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About the Prostate—Part II

HEALTH DR QUIROZ

By Salvador Quiroz

Last week, you read some generalities about the prostate gland, prostatitis, and the beginning of benign prostatic hypertrophy (BPH).

BPH is defined as the noncancerous growth of the prostate. It is common for the prostate to enlarge as men get older, and symptoms usually appear after age 55. Currently, treatments for BPH are aimed at reducing prostate volume with surgery, microwave therapy, or drug therapy. The transurethral resection of the prostate (TURP), or reaming, is the standard treatment for BPH. It removes prostate tissue and reduces pressure on the urethra. However, TURP surgery comes with the risks that are typically associated with anesthesia and any surgical procedure. Other complications associated with TURP include bleeding, infection, impotence, and incontinence. Another option available is nonsurgical treatment with medications whose action is directed at relaxing the smooth muscle tissue in the prostate and the outlet of the bladder. These medications, which your doctor would know about, are relatively new and quite effective. I must stress, however, that although they make it easier to urinate, they do not reduce the size of the prostate.

BPH does not appear to increase a man’s chance of developing prostate cancer. On the other hand, successful treatment of BPH does not reduce the risk of prostate cancer either. It is possible, and certainly not uncommon, for a man to have both BPH and prostate cancer at the same time.

Prostate cancer

According to the American Cancer Society (ACS), 164,690 men are expected to develop prostate cancer in 2018. Risk factors for developing prostate cancer include age, ethnic background, family history, and—potentially—lifestyle and environmental factors. As men age, the risk of prostate cancer increases. African American men have a significantly increased risk of developing this disease when compared to other racial or ethnic groups in the United States. Mayo Clinic research has shown that men with immediate family members with prostate cancer are twice as at risk as the average American male.

 

Evaluation

While prostatitis and BPH are not life-threatening, it is essential that a physician investigate any change in the prostate, both to rule out cancer and to treat any symptoms that can be alleviated. Differentiating between prostatitis, BPH, and prostate cancer can be quite challenging. The digital rectal examination (DRE) remains the key test for identifying prostate abnormalities. The DRE should be included in an annual check-up. If any abnormality is found, your physician may want to check you three or four times a year. It is advisable to have the same physician perform the DRE because although the written statements and descriptions found in your medical chart are useful, the details in your doctor’s memory are even more so.

Advances in ultrasound imaging enable the physician to painlessly visualize the prostate. Ultrasound can be used to help identify abnormalities in the prostate tissue, guide the surgeon during prostate biopsy, and measure and document the size of the prostate. A urine test may be necessary to rule out or confirm the presence of inflammation or infection of the prostate, urethra, or bladder.

Prostate-specific antigen (PSA), first approved by the Food and Drug Administration in 1986 as a monitoring tool for prostate cancer, is now approved as a screening tool for the detection of this disease. Although a safe, simple blood test makes PSA more attractive to patients than any other procedure, the DRE, ultrasound, and urine test are also paramount.

Dr. Salvador Quiroz, Internal Medicine and Kidney Disease, Hospital H+, Graduated from the Mayo Clinic. Tel: 152 2329.

 

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