Prostate Health
Contents
1. RESEARCH ADVOCACY For more information call the National Urology Health Line at 1 800 828 7866 or visit www AUAFoundation org 1000 Corporate Boulevard Linthicum MD 21090 TT Men with an enlarged prostate may have some or all of these symp toms e a frequent urge to urinate e astrong sudden urge to urinate e gets up to urinate two or more times a night Bladder e difficulty emptying his bladder e a weak urine stream that may start and stop e trouble starting to urinate e only urinates a little bit each time he goes to the bathroom e leaks or dribbles urine after going to the bathroom e feels like he still has to urinate even after he has gone to the bathroom Normal prostate Prostate Urethra How do they diagnose an enlarged prostate The American Urological Association AUA designed a series of ques tions that ask how often symptoms occur The International Prostate Symptom Score IPSS Index helps doctors measure the problems caused by enlarge prostate ranging from mild to severe Benign prostatic hyperplasia BPH Jennifer Fairman All rights reserved Incomplete emptying Over the past month how often have you had a sensation of not emp tying your bladder completely Frequency Over the past month how often have you had to urinate again less than two hours after you finished urinating Intermittency Over the past month how often have you found you stopped and started again se2. trasound uses sound waves to show an image of the prostate gland If you are at risk for cancer your physician may order a PSA test During a prostate infection however the PSA can be falsely high The doctor may analyze the urine and prostatic fluid for signs of inflammation and infection If the doctor thinks that a man has prostatitis or other prostate problems he may refer him to a urologist The urologist is a doctor who specializes in diseases of the urinary tract and male repro ductive system The urologist may use cystoscopy where he or she passes a small tele scope through the urethra into the bladder This allows the urologist to see the urethra prostate and bladder The urologist may also order urine flow studies which help measure the strength of your urine flow and any blockage caused by the prostate urethra or pelvic muscles How do they treat prostatitis There is no scientifically proven medication to cure prostatitis The treatment recommended often depends on the type of prostatitis a man has For many men with prostatitis the urologist may give antibi otics Depending on his symptoms a man may receive other treat ments These may include alpha blockers anti inflammatory drugs muscle relaxants plant extracts and repeat prostatic massage to drain the prostate ducts Heat therapies biofeedback and relaxation exercises may help relieve some symptoms A man may be advised to stay away from some foods e g spic
3. urine into the prostatic ducts Alpha blockers These drugs work by relaxing the smooth muscle of the prostate and bladder neck to improve urine flow and reduce blad der outlet obstruction Although alpha blockers may relieve the symp toms of BPH they usually do not reduce the size of the prostate Biopsy A procedure in which a tiny piece of a body part tissue sam ple such as the prostate or bladder is removed with a needle or dur ing surgery for examination under a microscope to determine if cancer or other abnormal cells are present Bladder neck Area of thickened muscle fiber where the bladder joins the urethra Acting on signals from the brain bladder neck muscles can either tighten to hold urine in the bladder or relax to allow urine out and into the urethra These muscles also tighten during ejaculation to prevent backflow of semen into the bladder Bladder The balloon shaped pouch of thin flexible muscle in which urine is temporarily stored before being discharged through the ure thra Catheter A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test such as insertion of a substance during a bladder X ray Chronic bacterial prostatitis An uncommon form of prostatitis caused by bacteria traveling up the urethra and the backward flow of infected urine into the prostatic ducts causing recurrent infections Cystitis Also known as bladder infection U
4. The Prostate Owner s Manual saser sneer What you Should Know about the Prostate Only men have a prostate A part of the male reproductive system the prostate is located just below the bladder It surrounds the urethra the tube that carries urine from the bladder and semen through the penis and out of the body The prostate s main job is to help create semen by generating ejaculatory fluid Semen is the fluid that helps protect and energize the sperm when a man ejaculates The seminal vesicles are located next to the prostate They also add fluid to semen The prostate gland is in front of the rectum The prostate gland may be a source of health problems in men The most common problems are en larged prostate benign prostatic hyperplasia or BPH an inflammatory disease prostatitis and prostate cancer Because the prostate is located inside the pelvis there are no simple self exams for a man to check his own prostate There are two main tests doctors use to monitor prostate health for men the digital rectal examination DRE and a blood test called a prostate specific antigen PSA test Most experts agree that men over the age of 50 should have an annual prostate examination with a PSA test and DRE to screen for cancer and other diseases Screening should occur earlier at age 40 in BLADDER SEMINAL VESICLE URETHRA o faine PROSTATE Jennifer Fairman All rights reserved TESTICLE those who are at a high
5. at enlarged prostates For some men a combination of drugs may work best If the medications do not help some minimally invasive procedures and sur gical procedures can help with the lower urinary tract symptoms If the symptoms do not improve after treatment men should report back to their doctor to see if there might be a different cause for their symp toms PUQOOUEEUEAATUUTATA EEL Are there risks in not seeking treatment for an enlarged prostate In many men enlarged prostate can get worse over time It can lead to bladder damage infection and even kidney damage A health care provider should monitor a man with enlarged prostate Prostatitis Prostatitis is a common and painful disease of the prostate gland and its surrounding structures Prostate Jennifer Fairman All rights reserved What are the different types of prostatitis and their causes Acute bacterial prostatitis is the least common type of prostatitis Bacterial infections are always the cause In acute bacterial prostatitis the symptoms are severe and sudden and may cause the patient to seek emergency medical care Chills fever severe burning during urination and being unable empty the bladder completely are common symp toms A visit to a doctor or hospital is required Acute bacterial prosta titis can affect any age group but commonly occurs in older and middle aged men Bacterial infections also cause chronic bacterial prostatitis In this condi
6. er risk of prostate cancer This includes African American men and those with a family history of prostate cancer What is the DRE The doctor inserts a lubricated gloved finger into the rectum He or she feels for abnormal size shape or con sistency in the prostate The DRE can help the doctor decide if a man has an enlarged prostate However the DRE by itself is not the best way to detect early prostate cancer A man should also have a PSA test URETHRA What is the PSA test This blood test measures the level of prostate specific antigen in the blood Very little PSA is found in the blood of a man with a healthy prostate Some conditions can cause larger amounts of PSA to leak into the blood One possible cause of a high PSA level is enlargement of the prostate Inflammation of the prostate called prostatitis is another common cause of PSA elevation Prostate cancer is the most serious possible cause of an increased PSA level Enlarged Prostate The prostate may become larger and may start to cause problems as a man ages Enlarged prostate is also known as benign prostatic hyperplasia BPH The prostate of a 50 year old man is about 20 30 grams or about the size of a walnut It may grow to 50 100 or grams or more with BPH As the prostate enlarges it can squeeze the urethra This can cause some men to have lower urinary tract symptoms LUTS when their prostate grows AMERICAN Urorocrca A Urorociear o EDUCATION
7. festyle Men with a close family member father brother or uncle diagnosed with prostate cancer are at greater risk of getting prostate cancer Prostate cancer also appears to be more common in men with a high intake of fat in their diets Talk to your doctor about what you can do to reduce the risk of prostate cancer Most doctors agree if you do things that are heart healthy that you will also help keep your prostate healthy Eating right exercising and not smoking can help improve men s health What are the symptoms of prostate cancer In its early stages prostate cancer often causes no symptoms When symptoms do occur they may include any of the following dull pain in the lower pelvic area frequent urination problems with urination such as the inability pain burning weakened urine flow blood in the urine or semen painful ejaculation general pain in the lower back hips or upper thighs loss of appetite and or weight and persistent bone pain The symptoms can be similar to those of BPH so it is very important to have the PSA and DRE when you have such symptoms How do they diagnose prostate cancer The DRE and PSA are the main methods to screen for prostate cancer If the DRE and or PSA suggest further testing a prostate biopsy is the next step to diagnose prostate cancer The biopsy removes small pieces of prostate tissue A pathologist a physician who examines human tis sue to see whether it is normal or diseased w
8. he bladder The prostate supplies fluid that goes into semen Prostatitis Inflammation or infection of the prostate Chronic prosta titis means the prostate gets inflamed repeatedly The most common form of prostatitis is not associated with any known infecting organism PSA Test Also referred to as prostate specific antigen test A blood test used to help detect prostate cancer PSA Also referred to as prostate specific antigen A protein made only by the prostate gland High levels of PSA in the blood may be a sign of prostate cancer Rectum The lower part of the large intestine ending in the anal opening Semen Also known as seminal fluid or ejaculate fluid Thick whitish fluid produced by glands of the male reproductive system that carries the sperm reproductive cells through the penis during ejaculation Seminal vesicles Two pouch like glands behind the bladder They produce a sugar rich fluid called fructose that provides sperm with a source of energy that helps sperm move The fluid of the seminal vesi cles makes up most of the volume of a man s ejaculatory fluid or ejacu late Sperm Also referred to as spermatozoa Male germ cells gametes or reproductive cells that are produced by the testicles and that are capa ble of fertilizing the female partner s eggs Testicular Relating to the testicle testis Tissue Group of cells in an organism that are similar in form and func tion Transrectal ultrasound TRUS A
9. ill confirm if cancer is present in the biopsy tissue If there is cancer the pathologist will also grade the tumor The grade indicates the tumor s degree of aggressive ness how quickly it is likely to grow and spread The Gleason grading system is the most widely used system for prostate tumors In this system the pathologist gives the tumor pattern seen the most in the biopsy sample a score from 1 to 5 The tumor pat tern they see next most often is also given a score using the same scale Both scores are added to give a Gleason score ranging between 2 and 10 Scores of 2 to 4 show low aggressiveness 5 to 6 mildly aggres sive 7 moderately aggressive and scores of 8 to 10 depict highly aggres sive prostate cancers The Gleason Scale Grade __ Grade __ Score___ Why do they stage prostate cancer The stage of prostate cancer guides a man s treatment options Has it spread beyond the prostate gland to the nearby tissues The urologist and other members of the health care team help guide men with prostate cancer as they learn about their treatment options How do they treat prostate cancer There are a number of treatment options for men with prostate cancer the most common being surgery or internal brachytherapy or external radiation The best option for each man depends on many factors in cluding his age overall health stage and grade of the cancer and per sonal preferences Once diagnosed men should discuss
10. isk factor for enlarged prostate When a doctor checks a man for enlarged prostate he or she takes a thorough medical history The doctor performs a physical exam includ ing a DRE and he or she may also ask questions about his symptoms The doctor will often do a urine test called a urinalysis They may offer other medical tests to a man who may have enlarged prostate These include 1 prostate specific antigen PSA a blood test to screen for prostate cancer 2 urinary cytology a urine test to screen for bladder cancer 3 measuring the amount of urine left in the bladder after urinating the post void residual volume or PVR 4 a urine flow study uroflowmetry to measure of how fast urine flows when a man urinates 5 cystoscopy a direct look in the urethra and or bladder using a small flexible scope 6 urodynamic pressure flow study that tests the pressures inside the bladder during urination 7 ultrasound or other imaging of the kidneys bladder or prostate When should a man see a doctor about enlarged prostate Aman should see a doctor if he has any of the symptoms that are bothersome In addition he should see a doctor immediately if he has blood in his urine pain with urination burning with urination or is un able to urinate Are there treatments for enlarged prostate prob lems A urologist will examine a man with enlarged prostate to determine the best treatment option for him There are medications to tre
11. prostate cancer treatment options with their health care team Prostate health is an important men s health issue Prostate health is important for men Winning the battle against prostate diseases involves a team approach With a urologist leading a team made up of healthcare workers family and friends men can take charge of their prostate health For more information about prostate health issues go to www UrologyHealth org or call 1 800 828 7866 TTT TLLLTNNDDPTT The American Urological Association Foundation The AUA Foundation is the nation s leading voluntary urological health care organization that promotes research patient public education and advocacy Our mission is to improve prevention detection treatment and ultimately cure urologic diseases The AUA Foundation provides this information based on current med ical and scientific knowledge This information is not a tool for self di agnosis or a substitute for professional medical advice It is not to be used or relied on for that purpose Please see your urologist or other healthcare provider regarding any health concerns and always consult a healthcare professional before you start or stop any treatments includ ing medications For more information about the AUA Foundation please visit www AUAFoundation org Glossary Acute bacterial prostatitis The least common form of prostatitis caused by bacteria traveling up the urethra and the backward flow of infected
12. rinary tract infection in volving the bladder which causes inflammation of the bladder and re sults in pain and a burning feeling in the pelvis or urethra Cystoscopy An examination with a narrow flexible tube like instru ment passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions such as tumors or stones Digital Rectal Examination DRE Insertion of a gloved lubricated finger into the rectum to feel the prostate and check for any abnormal ities Ejaculate The fluid that is expelled from a man s penis during sexual climax orgasm To release semen from the penis during an orgasm Ejaculation Release of semen from the penis during sexual climax or gasm Immunologic Relates to the immune system Nocturia Excessive urination at night especially common in older men Pathologist A scientist who is skilled in identifying the cause and progress of diseases by examining tissue and fluid from the body espe cially one who determines the cause of someone s death by conducting an autopsy Pelvic Relating to involving or located in or near the pelvis Penis The male organ used for urination and sex Perineum The area between the anus and the scrotum in males Pernieal Related to the area between the anus and the scrotum in males and the area between the anus and the vagina in females Prostate In men a walnut shaped gland that surrounds the urethra at the neck of t
13. s a higher risk if the man has recently had a catheter or other instrument inserted into his urethra The risk may also be higher if a man has an abnormality of his urinary tract or a recent bladder infection Unusual organisms such as chlamydia mycoplasma which may be transmitted by sexual contact and ureaplasma may cause chronic pro statitis or chronic pelvic pain syndrome It may also be due to a chemi cal or immunologic reaction to an injury The nerves and muscles in the pelvis may cause pain in the area either as a response to the prostate infection or inflammation or as an isolated problem itself How do they diagnose prostatitis The treatment is different for the different types of prostatitis syn dromes It is important to make sure other conditions such as urethritis cystitis an enlarged prostate or cancer are not causing the symptoms To help make an accurate diagnosis several types of examinations are useful To examine the prostate gland the doctor will perform a DRE He or she will be able to feel if the prostate is enlarged or tender Lumps or firm areas can suggest the presence of prostate cancer He or she will also ask about the level of pain or discomfort that the man may feel as the doctor presses the muscles and ligaments of the pelvic floor and perineum If a man has prostatitis he may have some pain or discom fort with the DRE exam If the doctor wants a closer look at the prostate gland a transrectal ul
14. special ultrasound test in which the sound waves are produced by a probe inserted into the rectum In men the structures most commonly examined with this test are the prostate bladder seminal vesicles and ejaculatory ducts Tumor An abnormal mass of tissue or growth of cells Urethra In males this narrow tube carries urine from the bladder to the outside of the body and serves as the channel through which semen is ejaculated Extends from the bladder to the tip of the penis Urethritis Inflammation of the urethra Urinalysis An examination of the urine to determine the general health of the body Urinary cytology Inspection under a microscope of cells found in the urine Urinary tract The system that takes wastes from the blood and car ries them out of the body in the form of urine Passageway from the kidneys to the ureters bladder and urethra Urinate To excrete urine Urine Liquid waste product filtered from the blood by the kidneys stored in the bladder and expelled from the body through the urethra by the act of urinating voiding This AUA Foundation urologic information was provided to you by AUA tee FOUNDATION EDUCATION RESEARCH ADVOCACY For more information call the National Urology Health Line at 1 800 828 7866 or visit www AUAFoundation org 1000 Corporate Boulevard Linthicum MD 21090 This product made possible with funding from GlaxoSmithKline GlaxoSmithKline
15. tion a man has urinary tract infections that keep coming back This condition is most common in young and middle aged men In chronic bacterial prostatitis the symptoms include burning during uri nation urinary frequency especially at night perineal testicular blad der and low back pain and painful ejaculation However it does not cause a fever Nonbacterial prostatitis and prostatodynia are now called chronic pelvic pain syndrome These are the most common types of prostati tis The symptoms of chronic pelvic pain syndrome include difficult and sometimes painful urination discomfort or pain in the perineum blad der testicles and penis as well as difficult and painful ejaculation In some cases these symptoms can be hard to tell apart from those of chronic bacterial prostatitis The exact cause of these non bacterial prostatitis conditions is unknown They may be due to persistent infec tion inflammation and or pelvic muscle spasm Inflammation in the prostate can also occur without symptoms What causes prostatitis The bacteria that cause acute and chronic bacterial prostatitis get into the prostate from the urethra by backward flow of infected urine into the prostate ducts You cannot catch bacterial prostatitis from some one else It is not a sexually transmitted disease A sexual partner can not catch this infection Certain conditions or medical procedures increase the risk of having bacterial prostatitis There i
16. veral times when you urinated Urgency Over the last month how difficult have ane 1 2 3 4 5 you found it to postpone urination Weak stream Over the past month how often 1 2 3 4 5 have you had a weak urinary stream Straining Over the past month how often have ie 1 2 3 4 5 had to push or strain to begin urination None o ltme time 2times times 3times times 4times times b5 times or more times or more Your score score Nocturia Over ee past month many times af you most typically get up to urinate from the time you went to bed until the time you got up in the morning Total IPSS score o Mixed about Mostl Quality of life due to urinary symptoms Delighted Pleased Mostly satisfied equally satisfied y Unhappy Terrible e dissatisfied and dissatisfied If you were to spend the rest of your life with your urinary condition the way it is now how 1 2 3 4 5 would you feel about that Total score 0 7 mildly symptomatic 8 19 moderately symptomatic 20 35 severely symptomatic Who is at risk for an enlarged prostate Prostate enlargement is common as men age Experts are still learning what causes an enlarged prostate Scientists have found that a hormone dihydrotestosterone or DHT may cause the prostate to grow larger Men who have close relatives with an enlarged prostate are more likely to have it Being overweight may also increase a man s risk Aging is the biggest r
17. y and drinks e g caffeinated acidic and avoid doing things e g bicycle riding that make the problem worse Once he has a cor rect diagnosis one of the best therapies may be that of reassurance that the man does not have a life threatening condition How will prostatitis affect a patient Prostatitis is frustrating for both the man and his doctor It can seri ously affect a man s quality of life The correct diagnosis of the prosta titis problem is difficult Prostatitis can be treated A man can usually get relief from major symptoms by following the recommended treat ment A cure for prostatitis is not always possible Prostate Cancer Prostate cancer is a major healthcare problem in the United States It is the most common non skin cancer Each year more than 200 000 American men learn they have prostate cancer Sometimes this cancer can be small and slow growing with a limited risk to the patient Other prostate cancers may threaten his well being or life Prostate Cancer Jennifer Fairman All rights reserved eA ON iaaa What are the causes and risks of prostate cancer Prostate cancer is rare before age 40 and the risk increases as a man ages One in six men faces a diagnosis of prostate cancer in his lifetime Researchers are still studying what causes prostate cancer It is likely that prostate cancer occurs due to many reasons some have to do with your family history or genetics others with diet and li
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