Most men face prostate problems

Most men face prostate problems
September 18, 2007

The prostate is a squishy, walnut-sized gland that is part of the male
reproductive system.

The gland is made of two lobes enclosed by an outer layer of tissue. It's in
front of the rectum and just below the bladder. It surrounds the urethra,
the canal through which urine passes out of the body. That information -
including the acknowledgment that "scientists do not know all the prostate's
functions" - is from the Web site of the National Kidney and Urologic
Diseases Information Clearinghouse (www.kidney.nih.gov).

The site also explains that it's common for the prostate to become enlarged
as a man ages. Dr. Leland Ronningen, a urologist and an associate clinical
professor at the University of California Irvine School of Medicine, says
more than half of men in their 60s and as many as 90 percent in their 70s or
80s will experience benign prostatic hyperplasia (BPH).


QUESTION: What are the symptoms of BPH?

ANSWER: The most common symptoms involve problems with urination - a weak
stream or urgency and leaking or more frequent urination and getting up a
lot at night.

That should be a pretty clear signal to a guy to see a doctor.

I've had patients show up who can't urinate at all. The symptoms progress so
slowly over the years, some people wait until they can't urinate at all.

QUESTION: So if the prostate is enlarged, do you automatically remove it?

ANSWER: No. There are 2 kinds of medicine given for enlarged prostate. Alpha
blocks work on certain receptors in the prostate and bladder to relax tissue
and make it easier to urinate. But it is not shrinking the prostate. It
still is growing.

Then there are drugs to inhibit the production of DHT hormone, which causes
the prostate to grow more.

Each treatment has benefit and must be evaluated individually for each
patient.

QUESTION: When patients are referred to you, have they usually been
evaluated by a primary care physician?

ANSWER: Yes. The recommendation is that older men once a year have a PSA and
finger test for prostate and also respond to a validated questionnaire of
symptoms.

(The National Cancer Institute, www.cancer.gov, says men 50 and older should
have an annual blood test for PSA levels. PSA, or prostate specific antigen,
tests for the level of PSA enzymes in the blood. Produced by the prostate
cells, increases in this enzyme level indicates further testing is needed.)

(The digital rectal exam screens for rectal and prostate cancer. The doctor
inserts a gloved, lubricated finger into the patient's rectum and examines
the rectal wall surface and the size and characteristics of the prostate.)

QUESTION: Tell me about the validated questionnaire?

ANSWER: This is based on the International Prostate Symptom Score and pretty
much helps me decide if I need to biopsy or use other treatment for
urinating symptoms. It asks if, after urination, the bladder is completely
empty, if there is frequency of urination or intermittent urination.

There are questions about the urgency to urinate, a weak stream, straining
and nighttime urination.

The score is anywhere from 0 to 35. A result of 20 to 35 indicates severe
prostate problems.


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