Prostate Cancer Lives As It Is Born: Slow
- By Daniel Pendick, Former Executive Editor, Harvard Men’s Health Watch
This year, more than 238,000 American men will be diagnosed with prostate cancer. In most cases, the cancer consists of small knots of abnormal cells growing slowly in the walnut-sized prostate gland. In many men, the cancer cells grow so slowly that they never break free of the gland, spread to distant sites, and pose a serious risk to health and longevity.
Evidence is growing that early treatment with surgery or radiation prevents relatively few men from ultimately dying from prostate cancer, while leaving many with urinary or erectile problems and other side effects. As a result, more men may be willing to consider a strategy called active surveillance, in which doctors monitor low-risk cancers closely and consider treatment only when the disease appears to make threatening moves toward growing and spreading.
This week, a study by Harvard researchers found that the aggressiveness of prostate cancer at diagnosis appears to remain stable over time for most men. If thats true, then prompt treatment can be reserved for the cancers most likely to pose a threat, whereas men can reasonably choose to watch and wait in other cases.
If you have chosen active surveillance, then this could possibly make you feel more confident in your decision, says Kathryn L. Penney, Sc.D., instructor in medicine at Harvard Medical School and the lead author of a report published today in the journal Cancer Research.
Keeping Track Of Your Prostate As You Age
Prostate cancer is the second most common cancer diagnosed in men. Catching the disease in its early stages may improve a manâs chance of survival.
When you reach age 40, talk to your doctor about your familyâs medical history and other key factors that will help determine your risk of developing the disease.
If you get tested, youâll likely undergo a digital rectal exam and a PSA test, a blood-draw that measures your levels of prostate specific antigen . High PSA levels could indicate cancer, but they can also be caused by other conditions, including BPH. Talk to your doctor to make sure you understand what the results mean.
How Might An Enlarged Prostate Affect My Life
Having an enlarged prostate affects men in different ways. Some men can manage mild symptoms and dont need treatment. Other men find they need to stay near a toilet. This can make it difficult to work, drive, be outdoors and attend social events. If you need the toilet a lot during the night, this can affect your sleep and make you feel more tired during the day.
Some men with an enlarged prostate find their symptoms improve over time without treatment. But for most, the symptoms will stay the same or slowly start to cause more problems over time unless they have;treatment.
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The Most Common Prostate Problem Among Men Over Age 50 This Condition Can Cause Embarrassing Urination Issues
While BPH does not increase your risk of getting prostate cancer or having sexual problems, it can affect quality of life, specifically by causing annoying and embarrassing urination problems.
“Since prostate enlargement happens gradually, men often think more frequent trips to the bathroom are a natural part of aging,” says Dr. Howard LeWine, chief medical editor at Harvard Health Publishing and an assistant professor of medicine at Harvard-affiliated Brigham and Women’s Hospital. “But a little medication can help relieve symptoms, meaning less urinary urgency and fewer nighttime awakenings to use the bathroom.”
Prostate Growth And Sex
Urinary problems caused by BPH are known as lower urinary tract symptoms, or LUTS. Men with LUTS often have problems in the bedroom.
The link between LUTS and sexual problems is not fully understood. But many of these men have a lowered sex drive, trouble maintaining an erection, and theyâre less satisfied with sex. Depression, loss of sleep due to frequent nighttime trips to the toilet, or some related physical cause may play a role.
Whatever the reason, the worse LUTS get, the more trouble a man may have in the bedroom. LUTS can be treated, so see a doctor early, before the symptoms cause a bladder problem or begin to spoil your sex life.
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Diagnosing An Enlarged Prostate
As with all incontinence conditions, a thorough diagnosis must be developed before action can be taken.; You may have heard of some of these exams. And if you havent, now is a good time to familiarize yourself with them. Not only is knowledge power, but it also eliminates surprises.
Because those with BPH can experience symptoms from mild to severe, the treatment options featured here are organized from least invasive to more intense.
What Medications Are Used To In The Treatment Of Bph
Several types of medications have been approved for treatment of urinary symptoms secondary to prostate enlargement. Men with severe symptoms may require treatment with a combination of these medications. Your doctor will determine the optimal combination for your condition:
Alpha-blockers, such as terazosin , prazosin , or doxazosin , relax the muscles in the prostate and thus may relieve symptoms. Newer alpha-blockers, such as tamsulosin , alfuzosin , and silodosin, are more commonly prescribed because they may have fewer side effects.
Finasteride or dutasteride can cause the prostate to shrink. As a result, the urinary symptoms may improve. These drugs are most helpful in men who have at least moderate enlargement of the prostate.
Tadalafil has recently been approved for the treatment of BPH.
Bladder calming medications that help with the symptoms related to bladder irritability from prostate blockage: oxybutynin , solifenacin , darifenacin , trospium , and mirabegron .
Once your doctor has given you a medical plan, you should stick to it and follow up as recommended. Sometimes men need follow-up with a urologist.
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Inflammation Of The Prostate Gland
Bacteria sometimes cause prostatitis . More commonly, the underlying cause is uncertain. Consult your doctor promptly if you experience:
- fever
- pain in the groin
- urgent and frequent urination.;
Treatment with antibiotics is essential for acute bacterial prostatitis. Admission to hospital is often necessary and, as with chronic bacterial prostatitis, specific antibacterial drugs are required for a long time.;
Persistent Ejaculation And Prostatitis
One study has found a connection between persistent ejaculations and the occurrence of chronic prostatitis, which is inflammation of the prostate over a period of time longer than 3;months.
Symptoms and signs of chronic prostatitis include the following:
- Post-ejaculatory;pain;is a hallmark of the condition.
- Perineal;or pelvic;pain;without any evidence of a urinary tract infection, which;lasts;longer than 3 months.;
- Pain can be present in the perineum, testes, tip of the penis;and the;pubic or bladder area.
- Pain which;radiates to the back and rectum and;makes;sitting down;uncomfortable.;
- Arthralgia.
- Constant burning pain in the penis.
- Abdominal pain.
- Erectile difficulties.
- Sexual dysfunction.
The reason for this is because persistent ejaculation causes buildup of lactic acid and free radicals. These products are not cleared properly by the liver because its activity is suppressed by stress hormones released during the ejaculatory process. The buildup of these products;then;leads to inflammation of the prostatic tissue.
Masturbation and testicular size
Testicular size can be negatively affected by the following issues:
There are literally over a hundred conditions that can cause testicular atrophy but masturbation is really one activity that one shouldn’t worry about causing this issue.
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What Happens When The Prostate Enlarges
As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract–even when it contains only small amounts of urine–which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely and leave some urine behind, leading to a frequent sensation of having to void, having a slow urinary flow, and waking up at night to urinate.
Blocking or narrowing of the urethra by the prostate and partial emptying of the bladder cause many of the problems associated with BPH.
How Is Bph Diagnosed
Diagnosing BPH in its earlier stages can lower the risk of developing;complications. Delay can cause permanent bladder damage for which BPH treatment may be ineffective. In addition to a complete medical history and physical examination, diagnostic procedures for BPH may include the following:
-
Digital rectal exam. A;procedure in which the;doctor inserts a gloved finger into the rectum to examine the rectum and the prostate gland for signs of cancer.
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Intravenous pyelogram. A series of X-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.
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Cystoscopy .;An examination in which a scope–a flexible tube and viewing device–is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
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Urine flow study. A test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest;BPH.
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Complications Of Prostate Enlargement
Left untreated, an enlarged prostate may lead to a number of complications, including:
- Pain in the lower abdomen due to the urethra becoming too narrow. Urine cannot flow through the urethra normally, which leads to a painful build-up of urine in the bladder;
- Bladder infections due to stale urine sitting in the bladder which becomes infected with bacteria;
- Bladder stones small, hard, gritty lumps that form in the bladder, due to the build-up of stale urine in the bladder. The stones dont usually cause any problems when they are in the bladder, but if they pass into the urethra, they may become stuck and cause sudden severe pain;
- Interrupted sleep because of the need to get up several times during the night to urinate;
- A lower quality of life because of the inconvenience and embarrassment of problems with urination; or
- Serious kidney problems if the flow of urine out of the bladder becomes blocked and causes a build-up of pressure all the way back to the kidneys.
When Is Bph Treatment Necessary
The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.
If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine; infected residual urine or bladder stones; and a backup of pressure that damages the kidneys.
- Inadequate bladder emptying resulting in damage to the kidneys
- Complete inability to urinate after acute urinary retention
- Incontinence due to overfilling or increased sensitivity of the bladder
- Bladder stones
- Recurrent severe hematuria
- Symptoms that trouble the patient enough to diminish his quality of life
Find a Location
Currently, the main options to address BPH are:
- Watchful waiting
- Medication
- Surgery
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Enlarged Prostate: A Common Condition As A Man Ages
The conditon doesn’t usually cause problems until later in life
The prostate is a walnut-sized gland that forms part of the male reproductive system.
The gland is made of two lobes, or regions, enclosed by an outer layer of tissue.
The prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.
Scientists do not know all the prostate’s functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.
Benign Prostatic Hyperplasia: A Common Part of Aging
It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia or benign prostatic hypertrophy.
As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. About age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.
Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their 60s and as many as 90 percent in their 70s and 80s have some symptoms of BPH.
Why BPH Occurs
Symptoms
Diagnosis
Urine flow study
Orgasm
Risk Factors For Prostate Cancer
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn’t mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Age. Men who are 50 or older have a higher risk of prostate cancer.
- Race. African-American men have the highest risk of prostate cancerâthe disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man’s relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.
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How Active Surveillance Works
The Gleason score is just one way that doctors monitor prostate cancer during active surveillance. They also do periodic follow-up biopsies and measure PSA levels, which may rise if cancer starts to spread in the prostate. Doctors may recommend treatment sooner if PSA begins to rise quickly or if a follow up biopsy reveals a higher Gleason score or more widespread ;cancer within the prostate. Its an inexact science that depends on a doctors skill and experience and a mans willingness to wait for signs that a cancer poses a clear threat before opting for treatment and its potential for side effects.
Penney says she and her Harvard colleagues are among the many scientists now searching for better ways to predict which prostate cancers are likely to be lethal and which can be monitored and not treated. The answer may be found in genetic changes in prostate cancer cells that signal a higher threat. But finding a better way to predict which prostate cancers are likely to turn lethal is far from guaranteed.
Some believe its not possible, Penney says. After the cancer is diagnosed, so many things can change in unknown ways. Diet, exercise, and other lifestyle factors, for example, could affect whether low-risk prostate cancers become more aggressive or threatening over time.
Questions You May Want To Consider Asking Your Doctor Include:
- What type of prostate problem do I have?
- Is more testing needed and what will it tell me?
- If I decide on watchful waiting, what changes in my symptoms should I look for and how often should I be tested?
- What type of treatment do you recommend for my prostate problem?
- For men like me, has this treatment worked?
- How soon would I need to start treatment and how long would it last?
- Do I need medicine and how long would I need to take it before seeing improvement in my symptoms?
- What are the side effects of the medicine?
- Are there other medicines that could interfere with this medication?
- If I need surgery, what are the benefits and risks?
- Would I have any side effects from surgery that could affect my quality of life?
- Are these side effects temporary or permanent?
- How long is recovery time after surgery?
- Will I be able to fully return to normal?
- How will this affect my sex life?
- How often should I visit the doctor to monitor my condition?
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Diagnosis Of Enlarged Prostate Gland And Urinary Problems
If you are troubled by urination problems, see a doctor no matter what your age. If your doctor agrees that your symptoms need further evaluation and treatment, you may need to undergo a few tests.These may include:
- general examination medical history and review of any health conditions including obesity, diabetes, obstructive sleep apnoea, depression and erectile dysfunction. A rectal examination may be done to check the size and shape of your prostate gland
- a urine check to ensure the prostate is not infected
- a flow-rate check to estimate the speed with which you pass urine
- an ultrasound examination to assess if the bladder is emptying completely and to examine your kidneys
- urodynamics a series of tests on the bladder to see how your urinary system is functioning may be recommended in some circumstances.