Prostate cancer kills more than 30,000 people a year in the United States. However, with early diagnose it is possible to be cured from cancer of the prostate and have a normal life. Prostate Anatomy The prostate is a walnut sized gland that plays a role in sexual function. It is located in the lower region of the human body between the bladder and the urethra, a channel which passes through the prostate and drains the urinary bladder.

Benign Hyperplasia of the Prostate

Beginning at age 40, the prostate, under the influence of male hormones, starts to enlarge. As it gets bigger, it will squeeze the urethra that passes through it, causing problems with urination. These problems consist mostly of frequency (frequent urination), hesitancy (difficulty in starting and voiding), nocturia (getting up at night to pass urine), and sometimes urinary retention (not being able to void).

The pressure that builds up in the bladder with incomplete emptying can cause urinary infections. Back -pressure into the kidneys may result in failure of the kidneys.

Prostatitis

This is another category of prostate disease and is usually caused from inflammation of the prostate. The symptoms are lower back pain, pain in the perineum and pain in the lower part of the body.

Cancer Of the Prostate

A more serious disease is cancer of the prostate. it starts in the prostate and gradually grows from the prostate on out. It may spread by blood or lymph into the bones and if not treated, may lead to death.

Diagnosis is made most commonly by digital examination of the prostate. If a nodule or an area of increased firmness in the prostate is felt, then the following tests are usually performed:

1. Biopsy - Obtaining a sample with a needle for laboratory examination.
2. Cystoscopy - Inspecting the bladder and the prostate with a special instrument.
3. Ultrasound - Imaging with sound waves.
4. I.V.P. - X-rays of the kidney and the bladder.

If the biopsy is positive for cancer, then further studies are done to make sure the cancer is contained in the prostate. These studies are:

1. Bone Scan - A nuclear study of the bones whereby a mild radioactive chemical is injected into a vein and the bones are scanned.
2. Chest x-ray -
3. Prostate Specific Antigen - A blood test to check on the amount of prostate tissue in the blood. Normal range is less than 4 ng/mL in males.
4. Acid Phosphatase - A blood test to check if the cancer is localized.
5. Computerized Axial Tomography of the Pelvis - This is also known as a CATScan, a special x-ray to check on the enlarged lymph nodes or extension of the tumor outside the prostate. This test is optional.

If these are negative, then most probably the cancer is contained.

Treatment

1. Radical Prostatecomy - This procedure is accomplished by completely removing the prostate and removing some of the pelvic lymph nodes.  Some of the complications of prostatectomy are:
1. Sexual dysfunction - This happens only in 5% of the patients who undergo surgery for benign prostatic enlargement. However, after radical surgery for cancer, even with the newer nerve sparing techniques, sexual dysfunction is a common problem.
2. Leakage of urine. This is a very rare after surgery for benign disease, but not uncommon after prostatectomy for cancer.
2. Radiation Therapy - Recent advances in radiation therapy have made radiation a second choice in most cases. This procedure is used when the disease is advanced or if the patient cannot have surgery because of difficulties with the heart or the lungs.
   
3. TURP - For benign enlargement of the prostate which is causing difficulties in urination. This procedure is done most often without an incision by using a scope which enters through the urethra. Laser energy can be used in some cases, making the hospital stay shorter.
   
4. Open prostatecomy - This procedure is done for very large prostates using an incision in the lower part of the body.
   
5. Balloon dilation of the prostate - This procedure is experimental and results are unpredictable.
   
6. Experimental treatments - Some experimental procedures are available including hyperthermia, hypothermia and titanium stents .

Medical Treatment

1. Alpha-Blockers are medications that relax the prostate and make urination easier. An important side effect is lower blood pressure.
   
2. Proscar is a medication that may be able to shrink the prostate. However it usually takes 6 months. Side effects include sexual dysfunction and changes in the PSA which may make detection of cancer harder. Both classes of medicine need to be taken for life

In conclusion, it is important to have the prostate examined and a PSA done at least once a year in most men after the age of 40. In men which have had a prostate operation for non-malignant disease, or who are fifty years or older, a digital exam and a PSA every six months is indicated.

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