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All About Prostate Health

By Jillian Foglesong Stabile, MD

June 30, 2023

Prescription Drugs, Your Health & Wellness

The prostate is a small gland that lives between the bladder and the rectum in men. It is responsible for one of the fluids that make up semen. The muscles of the prostate contract during ejaculation and force the fluid into the urethra for release. Three primary problems can occur with the prostate. Let’s talk about them and some of the things that can be done to help support prostate health.

Prostatitis

The first thing that can go wrong in the prostate is prostatitis or inflammation of the prostate. Prostatitis comes in 2 forms: acute and chronic. Prostatitis is usually very painful.

Asymptomatic inflammatory prostatitis

The prostate can be inflamed without the patient having symptoms. This diagnosis is usually found on other testing for urinary or reproductive problems. This condition doesn’t typically need treatment or monitoring because it does not cause any complications long term.

Acute prostatitis

Acute prostatitis is usually caused by a bacterial infection. About 10% of cases of prostatitis are acute bacterial prostatitis. The infection usually comes from the urethra or reflux within the prostate. Occasionally the infection can be a complication of prostate biopsy or other instrumentation of the urethra. About a quarter of cases of acute bacterial prostatitis are associated with instrumentation.

The bacteria associated with acute prostatitis are usually the same that are associated with urinary tract infections or sexually transmitted infections. In patients who are immunocompromised such as those with HIV, more rare bacteria can be seen.

This can cause the sudden development of bladder infection symptoms, such as pain with urination or urinary frequency, or difficulty voiding, such as a weak stream or having to strain to urinate. Pain with ejaculation, fevers, chills, or body aches can also occur.

Acute prostatitis is usually treated with antibiotics. Unless the specific bacteria is known, an antibiotic that covers different types of bacteria is usually prescribed. Antibiotics are typically given for 10-14 days but may be used longer if symptoms continue or if the infection is severe. Symptoms should start to improve within a couple of days of starting antibiotics.

Rarely, an abscess can form which requires a specialist to drain the abscess. About 13% of the time, the acute infection can recur. A little over 10% of patients will go on to develop chronic pain or chronic prostatitis.

Chronic prostatitis

Chronic prostatitis is a little less defined than acute prostatitis in terms of causes. If it’s bacterial then antibiotics are used for 4-6 weeks. It can also be a chronic noninfectious inflammation. This type of prostatitis is more likely to recur. This may be related to nerve damage or trauma. Psychological stress also seems to be associated with the development of chronic prostatitis.

Researchers are still working on what medication options may be best to treat chronic prostatitis and several types are being tested. Antibiotics and other oral prostate medications more commonly prescribed can be used. Sometimes anti-inflammatory medications are also taken. This is a chronic pain condition and can be very difficult to treat. In some cases, chronic prostatitis can lead to recurrent urinary tract infections in men.

Benign Prostatic Hypertrophy (BPH)

Benign prostatic hypertrophy is an extremely common condition characterized by an enlarged prostate that gets worse with age. This condition causes difficulty with urination, weak stream, the feeling of incomplete emptying, incontinence, urgency, frequency, or pain with urination. Symptoms can be associated with significantly decreased quality of life.

The diagnosis of BPH is made using a combination of patient history, and a physical exam done by doing a digital rectal exam. Sometimes labs, specialty urinary studies, or ultrasounds can be used to confirm the diagnosis.

Treatment for BPH depends on the severity of the symptoms. In mild cases, the symptoms can just be monitored as long as the symptoms don’t affect daily life. If symptoms are more moderate, lifestyle modifications such as fluid restriction, timed bladder voiding, regular activity, avoiding caffeine and alcohol, and treating constipation can be used. The hope is that lifestyle modification will help improve symptoms or prevent the progression of symptoms.

In more extreme cases, medications or surgery may be necessary. Medications may try to target and keep the prostate from continuing to grow or by relaxing the smooth muscles in the prostate to allow urine to flow more easily.

Medication has the potential to cause side effects such as erectile dysfunction, dizziness, headache, dry mouth, pain, or heart rhythm problems.

Surgery is an option when all else fails. One procedure called transurethral resection of the prostate (TURP) involves going through the urethra and boring out a larger opening to allow for better urine flow. In extreme cases, the prostate may be completely removed surgically.

A few kinds of supplements can be used to try to treat BPH. Supplements aren’t regulated by the FDA, and therefore, they typically don’t have as many studies to support their use or effectiveness. A few supplements that may have a benefit for BPH include Beta-sitosterol extract, cernilton, Pygeum africanum, or Saw palmetto. These supplements all have limited scientific evidence supporting their use. Before starting any supplement, you should talk with your healthcare provider to make sure that it is safe to do so.

Prostate Cancer

Prostate cancer is one of the most common types of cancer and one of the leading causes of cancer death. Prostate cells grow out of control and form tumors that may stay confined or could spread to other parts of the body. The most common risk factor for prostate cancer is age. Symptoms of prostate cancer include trouble urinating, weak flow, urinary frequency, incomplete emptying, pain with urination, blood in urine or semen, pain with ejaculation, or pain in the back that doesn’t go away. While these are all symptoms of prostate cancer, other conditions can also cause these symptoms.

Prostate cancer can be diagnosed through screening tests. However, prostate cancer generally develops slowly. Screening has been an area of controversy over the past several years. Because prostate cancer is so slow-growing, more men die of prostate cancer than of prostate cancer. This has led the US preventative services task force (USPSTF), to no longer recommend routine screening of asymptomatic, low-risk men. They recommend discussion with your healthcare provider about whether testing is right for you.

There is a benefit associated with prostate-specific antigen (PSA) testing, but there are also risks associated with screening including false-positive results, overdiagnosis, and over-treatment leading to the problems associated with the treatments. In men 55-69, there may be more benefit to PSA testing. In men 70 or older, the USPSTF recommends against PSA testing.

What is PSA testing? PSA stands for prostate-specific antigen. It is a protein that is made in the prostate and circulates in the blood. There is a normal range for the PSA that is expected in men. A normal PSA is generally less than 4.0ng/mL. The PSA can be increased with BPH, but in prostate cancer, it usually gets very high.

Sometimes a tumor can be felt on a digital rectal exam. If the PSA is elevated, there are a few different options to monitor or further evaluate. Depending on the level of PSA, it may be best to monitor it before doing further evaluation or treatment. The higher the level of the PSA, the more likely that doctors will recommend a biopsy. A biopsy involves an ultrasound probe in the rectum. A small needle is inserted into the prostate gland to get samples of the prostate to be evaluated under the microscope.

Prostate cancer is scored using a system called the Gleason scoring system. It evaluates the characteristics and the number of biopsy specimens that contain cancer. The higher the Gleason score, the more severe the cancer. This score guides the treatment options and recommendations for cancer.

Patients with prostate cancer have several options for treatment. In earlier forms of prostate cancer, the patient and their doctor may choose to wait and monitor cancer using serial PSA levels. If the PSA levels are increasing, then patients may need to progress to additional treatment.

Surgery can be used to remove the prostate gland. Lymph nodes near the prostate may also be removed to test if the cancer has spread. Radiation may also be used to kill residual cancer cells using several methods of radiation. Some types of hormones may be used to try to prevent cancer from spreading. Anti-testosterone medications can be used to try to shrink or keep the cancer from spreading. Prostate cancer is generally sensitive to testosterone so blocking it can treat the cancer. It is usually used to treat late-stage tumors or metastatic disease. Other treatments include chemotherapy, immunotherapy, high-intensity focused ultrasound, and cryotherapy.

Supplements are being studied concerning cancers including prostate cancer. Calcium, green tea, lycopene, modified citrus pectin, pomegranate, selenium, soy, vitamin D, and vitamin E have all been suggested as possible options. There may not be specific studies regarding these treatments, but many of these treatments may not cause any harm. It is strongly recommended that patients using alternative therapies discuss these with their treatment team.

Monitoring symptoms and discussing your concerns with your doctor is one of the most important things you can do. Finding problems early is the best way to approach prostate health. If your doctor has recommended medication, consider visiting us at https://wellrx.com to help find the best prices in your area. Some people save a little. Some people save a lot. Prices vary across zip codes. Even pharmacies across the street from each other can have huge price differences.

Dr. Foglesong Stabile is a board-certified Family Physician who enjoys full scope Family Medicine, including obstetrics, women’s health, and endoscopy, as well as caring for children and adults of all ages. She also teaches the family medicine clerkship for Pacific Northwest University of Health Sciences.

References:

https://www.health.harvard.edu/topics/prostate-health

https://www.ncbi.nlm.nih.gov/books/NBK279291/#:~:text=The%20prostate's%20most%20important%20function,then%20expelled%20outwards%20during%20ejaculation.

https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate

https://www.aafp.org/pubs/afp/issues/2016/0115/p114.html

https://emedicine.medscape.com/article/785418-overview

https://www.health.harvard.edu/a to z/chronic-prostatitis-a-to-z

https://www.aafp.org/pubs/afp/issues/2005/0801/p485.html

https://emedicine.medscape.com/article/437359-overview

https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.enlarged-prostate-herbal-therapy.ug1905

https://www.ncbi.nlm.nih.gov/books/NBK556081/

https://www.cdc.gov/cancer/prostate/basic_info/index.htm