Samuel Tomlinson, MD
A healthy prostate is an important aspect of overall well-being for men. The prostate is a gland about the size and shape of a walnut that plays an important part in male reproduction. It is located below the bladder and in front of the rectum. A tube called the urethra runs through the center of the prostate gland and carries urine from the bladder to exit outside the body.
The main functions of the prostate are to help make sem*n, the fluid that carries sperm, aid in pumping out sperm during sex, act as a filter to protect sperm from toxins, and produce hormones responsible for the male sex drive.
Most men will have some kind of prostate issue during their lifetime, with symptoms that can affect urination and/or sexual function. Medical issues such as inflammation, enlargement, or cancer of the prostate can press on or restrict the urethra and cause symptoms affecting urination. Urinary and sexual symptoms vary widely in men and can range from none to mild, moderate, to severe.
Prostatitis is when the prostate becomes inflamed. The two types are acute prostatitis and chronic prostatitis. There are a variety of medications to help manage symptoms of both acute and chronic prostatitis.
Acute prostatitis is caused by an infection, which is usually bacterial, and symptoms include sudden painful urination, a weaker urine stream, chills, and fever. It is typically treated with antibiotics.
Chronic prostatitis, also known as chronic pelvic pain syndrome, includes symptoms of persistent or recurring discomfort, pain, or burning with urination, an increased urge to urinate, difficulty emptying the bladder, and/or pain with ejacul*tion. While the exact cause of chronic prostatitis is often unknown, it is linked to chronic inflammation with or without infection.
Benign prostatic hyperplasia (BPH) is commonly referred to as an enlarged prostate. This is a common, non-cancerous medical condition that happens as men age. It usually occurs after age 50, when the prostate may even double or triple in size. While the size of the prostate does not always cause symptoms, the most common symptoms are related to urination.
Symptoms can include a frequent or urgent need to urinate, urinating more at night (typically two to four times), difficulty starting urination, a weak or start-and-stop stream, dribbling, or an inability to fully empty the bladder. Less common symptoms include urinary tract infections, blood in the urine, or not being able to urinate. The inability to urinate is a medical emergency, as this can damage the kidneys and increase PSA, a prostate-related substance in the blood, if not treated quickly. BPH can also affect sexual function, causing a decreased sex drive or erectile dysfunction.
There are many treatments for BPH, including medications, surgery, and other minimally invasive procedures. The type of treatment depends on the symptoms, the size of the prostate, and any other health conditions a man may have. Men can make an informed decision about treatment for BPH by discussing symptoms and treatment with their primary health care provider.
Men with higher levels of testosterone or who have jobs or hobbies that may irritate the prostate, such as riding horses, motorcycles, bicycles, or operating tractors and backhoes, may be at an increased risk of prostatitis and BPH over time.
Prostate cancer affects one in eight men in the United States at some point in their lives and the risk increases with age. The risk of prostate cancer is higher in African American men and in those with a family history or positive genetic testing for prostate cancer.
The good news is, the chance of dying from prostate cancer is low since most prostate cancers are slow-growing. Prostate cancer screening guidelines are as follows:
- Age 50 for men at average risk of prostate cancer and expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer before age 65.
- Age 40 for men at even higher risk or those with more than one first-degree relative diagnosed with prostate cancer before age 65.
The screening for prostate cancer is a simple blood test called PSA or prostate-specific antigen. Slightly elevated levels of PSA may be normal, but increased levels may indicate the presence of prostate cancer. A digital rectal exam may also be completed. Other tests to confirm the diagnosis of prostate cancer include imaging tests and biopsies. PSA tests may be recommended annually or bi-annually depending on risk status. Prostate cancer is easier to treat and cure if caught early. It is recommended that men talk to their primary health care provider about prostate cancer screening and follow-up testing.
If prostate cancer is diagnosed, there are many treatments available, including active surveillance for slow-growing cancers with further testing at scheduled intervals, surgery, radiation therapy, chemotherapy, and hormone therapy. Working with a urologist and/or oncologist along with the primary health care provider to develop a treatment plan can help men make the best decision for themselves.
A healthy lifestyle can help men lower their risk of developing prostate problems. Maintaining a healthy weight, getting regular physical activity, consuming a healthy diet, managing stress, and getting adequate rest are all part of the equation to lower the risk of prostate issues as well as other lifestyle-related conditions like diabetes and heart disease. Developing a relationship with a health care provider built on trust and honest conversations can help men make informed decisions on when to screen for prostate cancer, and opens a dialogue for when prostate or other medical issues arise.
Dr. Samuel Tomlinson is a family medicine physician serving patients at HopeHealth in Kingstree and is accepting new patients. Call 843-355-5628 or visit hope-health.org for more information.
