Benign enlargement of the prostate (BPH)

• Drug therapy
• Surgery (Transurethral resection of the prostate/ (TURP)
• Electrovaporization (Transurethral vaporization of the prostate/ TUVP)
• Laser therapy
• Microwave therapy
• Needle ablation therapy

Prostate disorder screening (PSA test)

PROSTATE GLAND ENLARGEMENT

The prostate is a walnut-shaped gland that forms part of the male reproductive system. It secretes fluid that helps transport the sperm. The prostate is located just below the bladder and surrounds the urethra, the tube that drains your bladder.

Often the gland enlarges as you age. That narrows the urethra, making it difficult to urinate. This is known as benign prostatic hyperplasia (BPH). More than half of men over 50, and 80 percent of men in their 70's experience prostate enlargement. Symptoms and signs include getting up at night to urinate, a weak urinary stream, a frequent urge to urinate, and a feeling that your bladder never completely empties.

Minor symptoms usually don't require treatment. But when your symptoms are moderate or severe, they interfere with your sleep or daily activities due to urine retention or bladder discomfort. Your doctor may advise treatment. Options include:

• Drug Therapy - There are two types, alpha blockers and prostate-growth suppressors. Alpha blockers relax smooth muscle tissue in your prostate and outlet of the bladder, making it easier to urinate. Proscar is a medication that shrinks the size of the prostate.
• Surgery - Standard treatment in an operation called transurethral resection of the prostate (TURP). A urologist passes a tube (resectoscope) through the urethra into the center of the gland, then scrapes away prostate tissue with it. Abdominal surgery is usually necessary only when your prostate is excessively enlarged.
• Electrovaporization - This is a modification of TURP. Electronic waves are applied through a device inserted into your urethra which vaporize prostatic tissue.
• Laser Therapy - A urologist inserts a laser fiber into your urethra. The laser heats and destroys prostate tissue, which you eliminate over time. It may take several weeks to a month to notice results.
• Microwave Therapy - The prostate microwave machine is known as the Prostatron. It microwaves energy to shrink prostate tissue. The Prostatron uses an antenna inserted through a catheter to apply microwave energy that heats and destroys cells deep within your prostate.
• Needle ablation therapy - This procedure uses high-frequency, high-intensity radio waves to destroy prostate tissue. It is performed much like laser and microwave therapy.

PROSTATITIS

Prostatitis is one of the most common reasons for visits to an urologist by men. Prostatitis symptoms include pelvic, lower back, and testicular discomfort. Men will often complain that when they sit, that it feels as if they are sitting on a golf ball. They may also complain of frequent, painful, and difficult urination, and/or painful ejaculation.

There are different types of prostatitis:

• Acute bacterial prostatis: This type presents with a sudden onset of fever with chills, lower back and perineal pain, and urinary frequency, burning and difficult urination sometimes leading to urinary retention. On physical examination, the prostate will be exquisitely tender to the touch. Urinalysis will reveal numerous inflammatory cells (white blood cells in the urine). For severe cases, treatment may require hospitalization. Otherwise, treatment can be done in the outpatient setting and of oral antibiotics and anti-inflammatory agents.
• Chronic Bacterial Prostatitis: This is a non-acute infection of the prostate. Patients present with irritative urinary symptoms and vague pelvic or lower back discomfort. Patients may also complain of pain during or following ejaculation. On physical examination, there is no fever and the prostate feels normal. Urinalysis is normal but will show inflammatory cells after prostate is massaged. Examination of the prostatic secretions under a microscope will show inflammatory cells. Treatment may require several months of antibiotics along with anti-inflammatory agents and sitz baths.
• Non-bacterial Prostatitis: The signs and symptoms are similar to those patients with chronic bacterial prostatitis except that documented urinary tract infections almost never occur in the former. Patients have abnormal numbers of inflammatory cells in their prostatic expresates, but no causative infectious agents can be found by culture or other means. Treatment consists of anti-inflammatory agents and sitz baths. Prostate smooth muscle relaxants may be of benefit.
• Prostatodynia (pelvic floor tension myalgia): The signs and symptoms of prostatodynia are similar to those of chronic bacterial prostatitis and non-bacterial prostatitis except that no inflammatory cells are seen in either the urinalysis or in the prostate exprestate. Unlike the other prostatitis categories, the symptoms are thought to be secondary to a contraction of the muscles of the pelvic rather than to actual inflammation of the prostate. Treatment recommendations may include anti-inflammatory medications and warm sitz baths. Prostate smooth muscle relaxants may also be of benefit.

PROSTATE DISORDER SCREENING (PSA TEST)

Prostate specific antigen (PSA) is a blood test for a protein that is produced by the prostate. PSA is not produced anywhere else in the body in significant amounts. The prostate releases small amounts of PSA into the blood stream throughout the day. Certain prostate conditions can increase the level of PSA in the blood stream. These include benign enlargement of the prostate (BPH), prostate infection or inflammation (prostatitis), as well as prostate cancer. Certain bladder conditions can also increase the blood stream PSA levels such urinary tract infection and urinary retention.

The most common use for PSA is for the detection of prostate cancer. Most patients believe that the PSA blood test is all that is needed for detecting prostate cancer. This interpretation, however, is not valid. PSA is used in a complimentary fashion to the digital rectal examination (DRE) for detecting prostate cancer. In fact 20% of prostate cancers have normal PSA's but abnormal DRE's. This is why DRE should always be included in the diagnosis process. The DRE also allows the urologist to feel if the prostate is enlarged, infected, or suspicious for cancer.

To summarize, PSA is specific for the prostate gland but not for prostate cancer.

A normal PSA value is typically less than 4ng/ml. However this may depend upon your age. This upper limit of normal is lower for men younger than 60 and greater for men older than 70. This is because the prostate enlarges with aging. Enlargement of the prostate increases the PSA level.

There are two tests that may help to differentiate PSA elevation as secondary to benign enlargement of the prostate as opposed to prostate cancer; one is PSA density and the other is Free and Total PSA. PSA density takes into account the volume of the prostate, as determined by the prostate ultrasound, and the PSA level. Free and Total PSA is a blood test that helps determine if the PSA is benign enlargement vs. potential malignancy. Note: not every patient with an elevated PSA needs these tests.

Finally, one other way to look at PSA is with PSA velocity. PSA velocity refers to the change in PSA value over time. We have learned that generally PSA should not increase by more than .75ng/ml per year. If your rate of increase is greater than this, your urologist may choose to look into some of the other PSA tests that we have already discussed. The only sure way to determine that reason for an elevated PSA is through a prostate biopsy. This is done at the same time as the prostate ultrasound to help the urologist get accurate sampling biopsies from the prostate.

To learn more
For more information, go to: Prostate health and disorders

Adult & Pediatric Urology, P.L.L.P
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