What is prostatitis and how is it treated?
What is enlarged prostate or BPH?
How is BPH treated?

What is prostatitis and how is it treated?

Several tests, such as DRE and a urine test, can be done to see if you have prostatitis. Correct diagnosis of your exact type of prostatitis is key to getting the best treatment. Even if you have no symptoms you should follow your doctor's advice to complete treatment.

There are four types of prostatitis:

• Acute bacterial prostatitis

  This type is caused by a bacterial infection and comes on suddenly (acute). Symptoms include severe chills and fever. There is often blood in the urine. Your PSA level (see "PSA test" on page 24) may be higher than normal. You must go to the doctor's office or emergency room for treatment. It's the least common of the four types, yet it's the easiest to diagnose and treat.

  Treatment:

  Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort. If your PSA level was high, it will likely return to normal once the infection is cleared up.

• Chronic bacterial prostatitis

  Also caused by bacteria, this type of prostatitis doesn't come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.

  Treatment:

  Antibiotic treatment over a longer period of time is best for this type. Treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that won't clear up.

• Chronic prostatitis or chronic pelvic pain syndrome

  This disorder is the most common but least understood type of prostatitis. Found in men of any age from late teens to the elderly, its symptoms can come and go without warning. There can be pain or discomfort in the groin or bladder area. Infection-fighting cells are often present, even though no bacteria can be found.

  Treatment:

  There are several different treatments for this problem, based on your symptoms. These include anti-inflammatory medications and other pain control treatments, such as warm baths. Other medicines, such as alpha-blockers, may also be given. Alpha-blockers relax muscle tissue in the prostate to make passing urine easier. Some men are treated with antibiotics in case the symptoms are caused by an undetected infection.

• Asymptomatic inflammatory prostatitis

  You don't have symptoms with this condition. It is often found when you are undergoing tests for other conditions, such as to determine the cause of infertility or to look for prostate cancer. If you have this form of prostatitis, your PSA test (see "PSA test" on page 24) may show a higher number than normal.

  Treatment:

  Men with this condition are usually not treated, but a repeat PSA test will usually be done if the PSA number is high.

"Changes happen so slowly that you don't even realize they're happening."

What is enlarged prostate or BPH?

BPH stands for benign prostatic hyperplasia.

Benign means "not cancer," and hyperplasia means abnormal cell growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer—yet the symptoms for BPH and prostate cancer

BPH affects most men as they get older. It can lead to urinary problems like those with prostatitis. BPH rarely causes symptoms before age 40, but more than half of men in their 60s and most men in their 70s and 80s will have signs of BPH.

The prostate gland is about the size of a walnut when a man is in his 20s. By the time he is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon.

The enlarged prostate can press against the bladder and the urethra. This can slow down or block urine flow. Some men might find it hard to start a urine stream, even though they feel the need to go. Once the urine stream has started, it may be hard to stop. Other men may feel like they need to pass urine all the time, or they are awakened during sleep with the sudden need to pass urine.

Early BPH symptoms take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor.

Urine flow in a normal (left) and enlarged (right) prostate. In diagram on the left, urine flows freely. On the right, urine flow is affected because the enlarged prostate is pressing on the bladder and urethra.

How is BPH treated?

Some men with BPH eventually find their symptoms to be bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms.

There are three ways to manage BPH:

• Watchful waiting (regular follow-up with your doctor)
• Drug therapy
• Surgery

Talk with your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.

Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach.

Watchful waiting means getting annual checkups. The checkups can include DREs and other tests (see "Types of Tests ¹"). Treatment is started only if symptoms become too much of a problem.

If you choose watchful waiting, these simple steps may help lessen your symptoms:

• Limit drinking in the evening, especially drinks with alcohol or caffeine.
• Empty your bladder all the way when you pass urine.
• Use the restroom often. Don't wait for long periods without passing urine.

"My doctor and I decide visit by visit about how long I should stay on watchful waiting for my BPH.

Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:

• Over-the-counter cold and cough medicines (especially antihistamines)
• Tranquilizers
• Antidepressants
• Blood pressure medicine

Drug therapy

Many American men with mild to moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s. Two main types of drugs are used. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

Alpha-blockers

These drugs (see the table on page 14) help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days. Possible side effects include dizziness, headache, and fatigue.

5 alpha-reductase inhibitor

These drugs (see the table on page 14) help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates prostate growth. When the action of 5-alpha reductase is blocked, DHT production is lowered and prostate growth slows.

This helps shrink the prostate, reduce blockage, and limit the need for surgery. Taking these drugs can help increase urine flow and reduce your symptoms. You must continue to take these drugs to prevent symptoms from coming back. 5-alpha reductase inhibitors can cause the following side effects in a small percentage of men:

• Decreased interest in sex
• Trouble getting or keeping an erection
• Smaller amount of semen with ejaculation

It's important to note that taking these drugs may lower your PSA test number. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear.

Surgery

The number of prostate surgeries has gone down over the years. But operations for BPH are still among the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked well.

Types of surgery for BPH include:

• TURP (transurethral resection of the prostate). The most common surgery for BPH, TURP accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block (anesthesia) is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer.
  
  TURP generally avoids the two main dangers linked to another type of surgery called open prostatectomy (complete removal of the prostate gland through a cut in the lower abdomen):
  • Incontinence (not being able to hold in urine)
  • Impotence (not being able to have an erection)

  However, TURP can have serious side effects, such as bleeding. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery.

• TUIP (transurethral incision of the prostate). This surgery, which is similar to TURP, is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.
• TUNA (transurethral needle ablation). Radio waves are used to burn away excess prostate tissue. TUNA helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.
• TUMT (transurethral microwave thermotherapy). Microwaves sent through a catheter are used to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.
• TUVP (transurethral electroevaporation of the prostate). An electrical current is used to vaporize prostate tissue.
• Laser surgery. The doctor passes a laser fiber through the urethra into the prostate, using a cystoscope, and then delivers several bursts of laser energy. The laser energy destroys prostate tissue and helps improve urine flow. Like TURP, laser surgery requires anesthesia. One advantage of laser surgery over TURP is that laser surgery causes little blood loss. The recovery period for laser surgery may be shorter too. However, laser surgery may not be effective on larger prostates.
• Open prostatectomy. This may be the only option in rare cases, such as when the obstruction is severe, the prostate is very large, or other procedures can't be done. General anesthesia or a spinal block is used, and a catheter remains for 3 to 7 days after the surgery. This surgery carries the highest risk of complications. Tissue is sent to the laboratory to check for prostate cancer.

Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure. For a list of questions to ask, see Checklist of Questions for Your Doctor ².

Glossary Terms

Symptoms or signs that begin and worsen quickly; not chronic.

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A substance that relaxes muscle tissue in blood vessels and in the prostate gland, which improves the flow of urine and blood. Alpha-blockers are used to treat the symptoms of many conditions, such as benign prostatic hyperplasia (BPH), high blood pressure, and some blood circulation problems. Also called alpha-adrenergic antagonist.

A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep.

A drug used to treat infections caused by bacteria and other microorganisms.

A drug used to treat depression.

A type of drug that blocks the action of histamines, which can cause fever, itching, sneezing, a runny nose, and watery eyes. Antihistamines are used to prevent fevers in patients receiving blood transfusions and to treat allergies, coughs, and colds.

A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.

Not cancerous. Benign tumors may grow larger but do not spread to other parts of the body. Also called nonmalignant.

The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).

A substance found in the leaves and beans of the coffee tree, in tea, yerba mate, guarana berries, and in small amounts in cocoa. It can also be made in the laboratory, and is added to some soft drinks, foods, and medicines. Caffeine increases brain activity, alertness, attention, and energy. It may also increase blood pressure, heart rate, breathing rate, and the loss of water from the body in urine.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.

A thin, tube-like instrument used to look inside the bladder and urethra. A cystoscope has a light and a lens for viewing and may have a tool to remove tissue.

A hormone made from testosterone in the prostate, testes, and certain other tissues. It is needed to develop and maintain male sex characteristics, such as facial hair, deep voice, and muscle growth. High amounts of dihydrotestosterone may increase the growth of prostate cancer and make it harder to treat. Also called androstanolone and DHT.

In medicine, a fluid that comes out of the body. Discharge can be normal or a sign of disease. Discharge also means release of a patient from care.

The release of semen through the penis during orgasm.

A protein that speeds up chemical reactions in the body.

In medicine, the swelling of the penis with blood, causing it to become firm.

A temporary loss of feeling and a complete loss of awareness that feels like a very deep sleep. It is caused by special drugs or other substances called anesthetics. General anesthesia keeps patients from feeling pain during surgery or other procedures.

Refers to the genitalia (external and internal sex organs and glands).

The area where the thigh meets the abdomen.

An abnormal increase in the number of normal cells in an organ or tissue.

In medicine, refers to the inability to have an erection of the penis adequate for sexual intercourse. Also called erectile dysfunction.

Inability to control the flow of urine from the bladder (urinary incontinence) or the escape of stool from the rectum (fecal incontinence).

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

One of a pair of organs in the abdomen. Kidneys remove waste from the blood (as urine), produce erythropoietin (a substance that stimulates red blood cell production), and play a role in blood pressure regulation.

A device that forms light into intense, narrow beams that may be used to cut or destroy tissue, such as cancer tissue. It may also be used to reduce lymphedema (swelling caused by a buildup of lymph fluid in tissue) after breast cancer surgery. Lasers are used in microsurgery, photodynamic therapy, and many other procedures to diagnose and treat disease.

Blockage of a passageway.

A medicine that can be bought without a prescription (doctor's order). Examples include analgesics (pain relievers) such as aspirin and acetaminophen. Also called nonprescription and OTC.

A doctor's order for medicine or another intervention.

A laboratory test that measures the amount of prostate-specific antigen (PSA) found in the blood. PSA is a protein made by the prostate gland. The amount of PSA may be higher in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate.

By or having to do with the rectum. The rectum is the last several inches of the large intestine closest to the anus.

In males, the external sac that contains the testicles.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

A temporary loss of feeling in the abdomen and/or the lower part of the body. Special drugs called anesthetics are injected into the fluid in the lower part of the spinal column to cause the loss of feeling. The patient stays awake during the procedure. It is a type of regional anesthesia. Also called SAB, spinal anesthesia, and subarachnoid block.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

A hormone made mainly in the testes (part of the male reproductive system). It is needed to develop and maintain male sex characteristics, such as facial hair, deep voice, and muscle growth. Testosterone may also be made in the laboratory and is used to treat certain medical conditions.

A group or layer of cells that work together to perform a specific function.

The organs of the body that produce and discharge urine. These include the kidneys, ureters, bladder, and urethra.

Closely monitoring a patient's condition but withholding treatment until symptoms appear or change. Also called active surveillance, expectant management, and observation.