If you’re like most guys, you spend much more time thinking about the family jewels than about your prostate gland. You may even think prostate problems are for old guys – and you’re not there just yet, thank you very much. But while many prostate problems do occur in men 50 and older, others occur in men of any age. And even if you’ve never experienced a problem, chances are that during your lifetime, you will. So it’s important to understand what can go wrong with your prostate – and to know when to seek medical help.
The little prostate gland – only about the size of a walnut – is one of the most important parts of a guy’s reproductive system. Sitting below the bladder and surrounding the urethra (the tube that carries urine out of the body), it secretes a milky fluid that makes up about 50-75 percent of the semen. Despite its diminutive size, the prostate can cause lots of trouble. Three of the most common problems are:
Benign Prostatic Hyperplasia (BPH): BPH is an enlarged prostate. “After age 40, all prostates become larger; it’s a universal problem,” says Damon Raskin, MD, board certified internal medicine physician practicing in Pacific Palisades, California.
In fact, according to Dr. Raskin, by age 60, more than half of all men have BPH. By age 85, this number increases to about 90 percent. Fortunately, the “benign” part of BPH means that the enlargement isn’t cancer. But because of the prostate’s position around the urethra, it can squeeze against the urinary tube, causing symptoms like slow, interrupted or weak urinary stream, urgency with leaking or dribbling and frequent urination, especially at night.
While there’s nothing you can do to prevent BPH, it’s important to get any urinary symptoms checked out to make sure they’re not signs of something more serious – especially if you’re older than 50. And if the symptoms are annoying enough, says Dr. Raskin, they can be treated with medication – or in severe cases, with surgery.
Prostatitis: Prostatitis is an inflammation or infection of the prostate gland that may cause painful urination or ejaculation, lower back, groin or pelvic pain, reduced stream during urination and sometimes a fever. Like BPH, says Dr. Raskin, prostatitis is not cancer, nor does it lead to cancer. It can occur in men of any age, but it’s more commonly seen in men younger than 50.
While it’s not entirely clear what causes prostatitis, most health professionals agree that mechanical trauma to the prostate, such as horseback riding, prolonged cycling or operating heavy machinery, may cause inflammation. Other culprits: holding your urine for a long period of time, heavy lifting when the bladder is full and unprotected anal sex. Some experts believe that certain foods, such as caffeine, alcohol and spicy dishes can irritate the prostate, too.
Prostatitis is treated with antibiotics and pain relievers, and in severe cases, with surgery.
Prostate Cancer: Prostate cancer usually affects men ages 50 and older. According to the American Cancer Society, more than 220,000 men in the United States will be diagnosed with prostate cancer this year. And prostate cancer is the second leading cancer killer next to lung cancer. While there’s no definitive cause, African American men are at higher risk of developing it, as are men who have a family history of prostate cancer.
There are no early warning symptoms of prostate cancer, and when symptoms do develop, they are much like the symptoms of BPH, including slow, interrupted or weak urinary stream, urgency with leaking or dribbling and frequent urination, especially at night. Only a physical exam and lab testing can determine whether you have prostate cancer.
While a diagnosis of cancer can be scary, the good news is that many prostate cancers are slow growing and may need nothing except “active surveillance” (no treatment other than frequent checkups to make sure that the cancer has not progressed). When treatment is needed, there are more options today than ever before, ranging from surgery to radiation, chemotherapy, even cryotherapy (freezing) or laser (burning) in order to destroy the cancer cells. There are pros and cons for each type of treatment, so it’s important to weigh your options carefully.
Gland Protection Plan
Think there’s nothing you can do to protect your prostate gland from trouble? Well, think again. While the cause of prostate problems, from prostatitis to prostate cancer, isn’t fully understood, there are a lot of things you can do to keep your prostate healthy – and stay ahead of the game. Here are some suggestions from the experts:
1. See your doc every year for a digital rectal exam and a PSA blood test, beginning at age 50, says Jay Cohen, MD, author of Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options. If you are African American or if you have a family history of prostate cancer, this testing should begin at age 45.
2. Pay attention to urinary symptoms, urges Damon Raskin, MD, board certified internal medicine physician practicing in Pacific Palisades, California. “A lot of men ignore their health,” he says.
3. Keep your weight down, advises Dr. Raskin. “Obese men are more likely to develop all kinds of cancer because of increased estrogen in fat tissue.” Although estrogen does not directly cause the DNA mutations that trigger the development of cancer, it does stimulate growth of cancer cells.
4. Exercise, exercise, exercise, recommends Dr. Dhiren Dave, MD, a urologist specializing in robotic surgery at Somerset Medical Center in Somerville, NJ. “Exercise keeps your weight down; there’s a link between obesity and getting prostate cancer, especially the more aggressive form,” he claims. Exercise has also been linked with a decreased incidence of benign prostatic hyperplasia (BPH) and also improvement in pain related to prostatitis.
5. Aim for a healthy eating plan, says Dr. Cohen. This includes five servings of fruits and veggies each day, soy products such as tofu and soy nuts, whole grain breads and cereals, and healthy fats, such as olive oil, nuts and avocados. It’s best to limit your consumption of animal products that contain fats, such as red meats, butter and whole fat dairy products. Alcohol should be taken in moderation, if at all. While there’s no clear evidence that alcohol can increase the risk of prostate cancer, research shows that those who indulge in several drinks daily over a long period of time have a higher incidence of prostate cancer.
6. Get it on. “Regular ejaculation is good for prostatitis,” says Dr. Raskin. In addition to this, several recent studies suggest that regular ejaculation (between 13 and 20 times per month) is associated with a lower lifetime risk of prostate cancer.
Better Options for Prostate Cancer Care
Twenty years ago, a man with a suspicious prostate lump on digital rectal exam was sent to a urologist for a “blind” prostate biopsy – meaning that small samples of prostate tissue were removed from random areas of the gland and examined for evidence of cancer cells. If cancer was detected, surgery was scheduled to remove the prostate – many times resulting in side effects such as urinary incontinence and/or impotence. But some cancers were missed, since prostate cancer may be present without a detectable lump on exam.
In 1994, a blood test called the PSA helped to refine prostate cancer diagnosis. PSA stands for prostate specific antigen, a protein released by prostate cells. An elevated PSA may occur with prostate cancer. But this is an imperfect diagnostic test, too, since PSA can be elevated due to harmless conditions such as benign prostatic hyperplasia (BPH), an enlargement of the prostate gland. It can also be elevated with recent ejaculation, prostatitis (an inflammation or infection of the prostate gland), or prolonged pressure on the prostate gland, such as occurs with cycling. And the PSA can be falsely lowered with certain medications used to treat prostatitis.
Even if the PSA test accurately reflects cancer, the cancer may be a slow-growing and relatively harmless one that needs no treatment other than active surveillance (frequent testing to determine whether the tumor is growing). This led the United States Preventive Services Task Force, a government advisory body, to recommend in 2011 against routine screening for men older than 50 with PSA testing, saying that more men were harmed by unnecessary prostate biopsies and treatments than were saved from dying of cancer.
“Eighty-five percent of men with a diagnosis of prostate cancer get surgery or radiation today,” claims Jay Cohen, MD, author of Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options. “And only 15 percent really need it. Doctors can be overly aggressive with prostate cancer.”
But according to Dr. Cohen, whose own prostate cancer diagnosis prompted his book, the PSA screening can be a useful diagnostic tool when used in conjunction with a digital rectal exam and several recent breakthroughs in diagnosing cancer, such as advanced prostate magnetic resonance imaging (MRI) and color Doppler ultrasound, tests that can identify the prostate cancer within the prostate itself. If a biopsy is needed, it can be directed toward the suspicious area of the prostate, rather than being done “blind.” And if treatment is needed, there are many newer techniques other than removal of the prostate, such as focal treatment (treating just the cancer cells rather than removing the prostate), which may be sufficient for treating cancers that have not spread, and which result in fewer troubling side effects.
But you’ll need to do your homework in order to take advantage of these new diagnosis and treatment modalities, adds Dr. Cohen, not only because they aren’t available everywhere, but because they haven’t been studied long enough for advisory boards to recommend them as a standard of prostate care. “What’s been happening recently in breast cancer care is just now beginning to happen in prostate cancer care, with new and better diagnosis and treatment options. But it will take a decade or so for them to be approved for general use – and I couldn’t wait for a board to approve,” says Dr. Cohen, who sought out the most advanced diagnostics – and a second opinion – before arriving at his own treatment decision.
Another up-and-coming approach to prostate cancer treatment, says Dhiren Dave, MD, a urologist specializing in robotic surgery at Somerset Medical Center in Somerville, NJ, are genetic-based tests that can both identify cancer more precisely, and also determine the aggressiveness of the cancer, helping with treatment decisions. “One of these tests is the PCA3 test, a urine test that detects the presence of PCA3, a genetic marker of prostate cancer,” says Dr. Dave. “We use this test if there is a persistently elevated PSA, and it can give us a little more information – although it’s not a definitive test,” he explains.
The PCA3 test, as well as several other tests, are currently being used in some medical centers, both to provide guidance as to whether someone needs a prostate biopsy and after a diagnosis of cancer to differentiate men who require immediate treatment from those who can be followed by active surveillance.
For more information on updated prostate cancer diagnosis and treatment as well as locations where you can receive this care, you can find Dr. Cohen’s book on Amazon.com. You can also check out Prostate-Cancer.org and ipcsg.org for more information.
Nutrients for Prostate Health
Certain supplements can support prostate health, says Jay Cohen, MD, author of Prostate Cancer Breakthroughs: New Tests, New Treatments, Better Options. Among them are:
Vitamin D: Research suggests that adequate levels of vitamin D reduce the risk of developing prostate cancer – plus suppress the growth and spread of prostate cancer cells in men who already have it.
Pygeum (African Plum Tree): This supplement is used for treating benign prostatic hyperplasia (BPH) by shrinking the prostate and relieving urinary problems such as decreased flow and nighttime urination.
Green tea extract: Drinking six cups of green tea has been shown to reduce prostate inflammation.
Lycopene: Research shows that lycopene, a chemical found in tomatoes and certain other foods, might help to prevent prostate cancer.
Pomegranates: Of all the fruits and veggies, pomegranates have been shown to be a star in promoting prostate health, including prostate cancer risk reduction.
By Linda Hepler, BSN, RN