While most men will be affected with prostate problems during their lifetimes, good news is prostate disease is rarely lethal if men start paying attention early enough. Annual PSA tests starting at age 50 are highly advisable to catch cancer early, the key to a high cure rate. The other prostate disorders can become severe annoyances that impact a man’s lifestyle, including a host of troublesome urinary issues from frequency to incontinence.
An Orderly Disease
There is a certain orderliness to a deteriorating prostate. Generally, first it enlarges – from walnut-sized to lemon-size to even apple-sized – often followed by a diagnosis of BPH or benign prostatic hyperplasia, which is common in the 40s and 50s. Then prostatitis may follow, frequently appearing in the 50s and 60s. Finally, but not inevitably, prostate cancer – most likely found in the 60s and 70s. But any of these disorders can appear earlier or later in life as well.
Here’s a quick primer on the prostate and related diseases.
The Prostate – What Does It Do?
The prostate begins as a walnut-sized gland, as mentioned, and it’s a crucial part of the male reproductive system, serving an important sexual function. The prostate gland secretes some of the seminal fluid that's combined with sperm during ejaculation.
Found at the base of your bladder, the prostate gland surrounds the urethra, which is the tube that carries urine from the bladder to the penis.
Enlarged Prostate and BPH
The first signs there may be a problem – the enlarged or inflamed prostrate squeezing the urethra -- is difficulty in urinating or frequent urination. This slowly progressive enlargement of the prostate can send men trudging off to the bathroom many times during the day and night.
Approximately half of all men experience symptoms of enlarged prostate and BPH by age 75.
Although BPH affects the prostate, the resulting symptoms are often called "lower urinary tract symptoms," or LUTS. These symptoms reflect not only the direct effects of the prostate on urinary flow and urgency, but functional changes in the bladder that result from the increased pressure.
Acute and Chronic Prostatitis
Prostatitis is often difficult to treat, and part of the problem is that the disease comes in several forms.
Acute prostatitis is characterized by severe flare-ups, with sudden and continuous pain that may last for several days. Rounds of antibiotics can quell the inflammation and reverse what can be very painful symptoms. But antibiotics are unlikely to eliminate all the bacteria, so the problem often reoccurs.
More common is chronic prostatitis, which may last for several weeks, only to disappear and then start up again. Frequent and painful urination are the most common symptoms. Some men even complain of painful ejaculation, others say that ejaculation provides pain relief.
Prostatitis is further differentiated by bacterial and nonbacterial causes. Most patients are thought to develop prostatitis from nonbacterial causes, which have yet to be identified.
Prostate Cancer
Prostate cancer is now the second most deadly cancer in American men, after lung cancer. The American Cancer Society estimates that in 2008 about 220,000 new cases of prostate cancer were diagnosed in the United States and approximately 31,000 men died from the disease. Prostate cancer accounts for about 11% of male cancer-related deaths.
According to John Hopkins Medicine research in 2007, autopsy studies have shown microscopic evidence of prostate cancer is 15-30% of men over the age of 50 and in 60-70% of men who reach the age of 80. Age will help determine a course of treatment, and after 75, many doctors may advise 'watchful waiting' because prostate cancer in older men generally grows more slowly than in younger men.
The underlying cause of prostate cancer is unknown. But plenty of research suggests that certain risk factors make men prone to prostate cancer, including race, being overweight, family history and a high fat diet.
Contributing background information for this article: John Hopkins Medical white papers 2007 and 2008, the New York Times online, and the American Cancer Society website
Other articles by Steve Vogel on prostate cancer risks and treatment options.
