Urology Topics

September focuses on the three most common prostate conditions: benign prostatic hyperplasia, prostate cancer, and prostatitis. Victoria Sharp, MD, urologist at University of Iowa Hospitals and Clinics, says benign p rostate hyperplasia (BPH) is the benign (noncancerous ) progressive enlargement of the prostate. "The prostate grows larger and squeezes the urethra (the tube that drains the bladder), which prevents the normal flow of urine. It is a common problem that affects most men over age 50."

The symptoms of BPH are:

• Hesitancy or straining to urinate
• Decreased force and caliber of urine stream
• Interruption of stream
• Postvoid dribbling
• Incomplete bladder emptying which may lead to urinary tract infections
• Urinating more frequently and getting up to urinate at night
• Urinary retention   (unable to urinate)

"The need for treatment depends on several factors, such as how bothersome the symptoms are and if the condition is causing any harmful effects such as urinary tract infections, blood in the urine, or urinary retention (inability to urinate)," Sharp says. The treatment options are watchful waiting (monitoring the symptoms but holding off beginning treatment), medications, or surgery.

Sharp says there are two types of medication used to treat BPH. Alpha blockers (Flomax, Hytrin, Cardura) work quickly (a few days or weeks) by relaxing the prostate, while 5 alpha reductase inhibitors (Proscar, Avodart) take longer to work (up to six months) and actually shrink the prostate. These have the effect of making the urine stream more forceful, therefore emptying the bladder better.  

"In general, medications are tried before surgery is considered," Sharp says. "The surgical options are the traditional TURP (transurethral resection of the prostate-like a Roto-rooter) and other newer options such as laser, microwave, and heat therapy."

Prostate cancer is the most common type of cancer for men in the United States. According to Sharp, "Screening for prostate cancer is done by a combination of a digital rectal exam, where a doctor inserts a lubricated, gloved finger into the rectum and feels the prostate for abnormal lumps, and a blood test called a PSA." If the prostate feels abnormal and/or if the PSA is elevated, or if the value is rising too rapidly over time, then a biopsy of the prostate is taken to see if cancer is actually present.

"The treatment options for prostate cancer depend on how advanced and aggressive the cancer is as well as the physical condition and age of the patient," Sharp says. "The options include watchful waiting, surgery, external radiation, internal radiation (seed implantation), and hormone therapy."

Prostatitis is an inflammatory condition of the prostate caused in general by a bacterial infection or some other irritation of the prostate. "It can be acute or chronic. Symptoms can include urinary frequency, urgency, burning with urination, and difficulty urinating. Also fever, chills, low back or perineal pain can occur and the prostate may be very tender and swollen when examined. The PSA blood test can become elevated because of prostatitis as well as cancer," Sharp says.

Men can develop prostatitis at any age. Treatment depends on the cause. "If it is a bacterial infection, antibiotics are used and if it is inflammatory, anti-inflammatory medications (like ibuprofen or naproxen) are used," Sharp says. "It is often difficult to get antibiotics into the prostate, so a strong antibiotic often has to be used for an extended period of time, sometimes for a couple of months."

Sharp says the importance for early detection and treatment depends on how bothersome the condition is to the person experiencing the symptoms. "For prostate cancer, early detection and treatment is important. It is recommended that men get their prostates checked starting at age 50 and have a PSA test yearly. African American men or men with a family history of prostate cancer should begin screening at age 40."

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