Prostate Gland Disease
The prostate gland is a mystery to most people, and doctors have not understood its function until quite recently. It is situated in the body behind the base of the penis. The bladder is above and behind the gland, and the tube which carries the urine from the bladder to the outside (the urethra) passes through the centre of the prostate. It is found only in men, and there is no female equivalent.
It is the size of a golf ball, is made of glands, fibrous tissue and muscle, and its prime purpose is the production of a secretion which makes up part of the semen a man ejaculates during intercourse. The contents of this secretion are essential for the nutrition of the sperm as they try to fertilise an egg (ovum) in the woman. Most men are totally unaware of the presence of the prostate unless it causes trouble.
The most serious disease to strike the prostate is cancer. Because this is a very slow-growing cancer, it may give no symptoms until many years after it has developed. The symptoms usually start with difficulty in passing urine, but the condition may not be diagnosed until pain occurs due to the spread of cancer to the bones of the pelvis and back.
Cancer of the prostate is rare before 50 years of age, and its incidence rises steadily with age. A very large proportion of men over 90 years of age have some degree of prostatic cancer. There are specific blood tests available that can detect most cases of prostatic cancer. It is treated with a combination of surgery, drugs and irradiation. Unless it is highly malignant, early stages of cancer of the prostate may not be treated in the very elderly, because it is unlikely to cause trouble in their life time.
Doctors can often diagnose disease of the prostate by feeling the gland. This is done by putting a gloved finger in the back passage, and the size and hardness of the gland can then be gauged.
The earlier any cancer of the gland is detected, the higher the chance of long-term survival. If the cancer is localised to the gland itself, the five-year survival rate is over 90%. With local spread, the survival rate drops to about 70%, but with spread to the bone, only 30% of patients survive five years.
Because of the discomfort, and the more serious possibility of cancer, any man who has difficulty in passing urine is risking fate if he delays having his prostate gland checked by a doctor.
Up to 20% of all men over 60 may have an enlargement of the prostate which causes difficulty in passing urine. This benign enlargement is usually associated with a drop in sexual activity. As the gland enlarges, it squeezes the urine-carrying tube which passes through it, making it steadily harder to urinate. Eventually the tube can be completely blocked, and the patient becomes extremely distressed as the pressure of urine in the bladder increases.
In the acute situation, doctors can normally pass a rubber tube through the penis into the bladder to relieve the sufferer, but sometimes a needle must be pushed through the lower wall of the abdomen, into the bladder, to release the urine. To prevent this acute situation, an operation is usually performed, although there are some medications that can relieve milder enlargements of the gland.
The operation can take several forms, from simply dilating the urine tube, to scraping away the part of the prostate constricting the tube by passing a specially shaped knife up the urine tube (trans-urethral resection of prostate, or TURP), or completely removing the gland.
In some cases, a drug called prazosin can be used to shrink the enlarged prostate slightly, and allow urine to escape more easily from the bladder.
The treatment for a benign enlargement of the prostate gland is almost invariably successful, with no subsequent effect on the sexual or general health of the patient.
Prostatitis (Prostate Infection)
In younger men, the most common cause of disease in the prostate is infection, when the gland may swell up and become very tender. Prostatitis can occur due to bacteria moving up the urethra from the outside, or uncommonly, from an infection spreading from other parts of the body. The symptoms include pain behind the base of the penis, a discharge from the penis, pain on passing urine, fever and passing urine frequently. The diagnosis can be confirmed by taking a swab from the urethra, and identifying the bacteria present.
Treatment involves a long course of antibiotics. The acute case usually settles with this treatment, but recurrences are common and a low-grade chronic infection may develop. These recurrent infections may become difficult to treat.
It is possible for the infection to spread to the man's sexual partner, in whom it may cause pelvic inflammatory disease.