Prostate Conditions & Treatments

Cancer occurs when abnormal cells form a tumor (a lump of cells that grow uncontrolled). If the results of your exam and tests lead your doctor to suspect prostate cancer, a core needle biopsy will be done. A thin needle is used to remove small samples of prostate tissue. These samples are checked for cancer.

Taking Tissue Samples

A biopsy takes about 15 to 20 minutes. Before it starts, you may be given an enema or suppository to clear the bowels. Antibiotics are given at least one hour pior to the biopsy. During the procedure:

• You will be given antibiotics to prevent infection.
• You may be given a sedative, local anesthetic, or pain medication.
• A small probe is inserted into the rectum as you lie on your side. An image of your prostate can then be seen on a video monitor. This is called a transrectal ultrasound (TRUS).
• With the TRUS image as a guide, your doctor uses a thin needle to remove tiny tissue samples from several sites in the prostate.

Risks and Complications of Core Needle Biopsy

• Infection.
• Blood in urine, stool, or semen.

Benign Prostatic Hyperplasia (BPH)

The prostate is a gland that is part of the male reproductive system. It sits below the bladder and wraps around the urethra (the tube that carries urine from the bladder and out through the penis). As you age, your prostate may grow larger. BPH is when the prostate gets large enough to cause urinary problems.

The enlarged prostate may press against the urethra and cause it to narrow. This can force your bladder to work harder to empty. When this happens, some people will experience urinary symptoms. Over time your bladder may weaken and lose the ability to fully empty your bladder. This can eventually affect your kidney function as well.

Symptoms of BPH

Symptoms of BPH may vary from person to person. You may notice a few or many symptoms. These symptoms bother some people more than others. Occasionally some people may have no symptoms at all, but a lab test shows their kidney function is worsening due to their bladder not emptying. Common symptoms of BPH may include:

• Frequent urination: the need to pass urine often, more than every two hours.
• Urgency: sudden feeling you need to rush to the bathroom to urinate. You may even leak urine before you can get to the toilet.
• Intermittent stream: your urine stream may stop and start when you are urinating.
• Weak stream: you may notice a weaker flow when urinating.
• Incomplete emptying: the feeling that your bladder is full, even right after you finish urinating.
• Straining: having trouble starting your stream, feeling you need to push in order to urinate.
• Nocturia: getting up more than two times at night to urinate.

How BPH is Diagnosed

A comprehensive health history evaluation, urine sample, and a simple ultrasound of the bladder will be completed at your office visit. Your provider will determine if any additional testing is needed. Examples of testing include:

• Lab tests
• Imaging (i.e., CT scan, Ultrasound, X-ray)
• Cystoscopy (see procedures)
• Uroflow or Urodynamics testing

Treatment Options

• Watchful waiting
• Medications
• Minimally invasive procedures
• Surgery

Prostatitis

Prostatitis is a common condition in men. Prostatitis is inflammation of the prostate gland. When the prostate is inflamed, it becomes painful and swollen.  Prostatitis is divided into categories based on cause.

Symptoms:

• Difficult or painful urination.
• Frequent urination.
• Feeling like you’re “sitting on a lump.”
• Low back or groin/pelvic pain.

Types and Causes:

• Acute bacterial prostatitis has a sudden onset of symptoms due to a bacterial infection.
• Chronic bacterial prostatitis has a gradual onset of symptoms over an extended period of time (greater than three months).
• Chronic prostatitis/pelvic pain syndrome is a condition that is not well understand, but multiple factors may play a role.
• Asymptomatic inflammatory prostatitis may be found incidentally during testing. It has no known cause and does not cause symptoms.

Possible Treatments:

• Antibiotics (it may take an extended course).
• Anti-inflammatory medications.
• Warm bath or sitz bath, or heating pad.
• Avoid bladder irritants (alcohol, nicotine, spicy foods, acidic food and drinks).
• Drink plenty of water.
• Pelvic floor physical therapy.

Prostate Specific Antigen Blood Test (PSA)

PSA is a test that measures the amount of PSA in a blood sample, which is a protein released by the prostate. The PSA test is used to help in the early detection of prostate cancer. An abnormal PSA lab finding may be due to an enlarged prostate, infection, inflammation, or a recent ejaculation.

When to Begin PSA Test Screening

Routine preventative care includes the PSA lab. The American Urologic Association (AUA) suggests this is tailored to the individual based on medical and family history, beliefs, and guidelines. 

It is recommended that a baseline PSA for cancer screening be done between the ages of 45-50. People at increased risk for prostate cancer include people of black ancestry, strong family history of prostate, breast, or ovarian cancers. This group should begin screening between the ages 40-45 years of age.

We recommend annual screening through the age of 69. Some may continue yearly screening if they have a life expectancy of greater than ten years.