As men grow older, they are often told to be concerned about their prostate. Britt Marcussen, MD, family physician at UI Family Care Center, North Liberty, talks about prostate health:
What is the prostate gland?
The prostate is a walnut-sized gland that sits at the base of the bladder, deep within the pelvis, that’s responsible for producing some of the fluid contained in semen in men.
What causes an enlarged prostate?
Prostates enlarge gradually as men age. Some men’s prostates enlarge faster than others and can cause things to get blocked up in the bladder.
Will men experience symptoms with an enlarged prostate?
Yes, often times that’s why people come in to talk with me about their prostate. They’re experiencing getting up at night to urinate; they urinate frequently during the day; they have a sense of urge to go all the time; flow can be diminished; slow stream; some dribbling can occur and a lot of people experience some hesitancy, it takes longer to get the stream going and it’s harder to stop it.
How is this diagnosed and treated?
Well, diagnosing the enlarged prostate is largely based on the symptoms that men come in with. We often do a digital rectal exam where we actually feel the prostate gland. But the prostate can enlarge both externally and internally, so feeling the gland often doesn’t give us a 100-percent clear picture of how big the prostate is or why there’s blockage.
There’s a number of ways that you can treat enlarged prostate glands. One is through medications and there are a couple of different classes of drugs that we use. One is called alpha blockers, and you may have heard of those referred to as Hytrin or Flomax. What they do is relax the muscle within the gland that allows flow to occur more easily. Then there’s another class of drugs called 5 alpha reductase inhibitors like Proscar or the generic form finasteride. This actually shrinks the prostrate gland slightly. And then you can do a combination of those two therapies if you have an individual who doesn’t respond to one or the other. Past that there are surgical options that our urology colleagues do to open the prostate gland. There’s even some herbal treatments, herbal supplements, for instance saw palmetto, which may help with the enlargement of the prostate.
What will happen if an enlarged prostate is left untreated?
Mostly that the men are bothered by the symptoms. Of course with enlargement of the prostate, we always have some concern about prostate cancer development.
What is a PSA test? What is a PSA checking for in the blood?
PSA stands for prostate specific antigen and it’s a molecule that circulates in the blood stream and is secreted by the prostate gland. It’s secreted by both benign forms of enlargement of the prostate and it’s also secreted by prostate cancer cells.
When should men consider having a PSA test, and how often from that point on?
It’s recommended that we discuss doing the test with all men age 50 and over. There are certain high-risk groups that we would consider screening earlier and those would include men with a family history of prostate cancer and blacks.
If prostate problems are screened and diagnosed early, is the outcome generally favorable?
Whether the PSA results in better outcomes in terms of prostate cancer is an area of controversy. I think it’s important to remember that an elevated PSA doesn’t always mean prostate cancer and that sometimes more sophisticated testing needs to be done if the PSA is elevated. Sometimes we do need to do biopsies to prove whether the elevation in the PSA is due to benign enlargement or whether it’s due to prostate cancer.
Are prostate issues something men should talk about with the primary care physician or a urinary specialist?
I think either one is fine. Family doctors and primary care providers are capable of discussing prostate health and whether the PSA makes sense for any individual. Our urology colleagues are more than skilled at having those conversations, doing those tests, and appropriate treatments. |
