What Every Man Should Know About His Prostate.
Your Local Health | Written by BJ Towe
At age 25, a man's prostate gland is about the size and shape of a walnut. But then it begins to grow — and for many men, that causes problems.
“A large percentage of men will be affected by their prostate at some point in their lives. Whether it's an infection or inflammation, enlarged prostate, or even prostate cancer, there are solutions available.”
— Kevin Birusingh, M.D., Urologist with The Iowa Clinic
Three Common Problems
1. PROSTATITIS — affects at least 50 percent of men during their lifetimes.
Common in men of all ages, prostatitis involves an inflammation of the prostate gland, which may be caused by a bacterial infection.
“Prostatitis can be difficult to diagnose and somewhat difficult to treat,” says Dr. Birusingh. “Symptoms can range from mild to severe, and diagnoses can range from simple to chronic.” (For a complete list of symptoms, see quiz on page 2.)
There are several courses of treatment, depending on the specific diagnosis. “We usually treat with a long course of antibiotics extending over a month or so. We'll often prescribe more than one medication to treat both the cause and the symptoms,” he says.
2. ENLARGED PROSTATE — eight out of 10 men will eventually develop an enlarged prostate.
An enlarged prostate (also called benign prostatic hyperplasia, or BPH) cannot be prevented; it's the natural result of getting older. By age 40, the prostate gland might have grown to be about the size of an apricot. By age 60, it could be as big as a lemon.
The larger the prostate becomes, the more likely that it will squeeze the urethra and make it difficult to pass urine. Typically, BPH doesn't cause problems before age 50. However, after age 85, about 90 percent of men will have BPH.
If it's not treated, BPH can lead to serious health problems, such as kidney or bladder damage. Therefore, it's important to see your doctor at the first sign of symptoms (see quiz, below). Treatment may involve:
Lifestyle changes. Many men find relief from mild symptoms by using the restroom more often, being sure to empty the bladder completely when passing urine, and limiting nighttime beverages — especially those containing alcohol or caffeine.
Medication. There are prescriptions specifically designed to reduce symptoms of BPH.
Surgery. Surgery is recommended for men who do not want to take daily medication, want to improve quality of life, or have severe symptoms not helped by other treatments.
3. PROSTATE CANCER — when caught early, 97 percent of cases can be cured.
After skin cancer, prostate cancer is the second most common cancer in American men. In fact, the Prostate Cancer Foundation reports that a man is 35 percent more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.
Prostate cancer cells usually grow at a very slow rate, meaning it could take decades for the cancer cells to grow large enough to cause symptoms (see quiz, below). However, left undetected and untreated, cancer cells may eventually spread beyond the prostate and through the body. This could lead to advanced prostate cancer, which is more difficult to treat. Therefore, the American Urological Association recommends that men be screened for prostate cancer beginning at age 55.
But “if your father, brother, or son has had prostate cancer, you're twice as likely to get it yourself. If you're African-American, you are at a 56 percent higher risk. We recommend you get screened beginning at age 40,” says Birusingh.
Screening for prostate cancer involves two tests:
If cancer is suspected, other diagnostic tests will be ordered.
Most problems with the prostate are not cancer. Birusingh adds, “However, if cancer is present, we can usually treat it effectively with hormonal therapy, chemotherapy, cryotherapy, surgery, and/or radiation.”
It's All About Quality of Life
“Not every man is the same, nor do they have the same concerns when symptoms of prostate problems are present,” says Birusingh. “Some patients are comfortable waiting and watching. Others are less comfortable doing so, and for those patients we're more aggressive in diagnosis and treatment.
“The biggest thing is this: No one should have to live with urinary symptoms that decrease quality of life because they think it's a natural part of aging. There are so many things we can do to help,” Birusingh says.
That includes curing prostate cancer when it's detected early.
What is a Prostate Gland?
Located in front of a man's rectum and just below his bladder, the prostate gland is part of the reproductive system and produces semen.
QUIZ: Do YOU have these symptoms?
If you are experiencing any of the symptoms below, see your Primary Care physician for an accurate diagnosis. Or make an appointment with The Iowa Clinic Men's Center at (515) 875-9801.
- Trouble passing urine
- Burning, stinging, or pain when passing urine
- Strong, frequent urges to pass urine
- Chills and fever
- Pain in the lower back, belly, groin, or behind the scrotum
- Body aches
- Rectal pressure or pain
- Urethral discharge with bowel movements
- Genital and rectal throbbing
- Sexual problems and loss of sex drive
ENLARGED PROSTATE (BPH)
- Trouble passing urine
- Weak or slow urine stream
- Stopping and starting again several times while passing urine
- Passing urine often, especially at night
- Feeling the bladder has not fully emptied
- Strong, sudden urges to pass urine
- Pushing or straining to begin passing urine
- Trouble passing urine
- Frequent urge to pass urine, especially at night
- Weak or interrupted urine stream
- Pain or burning when passing urine
- Blood in the urine or semen
- Painful ejaculation
- Nagging pain in the back, hips, or pelvis
For Patients with Advanced Prostate Cancer: New Drug Improves Quality of Life
For the first time last fall, The Iowa Clinic Nuclear Medicine physician John Berger, M.D., treated an patient with end-stage prostate cancer with a new drug — Xofigo®, which is an intravenous (IV) injection of the radioactive material radium 223. He remembers the patient and the drug's effects vividly:
“He had been very sick and was barely able to get here for treatment. He came in wearing three Fentanyl patches to help control his severe chronic pain,” Dr. Berger recalls. “After his first monthly injection of Xofigo, he only needed two Fentanyl patches. After his third treatment, he was down to just one patch. He looked and felt so much better.”
It takes just 15 to 20 minutes to receive a Xofigo IV treatment (which is typically administered every four to six weeks for a total of six treatments) on an outpatient basis in an authorized hospital or clinic. It can only be administered under the supervision of a Nuclear Medicine physician.
Since first seeing the life-enhancing benefits of Xofigo six months ago, Berger has seen advanced-stage prostate cancer patients achieve similar results time and time again. “When they're not in so much pain, they want to get out and do things. That makes life so much more enjoyable,” he says.
Xofigo has also been shown to prolong life by several months in clinical studies. Plus, it's less toxic to bone marrow and produces fewer side effects than most narcotic pain relievers. When side effects are present, they usually involve nausea lasting a day or two.
Berger says, “Most of our patients who have received the Xofigo injections have been able to significantly decrease the amount of narcotic pain relievers they need. As a result, they have fewer unpleasant side effects from those drugs, such as constipation or feeling like they're in a fog. Quality of life dramatically improves.”
When Xofigo May Be a Good Option
The FDA has approved this drug for use only in patients with prostate cancer that has spread to the bones and that no longer responds to hormonal therapy. It is not appropriate for prostate cancer patients that do not meet these criteria.
Xofigo is generally safe to use and can be given before or after the usually employed prostate cancer chemotherapy agents. Xofigo does not suppress bone marrow sufficiently to preclude further therapy in most cases. The radiation emitted from Xofigo (Radium 223) does not pose any safety hazard to patients' families and is administered on an outpatient basis. There is no requirement for patient quarantine with the use of this drug.
If you or someone close to you has end-stage prostate cancer and believe Xofigo may be beneficial, referrals to a Nuclear Medicine physician can be made by an Oncologist, Urologist, or Family Medicine physician. An initial consult and lab testing are required to determine eligibility and whether Xofigo is a good treatment option for each patient.