prostatectomy

Cancer is a disease in which cells in the body grow out of control. Prostate cancer begins in the cells of the prostate. The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

Prostate cancer is one of the most common types of cancer. It often grows very slowly. If it does not spread to other parts of the body, it may not cause serious problems. But sometimes prostate cancer can grow quickly and spread to other parts of the body. This kind of prostate cancer is serious.

Researchers don't know for sure what causes prostate cancer. They do know that it happens when there are changes in the genetic material (DNA).

Sometimes these genetic changes are inherited, meaning that you are born with them. There are also certain genetic changes that happen during your lifetime that can raise your risk of prostate cancer. But often the exact cause of these genetic changes is unknown.

Anyone who has a prostate can develop prostate cancer. But certain factors can make you more likely to develop it:

• Age. Your chance of developing prostate cancer increases as you get older. Prostate cancer is rare in people under age 50.
• Family health history. Your risk of prostate cancer is higher if you have a parent, sibling, or child who has or has had prostate cancer.
• Race. African Americans are more likely to get prostate cancer. They're also more likely to:
  • Get prostate cancer at a younger age.
  • Have more serious prostate cancer.
  • Die from prostate cancer.

Prostate cancer doesn't always cause symptoms, especially at first. If it does cause symptoms, they may include:

• Problems urinating (peeing), such as:
  • A urine stream that's weak, hard to start, or starts and stops
  • Suddenly needing to urinate right away
  • Urinating often, especially at night
  • Pain or burning when urinating
  • Blood in your urine or semen
• Pain in your lower back, hips, or pelvis that does not go away
• Painful ejaculation (the release of semen through the penis during orgasm)

But many of these symptoms may be from other common prostate problems that aren't cancer, such as an enlarged prostate.

You should discuss your prostate health with your health care provider if you:

• Have symptoms that could be prostate cancer
• Have a high risk for developing prostate cancer
• Had a screening test that suggests you could have prostate cancer

Tests which check for prostate cancer include:

• A digital rectal exam (DRE). In this exam, your provider feels your prostate for lumps or anything unusual by inserting a lubricated, gloved finger into your rectum.
• A prostate-specific antigen (PSA) blood test. A high PSA blood level may be a sign of prostate cancer. But many other things can cause high PSA levels, too.
• Imaging tests. These tests may use ultrasound or MRI to make pictures of your prostate.

If these tests show that you might have prostate cancer, the next step is usually a prostate biopsy. A biopsy is the only way to diagnose prostate cancer.

During a biopsy, a doctor uses a hollow needle to remove some prostate tissue. The tissue is studied under a microscope to look for cancer cells.

Your treatment options usually depend on your age, your general health, and how serious the cancer is. Your treatment may include one or more of options:

• Observation,which is mostly used if you are older, your prostate cancer isn't likely to grow quickly, and you don't have symptoms or you have other medical conditions. Your doctor will keep checking on your cancer over time so to see whether you will need to start treatment for the cancer. There are two types of observation:
  • Watchful waiting means having little or no testing. If symptoms begin or change, you will get treatment to relieve them, but not to treat the cancer.
  • Active surveillance means having regular tests to see if your prostate cancer has changed. If the tests show the cancer is starting to grow or if you develop symptoms, then you will have treatment to try to cure the cancer.
• Surgery to remove your prostate gland may be an option if your cancer hasn't spread outside of your prostate.
• Radiation therapy uses high energy to kill cancer cells or prevent them from growing.
• Hormone therapy blocks cancer cells from getting the hormones they need to grow. It may include taking medicines or having surgery to remove the testicles.
• Chemotherapy uses medicines to kill cancer cells, slow their growth, or stop them from spreading. You might take the drugs by mouth, as an injection (shot), as a cream, or intravenously (by IV).
• Targeted therapy uses drugs or other substances that attack specific cancer cells. This treatment causes less harm to healthy cells than radiation therapy or chemotherapy.
• Immunotherapy helps your own immune system to fight cancer.

Making healthy lifestyle changes may help to prevent some prostate cancers. These changes include:

• Being at a healthy weight
• Quitting smoking
• Getting enough exercise
• Eating healthy foods

NIH: National Cancer Institute

The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes fluid that is part of semen.

An enlarged prostate is when your prostate gland becomes larger than normal. It's also called benign prostatic hyperplasia or BPH for short. Benign means not cancer. And hyperplasia means too much cell growth. BPH isn't cancer and it doesn't increase your risk of getting prostate cancer.

Usually, the prostate gland continues to grow during adult life. That's why BPH is the most common prostate condition in people over age 50. As the prostate gets bigger, it may press against the bladder and pinch the urethra. This can slow or block the flow of urine out of your bladder.

Over time, the bladder muscle may become weak from trying to pass urine through a narrow urethra. When this happens, your bladder may not empty completely when you urinate. A narrowed urethra and weak bladder cause many of the urinary problems you may have with BPH.

Researchers aren't sure why the prostate keeps growing. Some researchers think changes in hormones with aging may cause the prostate to get bigger.

You're more likely to develop BPH if you:

• Are age 40 or older. The chance of getting BPH increases as you get older.
• Have family members who have had BPH.
• Have certain health conditions such as:
  • Obesity.
  • Heart disease and problems with blood circulation.
  • Type 2 diabetes.
  • Erectile dysfunction.
• Don't get enough physical activity.

Symptoms of BPH include:

• Having a frequent or urgent need to urinate
• Waking up many times to urinate
• Having problems with urine flow, such as:
  • Trouble starting to urinate
  • A stream that's weak, slow, or stops and starts
  • Dribbling after urination
  • Urinary incontinence
  • Feeling that you can't completely empty your bladder
• Pain after ejaculation or during urination
• Urine with an unusual color or smell

It's important to see your health care provider if you have any of these symptoms because they could be from a more serious health problem.

You should get medical help right away if you:

• Can't urinate at all
• Have fever and chills with urination that's painful, frequent, and urgent
• Have blood in your urine
• Have pain in your lower abdomen (belly) and urinary tract

For most people, BPH doesn't cause other problems. But BPH increases your chance of developing serious conditions, including:

• Acute urinary retention. With this condition, you suddenly can't urinate at all. This a medical emergency. Acute urinary retention is common in older males and the chance of having it increases with age. It may be triggered by:
  • Taking certain over-the-counter cold or allergy medicines
  • Drinking alcohol
  • Cold temperatures
  • Not moving enough over a long period of time
• Urinary tract infections (UTIs)
• Bladder damage and bladder stones
• Kidney damage

To find out if you have BPH, your provider will:

• Ask about your medical history. Be sure to tell your provider about all the medicines you take, because certain medicines can make BPH symptoms worse.
• Ask about your family health history.
• Examine you. The exam may include a digital rectal exam (DRE) of your prostate. In a DRE, your provider inserts a gloved finger into your rectum to check if your prostate is large, tender, or irregular in any other way.
• Order medical tests, if needed, such as:
  • Urine tests.
  • A PSA blood test (prostate-specific antigen test).
  • Urodynamic testing to see how well you can hold and release urine.
  • Cystoscopy to look inside your urethra and bladder.
  • Ultrasound pictures of your prostate and urinary tract.
  • A prostate biopsy to diagnose or rule out prostate cancer.

Not everyone needs treatment for BPH. Treatment options depend on how much your symptoms bother you, your health, age, and the size of your prostate:

• Lifestyle changes may improve mild symptoms. They include:

  • Drinking less before bedtime or going out
  • Avoiding or cutting back on beverages with caffeine and alcohol
  • Bladder training and exercising the muscles that control urine flow
  • Preventing or treating constipation

• Medicines can help mild to moderate symptoms by:

  • Stopping the prostate from growing
  • Shrinking the prostate
  • Relaxing muscles to improve urine flow

  Sometimes combining 2 types of medicine helps more than taking just one type of medicine.

• Medical procedures can help improve moderate to severe BPH symptoms when medicines don't help enough. There are several different types of procedures. They all use an instrument inserted into the urethra to either:

  • Widen the urethra
  • Destroy part of the prostate with heat

• Surgery may be helpful when symptoms are severe, other treatments haven't helped, or you have another problem, such as bladder damage. Different types of surgery are used to:

  • Remove part or all of the prostate
  • Make cuts in the prostate to take pressure off the urethra

  Most BPH surgery is done with tools inserted into the urethra.

Your provider can explain the possible benefits and side effects of your treatment options so you can decide what's best for you.

Researchers haven't found ways to prevent BPH. You can take care of your prostate health by:

• Talking with your provider about your risk for developing an enlarged prostate
• Getting regular checkups
• Paying attention to your symptoms so you can get treatment early if you see signs of BPH

NIH: National Institute of Diabetes and Digestive and Kidney Diseases