Prostate, that little gland that can cause so much trouble.

We have heard about the Secretary of Defense Austin and King Charles and their problems with their prostates.  Here is a quick guide to understand the issues.

What is benign prostatic hypertrophy (BPH)?

This is a condition faced by men as they age. It is called BPH, and more than 80 % of men who are older than age 70 have enlarged prostates.  It makes it difficult to urinate and to have intimacy, and the condition favors urinary tract infections. There is also a suggestion that a man’s life expectancy might be shorter with BPH.  BPH can cause bladder problems, kidney disease, and other conditions. BPH is not cancer and is benign.

How should I treat BPH if I have it?

First, you should see a urologist.  After the diagnosis is made, you should limit the amount of caffeine and alcohol intake because these stimulate the need to urinate.  Also, eat a low-fat diet.  The fastest way to shrink an enlarged prostate is to do Kegel exercises.  They tighten the pelvic muscles and control urination.  There are also many suggestions regarding diets, and some of them are a bit bizarre, such as limiting egg ingestion because of the role of eggs in enhancing prostate cancer. Choline, a substance in egg yolks, is one possible culprit in causing prostate cancer (I found this to be exciting but unusual).  Most commonsense regimens include avoidance of heavy amounts of liquid before going to bed, limiting fluids before going out socially, urinating when you first get the urge, and going to the bathroom on a timed schedule regardless of your “urge” to go. (Harvard Health Review).

What kind of doctor takes care of BPH?

A surgical specialist called a urologist is the physician who cares for your enlarged prostate. S/he will test your prostate, do an ultrasound, look for residual urine, perform a rectal exam, and if suspicious, the doctor will biopsy your prostate to make sure that there is no cancer.

What makes the doctor think that there could be prostate cancer?

There are many signs of prostate abnormalities, but not all of them suggest prostate cancer. Signs and symptoms of prostate cancer usually occur late in the disease. Prostate-specific antigen (PSA) testing is an excellent way to predict prostate cancer before symptoms appear. Another way to detect prostate cancer is a rectal exam, where the doctor feels for a lump or nodule.  Of course, an MRI done on the prostate gland will help to confirm the diagnosis, and it will guide the biopsy of the prostate if needed. A unique advanced diagnostic tool available in our area is called a prostate-specific membrane antigen (PSMA) positron emission tomography (PSMA-PET scan) (Valley Hospital). This procedure can determine if prostate cancer has spread to other parts of the body.  The great news is that prostate cancer is one of the most curable cancers in men.

What is the difference between prostatitis and BPH?

Prostatitis is an inflamed and infected prostate. Men with BPH do not have an infection of the prostate. BPH is a non-cancerous enlargement of the prostate gland. Prostatitis can be a cause of erectile dysfunction (ED).

What are some symptoms of prostatitis?

Pain around the penis, testicles, anus, lower abdomen, or lower back that may be severe can be a sign of prostatitis.  You can also have trouble urinating, and you might have to start and stop urinating.  You can also urinate blood when you have prostatitis.

Is it hard to tell whether you have a urinary tract infection or prostatitis?

If you are concerned, you should see your primary care doctor or a urologist. There are a couple of things that make prostatitis the true culprit here. Pain and pressure in the perineum (the part of the groin between the testicles and the rectum), high fever, and an elevated PSA.  This strongly suggests prostatitis. Men with Cancer or BPH do not get a fever.  However, the PSA can be elevated in both cancer and when you have an infection of the prostate.