What is the Prostate: What Men Should Know

The prostate is a small gland found only in men. It is located under the bladder and in front of the rectum. The prostate is about the size of a walnut. It surrounds the urethra, which is the tube that carries urine and semen out of the body. The main job of the prostate is to make fluid that helps carry and protect sperm cells.

The prostate needs the hormone testosterone to grow and stay healthy. As men get older, their prostate naturally gets bigger. This is called benign prostatic hyperplasia or BPH. A bigger prostate can squeeze the urethra and cause problems with urinating. Prostate cancer and prostatitis are other common prostate problems. Keeping the prostate healthy is important for men.

What Does the Prostate Do?

The prostate has 3 main jobs:

1. It makes prostatic fluid - This fluid mixes with sperm to create semen. It gives sperm nutrients and helps them move to fertilize an egg.
2. It helps with ejaculation - Muscles of the prostate squeeze together during ejaculation. This pushes semen out of the penis and delivers the sperm.
3. It controls urine flow - The prostate surrounds the urethra. Prostate muscles also contract to control the flow of urine from the bladder.

The prostate is always making prostatic fluid. During ejaculation, the smooth muscles of the prostate squeeze rhythmically. This mixes the prostatic fluid with sperm and pushes it into the urethra. Keeping the prostate healthy means it can do its jobs for fertility and urinating.

What are the Parts of the Prostate?

The prostate has different zones surrounded by a fibrous capsule:

• Central zone - Coils around the ejaculatory ducts. It makes up about 25% of the prostate.
• Transition zone - Wraps around the urethra as it enters the prostate. This zone is 5-10% of the prostate.
• Peripheral zone - Located behind the other two zones. It is the biggest zone, about 70% of the prostate.
• Anterior zone - Fibrous tissue without glands. It separates the transition and peripheral zones.
• Prostatic capsule - A dense fibrous cover over the outer prostate surface.

Over 70% of prostate cancers start in the peripheral zone. BPH affects the transition zone. Knowing prostate anatomy helps find problems.

What are the Most Common Prostate Problems?

The main prostate conditions are:

1. Benign Prostatic Hyperplasia (BPH)

• BPH enlarges the transition zone, squeezing the urethra.
• It happens from hormone changes as men age. About 50% of men have it by age 60.
• Symptoms include weak urine flow, not emptying all the way, and peeing often.

2. Prostatitis

• Prostatitis means swelling of the prostate. It is often caused by an infection.
• Acute prostatitis causes fever, chills, and flu-like symptoms.
• Chronic prostatitis causes repeat UTIs.

3. Prostate Cancer

• Uncontrolled growth of prostate cells causes prostate cancer.
• It is the most common cancer in men except for skin cancer.
• Early prostate cancer often grows slowly and has no symptoms at first.

Keeping the prostate healthy and finding problems early is important.

What Makes the Prostate Get Bigger?

Benign prostatic hyperplasia or BPH is the most common prostate problem. BPH makes the prostate get bigger, which can block urine flow. Causes include:

• Age - BPH often starts around age 40 and gets more common as men get older. About 90% of men in their 70s and 80s have some prostate enlargement.
• Hormone changes - The prostate grows due to more DHT, which comes from testosterone. DHT tells the prostate to grow.
• Genetics - Research shows inherited genes may make some men prone to BPH. It runs in families.
• Lifestyle - Obesity, lack of exercise, and bad diet may play a role in BPH.

BPH is natural with aging and can't be prevented. Not all men with BPH have symptoms. Checking prostate health helps find problems that need treatment.

What are Signs of an Enlarged Prostate?

Symptoms of benign prostatic hyperplasia happen because the urethra is squeezed and may include:

• Weak pee stream or trouble emptying all the way
• Pushing or straining to start peeing
• Dribbling after peeing ends
• Needing to pee often, especially at night
• Sudden urges to pee
• Trouble starting to pee
• Weak urine stream

As the prostate gets bigger, it squishes the urethra like pinching a straw. This blocks urine from flowing out of the bladder. Early BPH symptoms are mild but usually get worse over time without treatment.

How do Doctors Check for Prostate Problems?

Doctors use different tests to evaluate the prostate and diagnose conditions:

• Digital rectal exam - The doctor inserts a gloved, lubricated finger into the rectum to feel if the prostate is big, tender, or abnormal.
• PSA blood test - Measures prostate-specific antigen levels. High PSA may signal prostate cancer or BPH.
• Urine tests - Check urine flow rate and look for blood, bacteria or cancer cells.
• Prostate biopsy - Taking prostate tissue samples to check for cancer under a microscope. This is the only way to confirm prostate cancer.
• Cystoscopy - Looking inside the urethra and bladder with a thin camera scope inserted through the urethra. Checks for blockages.
• Imaging tests - Ultrasound, MRI, and CT scans show the prostate to help diagnosis.

Doctors combine results from medical history, physical exam, urine tests, and sometimes imaging to decide if a prostate biopsy or other procedures are needed.

How is an Enlarged Prostate Treated?

There are several treatment options for managing an enlarged prostate (BPH):

1. Medications

• Alpha blockers relax prostate muscles to improve urine flow.
• 5-alpha reductase inhibitors shrink the prostate by blocking DHT.
• Herbal remedies like saw palmetto may help mild symptoms.

2. Surgery

• TURP removes extra prostate tissue through the urethra.
• TUIP makes cuts in the prostate to widen the urethra.
• Laser procedures use heated laser fibers to remove prostate tissue.

3. Minimally invasive treatments

• Microwave therapy uses heat applied through a catheter to shrink the prostate.
• TUNA delivers low heat energy to prostate tissue using needles.
• Stents push back the prostate and hold the urethra open.

The choice depends on symptom severity, prostate size, other medical issues, and preferences.

What is the Prostate Cancer Survival Rate?

Prostate cancer is very treatable if found early. The 5-year relative survival rate by stage is:

• Local - Nearly 100% of men live at least 5 more years if the cancer is only in the prostate.
• Distant - 30% survive 5 years if cancer has spread to distant sites like bone.

Overall, the 5-year prostate cancer survival rate rose from 68% (1975-1977) to 99% (2009-2015). Early detection and better treatments have improved survival. Screening can find prostate cancer before symptoms start.

What Raises the Risk for Prostate Cancer?

Risk factors for prostate cancer include:

• Age - Risk goes up a lot after age 50. Over 60% of cases are in men 65 or older.
• Family history - Having a father/brother with it more than doubles your risk. Genetics affect risk.
• Race - Black men in the U.S. have the highest prostate cancer rates.
• Genes - Inherited BRCA1/2 gene mutations raise risk.
• Diet - Diets high in dairy/calcium and red meat may raise risk. Lycopene-rich foods may lower risk.
• Obesity - Obese men may have faster growing prostate tumors.

Age and race can't be changed, but lifestyle factors provide chances to possibly lower prostate cancer risk.

What Foods are Good for Prostate Health?

Certain foods and nutrients may support prostate health and lower risks of BPH and prostate cancer:

• Tomatoes - Cooked tomatoes have lycopene, an antioxidant that benefits the prostate.
• Soy foods - Isoflavones from soybeans may stop prostate cancer growth factors.
• Salmon - Omega-3 fats in salmon may slow prostate cancer progression.
• Walnuts - Alpha-linolenic acid, a plant omega-3, has anti-inflammatory effects that may prevent prostate enlargement.
• Green tea - Catechins, antioxidants in green tea, have anti-cancer effects.
• Broccoli - The plant nutrient sulforaphane in broccoli has anti-cancer properties.
• Coffee - Caffeine in coffee may alter cell signaling in prostate cancer progression.

Eating more vegetables, healthy fats, and antioxidants supports prostate health as men age.

What Lifestyle Changes May Prevent Prostate Problems?

Research indicates these lifestyle steps may maintain prostate health:

• Healthy weight - Obesity leads to hormone changes that may spur prostate growth. Losing just 5-10% of weight helps.
• Exercise - Active men have lower PSA levels. Aim for 150 minutes/week of moderate exercise.
• Stress management - Chronic stress may dampen immunity. Try meditation, yoga, or deep breathing.
• Pelvic exercises - Kegel exercises to strengthen pelvic floor muscles may improve urine flow.
• Limit alcohol - Heavy alcohol use raises prostate cancer risk. Drink moderately at most.

Making positive lifestyle tweaks can potentially impact prostate health and prevent future problems.

How Do Doctors Screen for Prostate Cancer?

The main screening tests for prostate cancer are:

• PSA blood test - Measures prostate-specific antigen levels. High or rising PSA may signal cancer risk. But PSA also goes up with BPH and prostatitis.
• Digital rectal exam - Checks for lumps, asymmetry, or hard spots that may indicate cancer. But DRE only assesses some prostate regions.
• MRI - Multiparametric MRI gives detailed prostate images to visualize abnormalities. It's more accurate than PSA or DRE alone.
• Biopsy - Transrectal needle biopsy taking samples from different prostate areas is used to definitively diagnose cancer. Biopsies are guided by abnormal DRE, PSA, or MRI results.

There are uncertainties around the best screening approaches. Many groups advise discussing PSA screening for men 55-69 based on individual risk profile and preferences.

What are Signs of Possible Prostate Cancer?

Signs that may indicate prostate cancer include:

• Peeing more often, especially at night
• Weak or intermittent urine flow
• Trouble starting to pee
• Blood in semen
• Discomfort or pain with urinating or ejaculation
• Frequent constipation and straining
• Pelvic pain or discomfort

However, early prostate cancer usually has zero symptoms. Later symptoms like bone pain, fatigue or unexplained weight loss often appear after cancer has advanced. This is why regular screening is key to catching prostate cancer early when it is most curable.

Who Should Consider Prostate Cancer Screening?

Current guidelines generally recommend discussing PSA screening with your doctor if you are:

• Ages 40-45 with a family history
• Between 55-69 years old with no major health issues
• African American or have other prostate cancer risk factors

Some medical groups say men 70+ in good health may still benefit from continued screening.

Younger men with risk factors often start screening in their 40s. Older men with health problems limiting life expectancy avoid screening. Talk to your doctor about your personal screening considerations.

What are the Stages of Prostate Cancer?

The stage indicates how far prostate cancer has spread and guides treatment:

• Stage 1 - Cancer is small and located in the prostate. 5-year survival is nearly 100%.
• Stage 2 - Cancer is limited to the prostate but larger. No symptoms yet. 5-year survival remains nearly 100%.
• Stage 3 - Cancer has grown outside the prostate but not to other organs. 5-year survival still over 95%.
• Stage 4 - Cancer has spread to lymph nodes, bones, liver, or lungs. 5-year relative survival drops to 30%.

Catching prostate cancer early when still inside the prostate provides the best odds for successful treatment with surgery and radiation.

How is Prostate Cancer Graded?

Gleason scoring indicates how normal or abnormal prostate cancer cells look under a microscope:

• Score 6 - Cancer cells look similar to normal cells - least aggressive.
• Score 7 - Cancer cells appear moderately abnormal. Intermediate risk.
• Score 8-10 - Cancer cells look very abnormal. Most aggressive.

Well-differentiated, slower growing tumors have lower Gleason scores. Poorly differentiated, faster growing tumors get higher Gleason grades. This classification helps guide treatment.

What are the Main Prostate Cancer Treatments?

Common treatments for localized prostate cancer include:

• Surgery - Radical prostatectomy removes the whole prostate plus surrounding tissue.
• Radiation - External radiation beams target the prostate from outside the body. Brachytherapy implants radioactive seeds inside the prostate.
• Cryotherapy - Using extreme cold to freeze and kill cancerous prostate cells.
• Hormone therapy - Lowering testosterone fueling cancer growth using medications or orchiectomy.

Treatment options depend on cancer stage, Gleason grade, PSA levels, age, and personal preferences. Many prostate cancers grow slowly allowing time to consider choices carefully.

What are Side Effects of Prostate Cancer Treatment?

Common side effects of prostate cancer treatments include:

• Erectile dysfunction - Surgery/radiation can damage nerves for erections. Orchiectomy also reduces testosterone needed.
• Urinary incontinence - Surgical damage to the urethral sphincter can cause urine leakage. This often improves over time.
• Bowel problems - Some men have fecal incontinence or urgency after radiation.
• Fatigue - Hormone therapy may cause extreme fatigue that gets better after treatment stops.
• Osteoporosis - Testosterone deprivation therapy increases osteoporosis risk. Drugs help prevent bone loss.
• Hot flashes - Hormone changes cause hot flashes like women in menopause.

Discussing potential treatment side effects helps inform decision making. Most bothersome symptoms dissipate within 1-2 years after treatment.

What are Treatment Options for Advanced Prostate Cancer?

Options for more advanced prostate cancer include:

Hormone therapy - Lowers testosterone fueling cancer growth using drugs or orchiectomy. Most commonly used for metastatic prostate cancer.

Chemotherapy - Cytotoxic drugs like docetaxel attack rapidly dividing cancer cells. Often combined with hormone therapy.

Immunotherapy - Drugs prompting the immune system to attack cancer cells may help some patients.

Radium-223 - Radioactive drug targeting bone metastases while sparing bone marrow.

Supportive care - Managing pain, constipation, nausea and other symptoms to improve quality of life.

Treatment for advanced prostate cancer focuses on slowing cancer progression and extending life while maximizing comfort.

What is Active Surveillance for Prostate Cancer?

Active surveillance involves closely monitoring low-risk, early stage prostate cancers instead of immediate treatment. It includes:

• PSA tests and DRE exams every 3-6 months
• Repeating prostate biopsies yearly
• Watching carefully for cancer progression
• Delaying active treatment until the cancer shows signs of growth

Active surveillance avoids side effects of surgery and radiation for men whose cancer is unlikely to impact their lifespan. However, it requires dedication to close follow-up.

What is Watchful Waiting for Prostate Cancer?

Watchful waiting takes a more passive approach of observation without testing for older men or those with other illnesses. Testing and treatment only occur if symptoms arise.

Watchful waiting may be an option for:

• Men over 70 years old
• Those with serious health conditions
• Slow-growing or early stage low grade cancers
• Patients unwilling or unable to tolerate cancer treatment side effects

Watchful waiting focuses on quality of life since prostate cancer often progresses slowly.

What Lifestyle Habits Help the Prostate?

Lifestyle habits that may benefit prostate health include:

• Exercise regularly - 3 hours weekly may lower mortality. Strength training increases testosterone.
• Lose excess weight - Obesity raises prostate cancer death risk 30-50%.
• Eat more fruits and veggies - A produce-rich diet appears protective.