Middle-Aged Men Confront Prostate Problems

Here's some information about prostate problems (andsolutions).Growth is commonThe prostate is a round gland that's underneath the bladderand 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 prostatichyperplasia -- is "as common a part of aging as gray hair," accordingto the National Institutes of Health, which says the condition sent 4.5million men to their doctors in 2000.That number is bound to increase as baby-boom men hit theirsenior years, said Joe Turner, a urology nurse practitioner at theMedical University of South Carolina.An enlarged prostate might not cause symptoms and isn'tnecessarily a crisis. But it can be, if the gland grows to the pointwhere it blocks the flow of urine. It can lead to serious bladder andkidney ailments.More commonly, urination may become difficult, more frequentor more urgent. As with the guy in the commercials with the "goingproblem," that can interfere with a man's normal activities and sociallife.Surgery to remove some tissue from the prostate -- which canreach the size of an orange or larger -- has been the time-honoredtreatment.

In a procedure called transurethral resection of the prostate(TURP for short), the surgery is done through an instrument insertedthrough the penis."About one in four men would have some sort of procedure forthis, before the (prostate) medicines came out," said Dr. John Woffordof Columbia Urological Associates.Now, Wofford said, most urologists probably perform only about20 to 25 TURP procedures a year. Usually, men whose enlarged prostatesare causing problems will try medication first: Avodart (dutasteride) works by lowering the level of thehormone dihydrotestosterone, which in turn can shrink the prostategradually. An earlier drug, Proscar (finasteride), is similar. Flomax (tamsulosin) is one of several drugs that work byrelaxing muscles in the prostate and the neck of the bladder, helpingurine flow more easily. It doesn't change the size of the prostate, butmay 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, medicationscan help men avoid surgery."If you are 75 and this could stop you from having surgery forseven years, in all likelihood that's the rest of your life," Turnersaid.

Prostate cancerA man who seeks treatmentfor problems caused by an enlarged prostatemay have tests including an examination of the prostate (which a doctorcan feel by checking through the rectum), tests of urine flow andvolume, and possibly ultrasound imaging.A major ailment that must be ruled out is prostate cancer.Thoughit 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 ashigh in black men compared to white ...Early prostate cancer usually does not cause symptoms, butwhenthe disease is advanced, it may cause symptoms similar to those of anenlarged prostate. Prostate cancer screening is recommended at age 50for 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 testfora protein found in the blood. A recent study did back the notion that arapidly rising PSA could signal more aggressive cancer.There's also debate on whether older men should be screened,onwhether surgery is advisable in some cases since it may cause impotenceand incontinence, and on when a strategy of "watchful waiting" makessense.Men need to read up on the options and discuss them with theirdoctors.

"You have to figure out what works best ... for the person andhis stage of life," Turner said.Surgical techniques and other treatments -- such as targetedradiation now offered at Lexington Medical Center in Columbia, S.C. --are focusing more on removing the cancer while preserving a man'sability to have sex and urinate normally.The robotic assisted prostate surgery O'Kelly is doing letshimoperate through five small incisions rather than one larger one. Sofar, he said, subsequent rates of impotence and incontinence aresimilar to those of regular surgery, but patients benefit from shorterhospital stays and lower rates of infection.The first man to have robotic prostate surgery in SouthCarolina was O'Kelly's patient Michael Best, who came to Florence,S.C., all the way from Chicago. Best, who sang for 22 seasons with theNew York Metropolitan Opera, has a home in Florence but was teaching inChicago when his prostate cancer was discovered.Best recalled that a cousin who had prostate surgery "waspractically immobile for two months. I was up and walking the next dayand they sent me home."When his prostate was removed, so was his cancer, said Best,67."We caught it, fortunately, at the earliest stage," he said."Fortunately" is right: Men whose prostate cancer is foundearlyhave a five-year survival rate of about 100 percent, compared with 33.5percent when the cancer has spread significantly.

Now, along with all those TV commercials, Best's male friendscan count on him to remind them about paying attention to earlydetection and prostate health."I was surprised to learn how common prostate cancer is," hesaid. "I'm preaching this to my friends."Prostate healthInformation on some problems that can affect the prostate: Prostate enlargement is common as men age, especiallyafter 50. Insome cases it can cause problems with urination (trouble starting tourinate, or frequent or urgent urination). Medications such as Avodart may shrink the prostate bylowering levels of a male hormone. Side effects may include impotenceand breast tenderness. Medications such as Flomax may help urinary symptoms byrelaxing prostate and bladder muscles. Side effects may includedizziness and retrograde ejaculation (semen flows back into thebladder). Prostatitis involves painful inflammation and swelling ofthe prostate, which may be treated with antibiotics and othermedications. Prostate cancer is the most common cancer in men and theNo. 2 cancer killer in men. More than 65 percent of cases are diagnosedin men 65 and older, with black men at increased risk. Annual prostate screening -- including a digital rectalexam and PSA blood test -- is recommended for white men starting at age50, black men at 45. There is evidence that obesity increases a man's risk forprostate cancer. For more information: www.nih.gov, www.cancer.org,www.ustoo.org.Sources: National Institutes of Health, American Cancer Society, MerckManual of Medical InformationSource: The State(Columbia, S.C.). Powered by Yellowbrix.