.

Prostatitis presents differently in that it is usually acute, meaning the symptoms are all of the sudden whereas benign prostatic hyperplasia is more gradual and slow. Symptoms of prostatitis include fever, tiredness, muscle pain, irritation during urination, pelvic pain, or cloudy urine.

What are the risk factors for prostate disease?

The following are risk factors for benign prostatic hyperplasia:

· Race-benign prostatic hyperplasia is less common among Asian men compared with white and black men³
· Family history
· Alcohol consumption may paradoxically reduce your risk of benign prostatic hyperplasia.⁴

Prostatitis occurs because of a bacterial infection of the prostate gland and the biggest risk factor is the use of bladder catheters.

Enquire with our urologists.

Did you know?

One of the interesting hypotheses to the cause of benign prostatic hyperplasia is that the cells in the prostate gland revert back to an embryonic-like state (think of these as stem cells). These embryonic-like prostatic cells are unusually sensitive to hormones in the body and in response, these prostatic cells grow, causing the abnormally enlarged prostate gland.⁵

What are the possible complications of prostate disease?

doctor speaking to a male patient in office

Untreated benign prostatic hyperplasia may cause problems with a man’s urinary tract system. These complications include urinary retention, urinary tract infection, blockage of urinary tubes (called hydronephrosis), and even kidney failure.

Untreated prostatitis can be a serious condition. The bacteria from the prostate gland can spread to other parts of the body, which can potentially be life-threatening.

When should I see a specialist for prostate disease?

Your urologist is an expert is diagnosing and managing various prostate diseases. If you have any of the symptoms listed above, you should ask your urologist. Prostate disease like benign prostatic hyperplasia is also more common as a man ages. Routine assessment of a healthy prostate gland can also be performed by your urologist to ensure there are no issues.

How should I prepare for my appointment?

Whether you have an appointment to see your urologist for an initial appointment or follow-up, you should always prepare a list of question ahead of time. Bring all your relevant medical documents and a list of your current medications.

If you require a surgical procedure called transurethral resection of the prostate (TURP), which will be discussed in a later section, your urologist will have an appointment with you prior to your surgery. You may be required to have some blood tests and ultrasound done before your surgery. You may also be given some antibiotics prior to your surgery. Ensure you understand the procedure and ask your urologist any questions.

How do specialists screen for and diagnose prostate disease?

The diagnosis of benign prostatic hyperplasia is subjective and based on your urologist’s findings and physical examination. There are no laboratory tests required to screen and diagnose for benign prostatic hyperplasia. Laboratory tests (such as urine sample or prostate-specific antigen) are only required to differentiate benign prostatic hyperplasia from other prostate disease such as urinary tract infection or prostate cancer.

Your urologist may provide you with a questionnaire to screen and diagnose benign prostatic hyperplasia. Your urologist may also conduct a physical exam called the digital rectal exam to assess the size and consistency of your prostate gland.

The diagnosis of prostatitis is a combination of symptoms and laboratory results. Your urologist will be conducting a digital rectal exam to feel out any tender areas of the prostate, which is suggestive of prostatitis. A urine sample will also be collected to identify the type of bacteria that is affecting the prostate gland.

What treatments are available for prostate disease?

The treatment of benign prostatic hyperplasia usually begins with behavioral management. Examples of behavioral management include avoiding fluids prior to bedtime and avoiding diuretics such as caffeine or alcohol. If symptoms remain after behavioral management, your urologist may prescribe a medication to help manage your symptoms. There are two classes of medications to manage benign prostatic hyperplasia:

1) Alpha-1-adrenergic blockers – These medications work by relaxing the muscles around the bladder and prostate gland to relief some of the urinary symptoms. The main side effect with these medications is low blood pressure. These medications are effective and work relatively quickly.

2) 5-alpha-reductase blockers – These medications work by lowering the testosterone levels in a man’s body. Testosterone is one of the hormones that contribute to benign prostatic hyperplasia and by lowering its level, it is effective in reducing the overall size of the prostate gland. The main side effect with these mediations is erectile dysfunction. These medications work slower than the alpha-1-adrenergic blockers and take 6 to 12 months to realize benefit.

In severe benign prostatic hyperplasia cases, a surgical procedure called transurethral resection of the prostate (TURP) may be done. This is a surgical procedure that removes part of the prostate gland to reduce its size.

The treatment of prostatitis is primarily with antibiotics. The specific class of antibiotic will depend on results from the urine culture.

Request an appointment with an urologist today.

References:

1 Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate. 1990;17:241.

2 Egan KB. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am. 2016;43:289.

3 Kang D, Andriole GL, Van De Vooren RC, et al. Risk behaviours and benign prostatic hyperplasia. BJU Int. 2004; 93:1241.

4 Crispo A, Talamini R, Gallus S, et al. Alcohol and the risk of prostate cancer and benign prostatic hyperplasia. Urology. 2004; 64:717.

5 Cunha GR, Donjacour AA, Cooke PS, et al. The endocrinology and developmental biology of the prostate. Endocr Rev. 1987; 8:338.