Understanding prostate disorders

What is the prostate?

The prostate is a small gland in men. It is part of the male reproductive system. The prostate is about the size and shape of a walnut. It sits low in the pelvis, below the bladder and just in front of the rectum. The prostate helps make semen, the milky fluid that carries sperm from the testicles through the penis when a man ejaculates. The prostate surrounds part of the urethra, a tube that carries urine out of the bladder and through the penis.

How does the prostate change as you get older?

The prostate gland surrounds the tube (urethra) that passes urine. This can be a source of problems as a man ages because:The prostate tends to grow bigger with age and may squeeze the urethra or a tumor can make the prostate bigger These changes, or an infection, can cause problems passing urine.

Tell your doctor if you:

• Are passing urine more during the day
• Have an urgent need to pass urine
• Have less urine flow
• Feel burning when you pass urine
• Need to get up many times during the night to pass urine

What prostate changes should you be aware of?

Growing older raises your risk of prostate problems. The three most common prostate problems are:

• Infection (prostatitis)
• Enlarged prostate (BPH, or benign prostatic hyperplasia)
• Prostate cancer

One change does not lead to another. For example, having prostatitis or an enlarged prostate does not raise your chance of prostate cancer. It is also possible for you to have more than one condition at the same time.

What are common tests for prostate changes?

Health history and current symptoms

This first step lets your doctor hear and understand the “story” of your prostate concerns. You’ll be asked about whether you have symptoms, how long you’ve had them, and how much they affect your lifestyle. Your health history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.

Digital rectal exam

DRE is the standard way to check the prostate. With a gloved and lubricated finger, your doctor feels the prostate from the rectum. The test lasts about 10-15 seconds.

This exam checks for:

• The size, firmness, and texture of the prostate
• Any hard areas, lumps, or growth spreading beyond the prostate
• Any pain caused by touching or pressing the prostate

The DRE allows the doctor to feel only one side of the prostate. A PSA test is another way to help your doctor check your prostate.

PSA (Prostate-Specific Antigen) test

PSA is a protein made by normal cells and prostate cancer cells. It is found in the blood and can be measured with a blood test. PSA tests are often used to follow men after prostate cancer treatment. PSA testing is still being studied to see if finding cancer early lowers the risk of dying from prostate cancer.

PSA levels can rise if a man has prostate cancer, but a high PSA is not proof of cancer. Other things can also make PSA levels go up. These may give a false positive test result. These include having BPH or prostatitis, or if the prostate gland is disturbed in any way (riding a bicycle or motorcycle, a DRE, orgasm within the past 24 hours, and prostate biopsy or surgery can disturb the prostate). Also, some prostate glands naturally produce more PSA than others. PSA levels go up with age. African-American men tend to have higher PSA levels in general than men of other races.

Researchers are trying to find more answers about:

• The PSA test’s ability to tell cancer from benign prostate problems
• The best thing to do if a man has a high PSA level

For now, men and their doctors use PSA readings over time as a guide to see if more follow-up is needed.

PSA levels are measured in terms of units per volume of fluid tested. Doctors often use a score of 4 nanograms (ng) or higher as the trigger for further tests, such as a prostate biopsy.

Your doctor may monitor your PSA velocity, which means looking at the rate of change in your PSA levels over time. Rapid increases in PSA readings can suggest cancer. If you have a mildly elevated PSA, you and your doctor may choose to check PSA levels on a scheduled basis and watch for any change in the PSA velocity.