OP: Prostate Health

Some doctors consider it high humour to tell male patients, “If you are fortunate, you will live long enough to develop prostate cancer.” And, older, say seventies and up, upon diagnosis are told, “We shall watch it until you die of something else.” These statements are accurate and reflect the good practice medicine but hide deeper truths. Prostate cancer in older patients is lazy, slow growing and tends to not metastisise to other organs; it is not a real threat. Prostate cancer in younger patients is quite different. It tends to be quite virulent and metastisises readily; it can be quite deadly. What is worse, is that prostate cancer is the fastest growing killer of middle age men.

The key, as with many cancers, is early diagnosis. We are entering an era when, caught early enough, most cancers can be treated as chronic conditions and are quite survivable. Too few men know much about danger signs or, really, what the prostate does. Where is it , anyway?

The prostate is often referred to as being about like a walnut. I do not know why because it is not the size, shape or texture of a walnut. The prostate is a gland/muscle at the bottom of the bladder when standing. The urethra passes through the prostate in route from the bladder to the exit. In a relaxed state with a healthy, youthful prostate the urine stream passes readily and forcefully. The prostate begins growth during puberty with the burst of hormones and continues to develop throughout life. By the age of fifty about half of all men have a prostate that is enlarged to the extent that it interferes with the passing of urine.

The prostate is many things. It is a series of valves and tubes that control urination or, when sexually aroused, the passage of semen and sperm. It is a storage facility for already produced sperm, from the testes, and semen, from the vas deferens, adds its own prostatic fluid and, with help of a few other muscles it calls upon, powers it all into a lucky woman. Or tissue. About sixty percent of the ejaculate is semen; ten percent, by volume, sperm; and, the remainder, prostatic fluid. The fluid that precedes ejaculation enters the urethra from ducts from the Cowper’s Glands. Whilst no sperm passes through those glands, there are always an anxious few that have left the prostate before the big call and they may be transported by the Cowper’s fluids preceding ejaculation.

As a man ages, the prostate becomes larger by expanding in all directions, including partially blocking the duct work through its center, leaving men with some difficulty in urination. A few decades ago, this condition was treated by surgically removing the prostate. About twenty years ago, this gave way to inserting a scraper through the urethra (under anesthesia) to trim the interior. Today, there are a variety of drugs, including an older heart medication, that alleviate the problem in many cases. This problem is a natural effect of aging and all men should anticipate this problem at some point.

The most commonly reported urinary symptom in younger men is painful or burning urination. This should be checked out because it is almost always a result of a urinary tract infection. This usually begins in the urethra and, if treated, spreads no further and does no harm. Other than the burning sensation, the most common symptom is blood in the urine. Left untreated or ignored because “it went away” it will spread either to the bladder or, more commonly, the prostate. Either can become a serious problem. Once established in the prostate, the infection is more difficult to treat but the patient cannot usually tell the difference between pain in the urethra or the prostate. The only indication of prostatitis identifiable to the patient may be blood in the ejaculate. Some time ago a woman came to see me in an alarmed state. The night before, after sex with her husband she had had heavy bleeding. It was the middle of her cycle and she was on the pill. She put in a tampon which collected next to nothing and had no sign of menstruation the next day. I asked her to use a condom, tie the end shut, put it in the fridge and bring it in the next day. I took a vaginal swab from her and to sate her curiousity took her into the lab with me. The swab from her was normal and then I prepared a few slides of the semen in the condom. What we saw was sperm, blood cells and lots of bacteria. She said her husband would be mortified to come see me (not unusual), so, I gave her a prescription for a two week regimen and told her he needed an ejaculation every day but use condoms to avoid reinfecting him. The daily ejaculation does help: it increases blood flow to the prostate getting the antibiotic there and it also expels the bacteria.

A proper examination of him would have been to have him lean with his elbows on the exam table and insert a finger into his rectum, pressing forward. The healthy prostate has a characteristic spongy feel recognized by any advanced med student. Infected prostates become very hard; bumpy prostates require further investigation. Not usually good news. Many, if not most, men will experience urethral infection during their lives. This can indicate any of several bacterial STDs or, more commonly, it is a non-specific infection usually cause by entero-bacteria. These belong in the intestines, not in the urethra. Do not jump to conclusions about unprotected anal sex. Yes, that can do it but more commonly the bacteria have simply migrated in his drawers. The head of the penis in jockey shorts gets very close to the anus and a sweaty, hard day can easily set up the infection.

The most common lab test for cancer screening in younger men is the “PSA” which detects antigens caused by cancer cells specific to the prostate. This test is presently controversial because it has a high rate of false positives. Some NHS (or CDC) around the world have backed off their recommendations for regular PSA screening. The reasoning is that the false positives cause emotional upset for the patient and it leads to “unnecessary and expensive” further testing. My recommendation: Have the screening annually. You get upset for two weeks, big deal. It costs NHS a few quid, big deal. The alternative could be a rapidly spreading cancer ignored in its curable state.
There is no link that I know of between urinary tract infection and prostate cancer (not my area of study or practice) but it is good to develop the knowledge of your own body such that you know when something is changing and it is time to get help. Better to keep track so you last “long enough to develop prostate cancer” when you no longer need worry about it.

Addendum: Whilst the infection is the most common reason for blood in the urine for most men, those a bit older need also consider the passing of stones. Those require a bit more than a regimen of antibiotics.

OP: Brandye 06/24/2010

Posted: 23 Sep 04:23