Benign Prostate Disease

What is the prostate gland?
The prostate gland is about the size of a walnut and is located below the bladder, the organ that stores urine. The prostate gland is part of the reproductive system in men. The job of the prostate gland is to make fluid for semen, which is used to carry sperm during ejaculation.

Why does the prostate gland cause problems?
The prostate gland can cause a problem if it becomes enlarged because this can interfere with the flow of urine. The prostate gland wraps around the urethra, the tube that carries urine from the bladder to the tip of the penis. As the prostate enlarges, it causes a gradual squeezing of the part of the urethra that runs through it, and this may cause difficulty urinating.

How common are prostate problems?
More than half of men over the age of 60 have enlarged prostates. As men age, the chances that their prostate will become enlarged increases. By age 80, about 80 percent have an enlarged prostate gland. Only about half of these men have any symptoms due to their prostate.

Why does the prostate gland enlarge?
It is not known exactly why the prostate gland enlarges with age, but male hormone plays an important part.

What are the symptoms of a prostate problem?
The most common symptoms of urinary problems from the prostate are:

• a weak urinary stream
• a sense of not being able to empty the bladder completely
• trouble starting urination
• going more often or a sense of urgency or having to go right away
• having to get up often at night to urinate
• stopping and starting of the urine stream

How is a prostate problem diagnosed?
A prostate problem is most often diagnosed because of the symptoms that it causes. Your doctor will also do a physical examination and feel your prostate gland.

Does an enlarged prostate mean cancer?
No. Most men who have a prostate problem do not have cancer. Cancer does occur in the prostate gland and is more common as men age. It is important for your doctor to check your prostate gland particularly as you age. The doctor can do a rectal examination to feel whether the prostate gland is enlarged or has lumps or areas that do not feel normal. In addition, there is now a blood test called the PSA or prostate specific antigen test, which measures a substance that increases in the blood when prostate cancer has spread. The American Urologic Association (AUA) recommends a yearly prostate examination for all men over age 50. However, men who have a higher risk of developing prostate cancer, such as African-American men and men who have a family history of the disease, are advised to begin yearly prostate exams at age 40.

What other tests are used for prostate problems?
Other tests can be done to measure the urine flow, which can help the doctor decide how much the prostate is blocking the urine stream. The amount of urine left in the bladder after urinating can also be measured and this can sometimes be helpful. Other tests can be done such as ultrasound, which also can give information about the prostate gland.

When does a prostate problem need treatment?
Enlarged prostate or BPH requires treatment only if the symptoms are severe enough to be troublesome to the patient, if the function of the urinary tract is seriously affected or if there are other complications, such as bleeding, kidney infections or kidney damage. An enlarged prostate by itself is not enough reason to need treatment.

What treatments are used for an enlarged prostate?
A number of treatments are available for an enlarged prostate that is causing urine problems. If you are not bothered by your symptoms, your doctor may choose to watch the condition for a period of time during which you will be examined one or more times a year to make certain that you are not developing complications. If more active treatment is needed, some of the following may be used:

Medicine: Two types of medicines are now in use to treat prostate enlargement. A medicine that is normally used for high blood pressure (alpha blockers) helps to relax the muscle tissue in the prostate, relieving part of the blockage. The second type of medicine used shrinks the enlarged prostate by blocking the effect on the prostate of the male hormone, testosterone. These medicines are helpful to some of the men who have enlarged prostates.

Surgery: This is currently the most widely accepted method of treating enlarged prostate when symptoms are severe. Basically, the operation removes some of the enlarged tissue to relieve the symptoms. More limited types of surgery are also done, which just make cuts in the prostate instead of removing tissue. New forms of therapy including laser therapy are being developed. While these types of surgery help most of the patients, they may not eliminate the symptoms entirely.

Does surgery on the prostate gland interfere with sexual function?
Surgery for an enlarged prostate does not usually interfere with a man's sexual functioning. However, about 10 to 15 percent of men may have trouble getting erections after surgery. Men may have a problem called retrograde ejaculation, which causes semen to go backward into the bladder instead of through the urethra to the outside). This means they are no longer able to father children but causes no other harm.

Who should I see if I have a prostate problem?
You should first see your regular doctor for this problem. Your doctor may refer you to a special doctor called a urologist for further evaluation and treatment. Urologists have additional training in treating problems of the urinary tract. Prostate gland problems are the most common disorders treated by urologists.

What if I have more questions?
If you have more questions, you should speak to your doctor. You can also get more information by contacting your local National Kidney Foundation Affiliate.

What is the National Kidney Foundation and how does it help?
More than 20 million Americans have some form of kidney or urologic disease. Millions more are at risk. The National Kidney Foundation, Inc., a major voluntary health organization, is working to find the answers through prevention, treatment and cure. Through its 52 Affiliates nationwide, the Foundation conducts programs in research, professional education, patient and community services, public education and Organ and Tissue Donation. The work of the National Kidney Foundation is funded entirely by public donations.