The Prostate

It’s nice to do an article in a woman’s magazine about a man’s health issue. I hope to clear up some misconceptions about the prostate and give some helpful advice to both men and women about this gland. First of all, it is the PROSTATE gland not the PROSTRATE gland. This is only one ‘R’ in the word. Prostrate means to be completely overcome or powerless. Although this gland can make our urine flow sometimes powerless, let’s call it what it is: the prostate. It is a gland about the size of a walnut that is part of the male reproductive system. Its function is to produce semen, the thickened liquid substance that is ejaculated from the penis when a male has an orgasm. The prostate gland and the two seminal vesicles combine to produce all of the semen. Although within the semen millions of sperm are carried, the sperm make up only 5% of the volume of each ejaculation. Men need the prostate to form a vehicle to carry sperm into the woman’s uterus for conception.

Unfortunately, the prostate can be affected by all sorts of problems from infection to cancer. As we age, our prostates get larger. 50% of men over 50 have enlarged prostates. I always tell my male patients two things get larger as we get older – our bellies and our prostates. As the gland enlarges it can cause blockage to the flow of urine since the tube (urethra) coming from the bladder out the penis runs through the prostate. This condition is called BPH, benign prostatic hypertrophy. We can naturally help prevent the process by using the right supplements like Zinc, Saw Palmetto and regularly exercising the prostate. A male can exercise the prostate, not by having it join a gym, but by having frequent ejaculations.

Two types of medications can help BPH. Cardura, Hytrin or Flomax can improve urine flow by relaxing the pressure on the urethra and Proscar or Avodart can actually decrease the size of the prostate and treat BPH.

Infection of the prostate called prostatitis can occur and needs to be treated with antibiotics. Usually these antibiotics have to be taken for at least 10 days for first infections but may require a 30-60 day course of treatment if the infection is recurrent or chronic.

Cancer of the prostate has usually been a disease affecting men in their 70’s. Recently we are seeing this cancer occur in men in their 50’s. Every man over 40 needs a digital rectal exam, not only to feel the prostate, but to screen for colon cancer. Several years ago we started ordering a blood test called PSA (prostate specific antigen) in all men at 50 and older. Although not a perfect prostate cancer screening test, it can help pick up prostate cancer earlier. An elevated PSA (usually >4.0) doesn’t mean you have prostate cancer. BPH and infections can cause a PSA to be higher than normal. Regardless, an elevated PSA or any bump felt on the prostate during an exam needs to be evaluated by an urologist. The urologist will order an ultrasound and may do a prostate biopsy. If prostate cancer is found, the urologist will discuss treatment options which include surgery, radiation treatments either externally or through the use of implanted seeds and the use of androgen suppression chemotherapy, Lupron, being one of these. Your family doctor can help coordinate with the urologist and oncologist the best treatment to use to give you the best chance for cure.

Any symptom such as pain in the pelvic area, decrease in the force of urine flow, hesitation or delay in the beginning of the stream, uncontrolled post-void leaking, frequency of urination, especially if you get up 3-4 times a night to use the bathroom may be warning signs of prostate problems. If you have any of these or are over 50, make sure you see your family doctor. Doing a PSA blood test is not enough. I have had patients whose PSA was normal, yet on exam I felt a bump on their prostate. Subsequent biopsy showed early cancer and because of that exam less radical treatment was needed. If you are over 40 and your doctor doesn’t do a digital rectal exam on you, change doctors. Trust me, we don’t enjoy the exam any more than you, but it must be done.

To all the wives and girlfriends out there, make your man go for HIS annual exam. You might just save his life!