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Prevalance
In terms of health issues, the Prostate is to the Male, what Breasts are to the Female. But while women are conscious and open about Breast Cancer Awareness and Breast Health and Annual Mammograms, men tend to ignore the facts about Prostate Problems.
prostate problems
Prostate Issues include:
- Prostatitis - 10 % of men are diagnosed, and 75 % of men have it on autopsy.
- Benign Prostatic Hypertrophy - though benign, urinary symptoms interfere with daily and sexual activity that affects half of all men by age 60, and 90 % by age 85.
- Prostate Cancer - 1 man in 8 will be diagnosed with prostate cancer, which is the second cause of cancer deaths in American men behind lung cancer.
Treatment options
If you have symptoms with urination, poor stream, decreased libido or erection, and pelvic pain, then contact us at our Offices in Northern and Southern California, or on our Telemedicine site throughout California, for Evaluation and Treatment options that are discussed below
The Prostate
location of the prostate
location of the prostate
location of the prostate
The prostate is a walnut-sized gland located below the bladder and before the penis. The prostate is just in front of the rectum or lower bladder, so easily palpated by a digital rectal exam or measured by a transurethral ultrasound. The urethra from the bladder runs through the center of the prostate, and from there to the penis.
prostatic zones
location of the prostate
location of the prostate
The prostate is composed of three different tissues, called zones.
- The Peripheral Zone, where most prostate cancers start.
- The Central Zone, that surrounds the ejaculatory ducts.
- The Transitiion Zone surrounds the urethra, and this zone gets bigger with age resulting in Benign Prostate Hypertrophy or BPH.
Function of the Prostate
location of the prostate
The prostate is a male reproductive gland that produces fluids that protects and energizes the sperm during ejaculation. It works in combination with Cowper's glands, a pair of pea-size glands which open into the urethra below the prostate and at the base of the penis and secrete a constituent of seminal fluid that makes the medium alkaline and keeps the sperm alive.
Seminal fluid
Nearly a third of your ejaculum is prostatic fluids, with nutrients such as citric acid, acid phosphatase, calcium, sodium, zinc, potassium, protein-splitting enzymes, and fibrolysin.
embryonic origin of the prostate
embryonic origin of the prostate
There is some controversy of the analogous female structure, with mention of the vagina, uterus, and the Skene's glands, which are also known as the lesser vestibular glands, which are two glands located on either side of the urethra.
The Prostate - a Growing problem
embryonic origin of the prostate
For reasons not totally known, the prostate gland grows from the size of a walnut to over the size of a lemon, with the majority of the volume increase being in the Transition Zone.
Benign Prostatic Hypertrophy - BPH
prevalance
By Age 60, half of all men have an enlarged prostate. By Age 85, nearly all men have an enlarged prostate. .
Benign but disruptive
BPH or Benign Prostatic Hypertrophy does not in itself lead to Prostatic Cancer, but it does present with disruptive urinary symptoms that can interfere with lifestyle and sleep, and can affect sexual function.
Transitional zone enlargement
The majority of the enlargement of the prostate occurs in the Transition Zone, the tissue immediately surrounding the urethra. Thus the blockage of flow of urine.
medications help
A few prescriptions are helpful in the management of BPH and the urinary symptoms. Like all medications, they come with pros and cons.
Tadalafil (brand name Cialis) taken daily is not only approved by the FDA for Erectile Dysfunction, but also BPH. There is no impact on fertility, and actually an improvement in sperm motility and numbers.
5-ARIs slowly shrink the prostate so it stops pressing on the urethra. Treatment often reduces the prostate's size by one-quarter after six months to a year. The two common drugs are finasteride (Proscar) and dutasteride (Avodart). Finasteride can also increase hair growth. But Finasteride and Dutasteride should be avoided if trying to conceive, as there can be a reduction in sperm quality and count, as well as cause problems with erectile dysfunction. Women trying to conceive need to avoid contact with these drugs due to its effect on the developing fetus.
Alpha blockers relax the muscles around the prostate and the opening of the bladder, so urine can flow easier in a matter of days. Commonly prescribed drugs in this class include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo), tamsulosin (Flomax), and terazosin (Hytrin). There is decrease in sperm motility and ability to ejaculate.
Surgery
Men might elect to choose surgery to remove excess tissue from the prostate if medications do not relieve symptoms sufficiently or cause undesirable side effects, or if there are complications like urinary retention or recurring urinary tract infections However, surgery itself can result in significant side-effects or complications.
preventive measures
Prevention is the best course to take, but even with symptoms, making lifestyle and dietary changes can have a significant impact.
- Maintain an ideal body weight. Studies have shown an association with increase weight or BMI, and the size of the prostate.
- Follow the Mediterranean Diet which is high in fibre, vegetables, fruits, legumes, and low in animal fat and protein. To this end, avoid processed foods of any kind.
- Exercise regularly, especially to improve core and pelvic muscles
- Drink Green Tea and Hibiscus Tea
Prostatitis
prevalance
With 10 per cent of men being diagnosed with prostatitis in their lifetime, but over 75 per cent of men having histological evidence for prostatitis at autopsy, it is clear that Prostatitis is an under treated condition in men, that can lead to other conditions, and contribute to BPH and cancer.
location
Urinary Tract Infections are not uncommon in females, and by its very location, the prostate is obviously prone to infection. Sources can be viral or bacterial, from STD's, from the urinary tract, or from nearby lymphatics.
prostatitis symptoms and presentation
Symptoms can be vague, but can include pelvic or low back pain, pain with urination, cloudy and/or foul-smelling urine, blood in urine, urgency, frequent urination, dribbling with urination, symptoms with bowel movement, penile discharge, pain in penis or testicles, erectile dysfunction, and painful ejaculation. Lymph nodes in the groin greater than 1 cm can suggest infection.
lab and urine tests
A number of blood lab tests can be elevated such as the Prostate-specific Antigen (PSA) and inflammatory markers, as well as an abnormal urine analysis. TRUS (transrectal Ultrasound) can be abnormal and enlarged, and of value if an abscess is being considered.
antibiotic Treatment of prostatitis
Nitrofurantoin, sulfonamides, vancomycin, penicillins, and cephalosporins do not penetrate well into the prostate.
Trimethoprim (available in the US as trimethoprim-sulfamethoxazole TMP-SMZ), rifampin, are limited. Only the TMP penetrates the prostate, and its sulfa component may be nephrotoxic. Rifampin should never be used alone. It needs to be given with at least one other antibiotic to which the pathogen is sensitive, since resistance to rifampin develops quickly.
Drugs that best penetrate the prostate are the fluoroquinolones, doxycycline, minocycline (particularly effective against methicillin-resistant Staphylococcus aureus MRSA), and erythromycin. Of this group, the fluoroquinolones achieve the best tissue levels. The second-generation quinolones widely used to treat prostatic infection include ciprofloxacin, ofloxacin, norfloxacin, and levofloxacin. However, increased resistance is of concern. Erythromycin is used as a second-line agent when culture results are available.
Therapy should be continued for a minimum of 4 weeks to prevent chronic bacterial prostatitis from developing.
If therapy fails, appropriate management of chronic bacterial prostatitis is to either treat acute exacerbations or to try chronic suppressive therapy (using half-normal doses).
epididymitis therapy
For epididymitis, antibiotic treatment for patients younger than 35 years should target Chlamydia and gonococci. Ceftriaxone IM injecton 250mg, followed by doxycycline orally 100mg twice daily for 7-10 days is usually effective.
Epididymitis therapy for older men should address enteric gram-negative rods. TMP-SMZ double-strength, 1 dose twice a day, or a fluoroquinolone, can be used; a 30-day course covers concomitant prostatic infection.
When risk factors for urosepsis are present, such as fever or urinary retention, hospitalization and IV antibiotics is required.
With acute scrotum, 90% are caused by epididymitis, torsion of the spermatic chord, and torsion of a testicular appendage. Torsion of the spermatic cord must be assumed until proven otherwise, because unresolved torsion of the cord is likely to result in irreversible necrosis in less than 12 hours.
Prostate Cancer
Prevalance
According to the CDC, for every 100 American men, 13 will get prostate cancer, and about 2 to 3 of those will die from the prostate cancer. The most common risk factor is age. The average age of men at diagnosis is about 66.
Slow or Fast growing
Prostate cancer is one of the most common cancers, and if you live long enough, you will have a good chance of getting it. For most men, this means careful monitoring and conservative care for what proves to be a slow-growing tumor with the likelihood that will die from another cause. For others, when presented at a younger age in the 50's, prostate cancer can be a fast-growing tumor which quickly spreads resulting in mortality.
prevention
Diet and Weight Management can have a role in reducing the chance of prostate cancer. A diet with more fruits and vegetables, and less processed-foods plus less animal-protein and animal-fat has been shown to result in less incidence of prostate cancer.
Maintaining your a healthy weight and BMI under 25.
Regular daily exercise, including Kegel exercises..
early symptoms
LIke all cancers. early detection and monitoring is the greatest factor in successful management and treatment of prostate cancer.
Unfortunately, there are no symptoms or signs in its early stages.
As prostate cancer advances, there may be vague symptoms and signs such as:
- Pelvic pain
- Trouble urinating
- Decreased stream of urine
- Blood in the urine
- Blood in the semen
- Erectile dysfunction
- Bone pain
- Losing weight without trying
Prostate pain may present as pain around the base of the penis and behind the scrotum, pain in the lower back, and the feeling of a full rectum. As the prostate becomes more swollen, it may be more difficult to urinate, and the stream has a poor flow
detection and monitoring
Who is at risk. All men. We dare say that there are risk factors for fear that men will think it does not apply to them. It applies to every man. More aggressive prostate cancers can occur if there is a family history of prostate or breast cancer (especially with genetic BRCA1 or BRCA2 being positive), increasing age, obesity, and being of African descent.
There is no perfect lab or diagnostic test. So we have to do with what we have:
- Digital rectal exam
- Lab works including PSA and IGF-1
- Prostate Health Index (PHI) is a more accurate blood test and measures your risk for having prostate cancer. Approved by the FDA if the PSA level is between 4 and 10.
- Prostate Cancer Urine Test detects the gene PCA3 - a prostate-specific noncoding RNA only in your prostate. If the gene is “overexpressed”, then there’s a greater chance you have prostate cancer. Like PSA and PHI tests, this is not definitive, but when cancer is present, the PCA3 will be positive 80 percent.
- Genetic testing
- Transrectal Ultrasound
- MRI
- Prostate biopsy is the most definitive test, and requires taking multiple samples in a fishing trip that is improved with US or MRI-guidance
conservative vs active treatment
Depending on the stage of the prostatic cancer, there may be minimal to no care except regular monitoring. If the prostate cancer is at a higher stage or there is concern about spread, then more aggressive treatment is considered such as hormone therapy, radiation, surgery, immunotherapy, and chemotherapy. These are best handled by specialist physicians, as both prostate cancer and its treatment can cause urinary incontinenceand impotence.