Prostate health is taking its place among all those things you’re not sure you want to hear about while snacking in front of the TV.
Not since “erectile” and “dysfunction” became household words have there been so many media messages about middle-aged men and their plumbing problems.
But here’s the thing about the prostate gland: Every guy has one.
And as men get older, this body part they were only vaguely aware of can cause problems such as frequent or difficult urination.
Thus they might wonder whether they have “a going problem” or “a growing problem,” as described in a commercial for a medication treating an enlarged prostate.
Ads for medications such as Flomax and Avodart depict men who now can enjoy ballgames, go fishing and get a good night’s sleep without the worry of urination difficulties that an enlarged prostate can entail.
I think the overall effect of the ads has been positive, because I think education is the key to health care,” said Dr. Kevin O’Kelly, of Low Country Urology in Florence, S.C.
The ads also urge patients to make sure their symptoms are not related to prostate cancer. That helps raise awareness about the cancer most frequently diagnosed in men, said O’Kelly.
It’s getting the attention of a lot of females, too,” he said. “A lot of wives and sweethearts are saying, ‘You need to make sure you don’t have prostate cancer.”‘ Here’s some information about prostate problems.
Growth is common
The prostate is a round gland that’s underneath the bladder and usually is about walnut-sized. It manufactures the fluid in semen. It surrounds the urethra, through which urine and semen pass.
A painful, swollen prostate might mean a man has prostatitis, an inflammation usually treated with antibiotics and other drugs.
But simple prostate enlargement – benign prostatic hyperplasia – is “as common a part of aging as gray hair,” according to the National Institutes of Health, which says the condition sent 4.5 million men to their doctors in 2000.
An enlarged prostate might not cause symptoms and isn’t necessarily a crisis. But it can be, if the gland grows to the point where it blocks the flow of urine. It can lead to serious bladder and kidney ailments.
More commonly, urination may become difficult, more frequent or more urgent. As with the guy in the commercials with the “going problem,” that can interfere with a man’s normal activities and social life.
Surgery to remove some tissue from the prostate – which can reach the size of an orange or larger – has been the time-honored treatment.
In a procedure called transurethral resection of the prostate (TURP for short), the surgery is done through an instrument inserted through the penis.
About 1 in 4 men would have some sort of procedure for this, before the (prostate) medicines came out,” said Dr. John Wofford of Columbia Urological Associates.
Now, Wofford said, most urologists probably perform only about 20-25 TURP procedures a year. Usually, men whose enlarged prostates are causing problems will try medication first: Avodart (dutasteride) works by lowering the level of the hormone dihydrotestosterone, which in turn can shrink the prostate gradually.
An earlier drug, Proscar (finasteride), is similar.
Flomax (tamsulosin) is one of several drugs that work by relaxing muscles in the prostate and the neck of the bladder, helping urine flow more easily. It doesn’t change the size of the prostate, but may relieve symptoms such as difficult urination in only a few days, Wofford said.
Side effects are possible with both types of medication, but “very few men have complaints,” Wofford said.
Turner said that for older patients especially, medications can help men avoid surgery.
“f you are 75 and this could stop you from having surgery for seven years, in all likelihood that’s the rest of your life,” Turner said.
A man who seeks treatment for problems caused by an enlarged prostate may have tests including an examination of the prostate (which a doctor can feel by checking through the rectum), tests of urine flow and volume, and possibly ultrasound imaging.
Ruling out cancer
A major ailment that must be ruled out is prostate cancer. Though it usually grows very slowly, it is the No. 2 cancer killer of men (behind lung cancer).
Prostate cancer death rates are declining, but are twice as high in black men compared to white.
Early prostate cancer usually does not cause symptoms, but when the disease is advanced it may cause symptoms similar to those of an enlarged prostate. Prostate cancer screening is recommended at age 50 for white men and at 45 for black men.
Virtually everything about prostate cancer is complicated, however. Experts disagree on the usefulness of the PSA screening test, for a protein found in the blood. A recent study did back the notion that a rapidly rising PSA could signal more aggressive cancer.
There’s also debate on whether older men should be screened, on whether surgery is advisable in some cases since it may cause impotence and incontinence, and on when a strategy of “watchful waiting” makes sense.
Men need to read up on the options and discuss them with their doctors. “You have to figure out what works best … for the person and his stage of life,” Turner said.
