The main role of the gland is to add vital nutrients and fluid to the sperm. As the gland enlarges from normal growth or from cancer, it may cause narrowing of the urinary passage making it difficult to urinate.

The three most common types of prostate disease are benign prostate hyperplasia (BPH), prostatitis and prostate cancer.

1. BENIGN PROSTATE

HYPERPLASIA (BPH)

BPH is the abnormal growth of benign (non-cancerous) prostate cells. In BPH, the prostate grows larger and pushes against the urethra and bladder, blocking the normal flow of urine. Although this condition is seldom a threat to life, it may require treatment to relieve symptoms.

Symptoms include:

Poor urine stream
Interrupted urine stream
Incomplete emptying of bladder
Difficulty in initiating urination
Waking up often at night to pass urine
Unable to hold bladder (urgency)
Passing urine too frequently during the day

Patients should be seen by a doctor who will then determine if they need to be treated. Patients who suffer from severe symptoms and are not treated may suffer from complications which may include:

Unable to pass urine at all (retention of urine)
Urine infection
Blood in urine (hematuria)
Damage to kidneys (renal failure)

If detected early, many patients can be treated with medication, which is usually taken once at night. If medication does not work, or if symptoms are more severe after taking them, patients may have to undergo surgery known as transurethral resection of prostate (TURP).

2. PROSTATITIS

Prostatitis is inflammation or infection of the prostate gland. Prostatitis can be difficult to diagnose, in part because its signs and symptoms often resemble those of other conditions, such as bladder infections, bladder cancer or prostate enlargement due to benign or cancerous growth of the prostate.

There are several types of prostatitis:

Category 1 or acute bacterial prostatitis.
Category 2 or chronic bacterial prostatitis.
Category 3 includes the conditions previously known as non-bacterial prostatitis, prostatodynia and chronic pelvic pain syndrome.
Category 4 or asymptomatic inflammatory prostatitis.

Symptoms

These vary depending on the type of prostatitis.

They include:

Fever and chills
Flu-like symptoms
Pain in the prostate gland, lower back or groin
Urinary problems, including increased urinary urgency and frequency, difficulty or pain when urinating, inability to completely empty the bladder and blood-tinged urine
Excessive urination during the night (nocturia)
Pain in the lower back and genital area
Frequent and urgent need to urinate

3. PROSTATE CANCER

It is the most common cancer among men worldwide. In Asia the incidence is 1.9 cases for every 100,000 men. Eighty-five per cent of them are diagnosed after the age of 65, but it can occur in younger patients.

Risk factors:

Family history
Diet (low fibre, high meat) and obesity

Most cases have no symptoms during the early stages. Patients with lower urinary tract symptoms are usually screened for prostate cancer. The symptoms are similar to that of BPH such as:

Poor urine stream
Interrupted urine stream
Incomplete emptying of bladder
Difficulty in initiating urination
Waking up often at night to pass urine
Unable to hold bladder (urgency)
Passing urine too frequently during the day

Screening for prostate cancer will include a blood test (prostate-specific antigen or PSA), which is a tumour marker for prostate cancer, and an examination by a doctor.

Abnormal results will require further tests, which include a biopsy of the prostate - usually an outpatient procedure.

If detected early (when the cancer is confined within the prostate), the patient can be cured. There are various options for treatment which include:

Prostate surgery (radical prostatectomy) which is done using a minimal invasive technique (robotic surgery) that reduces hospital stay
External beam radiation therapy
Brachytherapy (implantation of a radioactive seed into the prostate)

If the cancer is not detected early, it will spread to surrounding structures such as the bladder and rectum, or it can spread to distant sites, i.e. bones.

In such cases the patient can't be cured. However, the cancer can be controlled through hormonal manipulation, i.e. by reducing testosterone levels through castration or medication.

[Readers are advised to always consult expert advice on the issues raised here. NST and AsiaOne do not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. NST and AsiaOne disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.]

The New Straits Times/Asia News Network

This story was first published in the New Straits Times on July 28, 2008.