Your Prostate: An owner’s manual

Editor’s note: In honor of Father’s Day, we asked Chuck Mayfield, VRMC physician assistant, to discuss prostate health. - Jean

What is a prostate?

The prostate is a gland that forms part of the male reproductive system. It is about the size of a walnut and it lies at the base of the urinary bladder. The urethra is the drain tube from the bladder to the outside of the body and runs down and through the middle of the prostate (Picture a walnut with a drinking straw through it).

What does the prostate do for a living?

Like any gland in the body the prostate secretes fluid. Prostate fluid helps sperm cells in their travel to find an egg to fertilize. When sperm are ejaculated from the testicles they pass through the prostate where they are coated with prostatic seminal fluid (semen), from there the sperm imbedded in the semen are ejaculated into the vagina. Semen changes the pH of the vagina and without semen the sperm would be killed on contact. Semen is made of a sugar and a protein (glycoprotein) and sperm cells feed on it for energy during their journey to find an egg to fertilize which may take 2 days. Another component of semen is prostate specific antigen (PSA) which liquifi es semen allowing sperm cells to swim freely from the coagulum and plays a role in dissolving the cervical mucous cap.

What is BPH?

It stands for benign prostate hyperplasia and is considered a normal aging process. After the age of 40 a DNA switch is flipped inside the body and some men's prostates become larger or more dense with prostate cells. As prostate cells proliferate they compress the urethra and block the flow of urine from the bladder (obstruction). Obstruction symptoms may include a slow stream, frequent urination, intermittent interruption of urine stream, urgency, getting up too many times a night to urinate, or difficulty starting the urinary stream. Fifty percent of men aged 60 years old show signs of BPH and that number jumps to 90% by age 85. What is the treatment for BPH?

Mr. Gene Poole has BPH causing him symptoms of obstruction, i.e., the prostate doesn't let the bladder empty. If the bladder cannot empty, then Mr. Poole always has urine left behind after every urination. A normal bladder holds approximately 16 ounces. If Mr. Poole can only urinate 10 ounces then he is always leaving 6 ounces behind. It doesn't take long to fill the bladder with 10 more ounces and he has to urinate again (frequency). Further, the obstruction causes Mr. Poole to stand there longer than normal to empty his bladder (hesitancy and slow stream), and his stream may start and stop (intermittency).

There are medicines that relax the smooth muscles of the prostate and increase urinary flow and decrease post void residual, as well as medicines that stop the BPH progression. Some men respond better to medications than others. If Mr. Poole did not want to take a daily medication he could be evaluated for an office procedure using a local anesthetic to remove the prostatic obstruction, or a more involved surgical procedure using general anesthesia to alleviate his symptoms.

What is my healthcare provider doing when he/she checks my prostate?

The prostate is not in the rectum, but the posterior prostate can be felt through the rectal wall. The practitioner is using his/her finger to check the size of your prostate, tenderness, asymmetry, abnormal nodules, or firmness which may indicate a serious problem such as prostate cancer. Remember, the normal prostate is the size of a walnut. When I check a prostate my index finger checks the left side (should be 1 finger wide) and then the right side (should be 1 finger wide). If the prostate is 3 fingers wide, or larger, I recommend to the patient that he start one of the medications that stop the BPH progression. Remember, 50% of men age 60 years have symptoms and that number jumps to 90% by age 85. What is prostate cancer?

Normally, prostate cells grow and divide to form new cells as the prostate needs them. Old cells die and new cells take their place in physiological balance. Prostate cancer occurs when prostate cells become abnormal and multiply outof control to form a tumor. Prostate cancer is usually asymptomatic, but can mimic BPH symptoms. Cells from the tumor can spread to other parts of the body, usually the bone, via the blood stream or lymph nodes. Once in the bone, the prostate cancer cells form a new tumor that causes bone marrow suppression, anemia, fractures or pain. Complications of bone marrow suppression eventually leads to death. Prostate cancer is the most common non-skin cancer among men in the United States. Median age at diagnosis is 67 years and 192,000 men were diagnosed last year. About 1 man in 6 will be diagnosed with prostate cancer in their lifetime, and prostate cancer kills 3 men every hour in the United States. Some famous men who have died from prostate cancer include Telly Savalas (70), Frank Zappa (52), and Merv Griffin (82).

Is there a test for prostate cancer?

No, but there is a blood test called PSA. PSA is present in small quantities in the serum of the normal men and when elevated may signal prostate cancer or other prostate abnormalities. When should a man have his PSA blood test?

Native Americans, Asians, Blacks and Hispanics begin annual blood test at 40 years old. Whites begin at 50 years old unless they have a father, or brother, with prostate cancer, then they start at 40 years old. It's an annual test until the age of 80 years old. A PSA 0-2.5 ng/ml is normal for men in their 40's and 50's. A PSA 0-4 ng/ml is normal for men in their 60s and older.

Does an elevated PSA mean I have prostate cancer?

No. BPH, prostatitis, catheterization, urinary tract infections and ejaculation can cause an elevated PSA. Only a positive prostate biopsy can confirm prostate cancer.

Does a normal PSA mean that I do not have prostate cancer?

No. Twenty percent of men with normal PSA levels were found to have prostate cancer at biopsy.

What is the treatment for prostate cancer?

Treatment options vary according to age at diagnosis and present health status. They include watchful waiting, hormonal therapy, cryotherapy, brachytherapy, radioactive seed implants, radiation therapy and surgical removal of the prostate.

Is there anything I can do to guarantee a healthy prostate?

Like Clint Eastwood says, "If you want a guarantee, buy a toaster!" So there are no guarantees, but there is data that suggests that healthy prostates are the product of a healthy life style using a heart healthy diet and plenty of exercise. If you smoke, QUIT!

If you're taking cholesterol medications to increase your HDL (good cholesterol) and lower your LDL (bad cholesterol) stick with the program. Follow-up annually for your PSA test and digital rectal exam so that any abnormals can be found early. It's a lot easier to stamp out a campfire than it is to put out a 10,000 acre forest fire, so early detection is the key. Some famous survivors of prostate cancer include Robert DeNiro, Colin Powell, Sen. Bob Dole, Rudy Giuliani, Nelson Mandela and Harry Belafonte.

What are the points to remember?

Prostates get larger as you get older. Symptoms of an enlarged prostate can be managed. Prostate cancer is treatable if found early. To find it early get an annual digital rectal exam and a PSA blood test and I said that out loud 3 times.

I hope this information helps. If you would like specific questions answered, you may contact Dr. Samuel Kriegler, or myself, at the Virginia Regional Medical Center, Urology Department at 218-742- 8640.

Chuck Mayfield is a physician assistant in the urology department of Virginia Regional Medical Center in Virginia.