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Prostate Disease
The Prostate Gland
The prostate gland is a small gland that is only found in men. It is located between the penis and bladder and it surrounds the urethra (the tube that carries urine from the bladder to the penis).
The prostate gland helps with the production of semen (the fluid that transports sperm). It produces a thick, white fluid that is liquefied by a special protein called prostate-specific antigen (PSA). The fluid is mixed with sperm, produced by the testicles, to create semen.
There are a number of conditions that can affect the prostate gland. These include:
Prostate Enlargement
Prostate enlargement is a common condition associated with ageing. About a third of all men over 50 will have symptoms of prostate enlargement (see below). The urethra is a tube that runs from the bladder through the prostate to the end of the penis. Urine flows through the urethra and out of the body when a man urinates. If the prostate becomes enlarged it can place pressure on the urethra, making it more difficult for the bladder to empty. An enlarged prostate can cause symptoms that can affect the normal pattern of urination. For example, it can:
- make it difficult for you to start urinating
- weaken the flow of urine or cause 'stopping and starting'
- cause you to strain to pass urine
- cause you to urinate more frequently
- wake you up frequently during the night to urinate
Medications such as alpha blockers are also available to help relax the prostate gland muscles or to reduce the gland, making it easier to urinate.
In severe cases that fail to respond to medication, the inner part of the prostate gland that is blocking the urethra can be surgically removed.
Prostatitis
Prostatitis is an inflammatory condition where the prostate gland becomes inflamed (red and swollen). Inflammation often occurs as a response to infection, but in many cases of prostatitis no infection can be proved. Symptoms include:
- pelvic pain
- testicular pain
- pain when urinating (this is less common and more likely with a urinary tract infection)
- pain when ejaculating semen
- pain in the perineum (the area between the anus and back of the scrotum), which is often worse when sitting, particularly on hard chairs and bicycle saddles
Prostatitis is thought to affect up to 3 in 20 men (15%) at some point in their lives. Although it can affect men of any age, it is more common in men between 30-50 years of age.
Prostatitis can be treated using a combination of painkillers and other medication, such as alpha-blockers, which can help relieve the symptoms.
Prostate cancer
Your chances of developing prostate cancer increase with age. Most cases occur in men who are 50 years of age or older. The causes of cancer of the prostate are unknown, but risk factors include age, ethnic origin, family history and diet and exercise. Cancer of the prostate is more common in African and Afro-Caribbean men and less common in Asian men. The reasons for this are not fully understood. Prostate cancer can be diagnosed early before it causes any symptoms. The symptoms of prostate cancer are similar to those of prostate enlargement and include:
- needing to urinate more frequently (often during the night)
- needing to rush to the toilet
- difficulty starting to urinate (hesitancy)
- straining or taking a long time while urinating
- weak flow
- feeling that your bladder has not emptied fully
The outlook for prostate cancer is usually good because, unlike many other types of cancer, it usually progresses very slowly. If treated early, prostate cancer can often be cured.
Treatments include:
- surgery to remove the prostate gland
- radiotherapy - using radiation to kill the cancerous cells
- hormone therapy - using medication to block the effects of testosterone (the hormone that stimulates prostate cancer)
These treatment options carry the risk of significant side effects including:
- loss of libido (sexual desire)
- erectile dysfunction (the inability to obtain or maintain an erection)
- urinary incontinence (loss of bladder control)
For this reason, many men choose to delay treatment until there is a significant risk of the cancer spreading. It is usually not possible to cure the cancer if it spreads from the prostate gland to other parts of the body, such as the bones (a process known as metastasis). In this case, the aim of treatment will be to relieve the symptoms and prolong life.
