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Keep your nut healthy


A medical professional talks about an obscure but important organ called the prostate.

By Ivan Olegario, M.D.

 
JUNE 2013 


My best friend from high school gave me a book of tips for new doctors. One of its aphorisms says, “If a man comes to visit you, there is a woman forcing him to do it.” Sexism aside, a man, with his machismo, is the last person to admit that his body is failing him.

But imagine an organ in men that, when diseased, can a) disrupt not just urination, but also sexual prowess occasionally, b) require screening by examination of a man’s behind, and c) has a connotation of old age. If it’s difficult enough to get a guy to go to the doctor for a cough, how much more for such a condition?


The “guardian” gland

What I’m talking about is the obscure male organ called the prostate gland. It’s so taboo that there isn’t even a Filipino word for it. But its name is derived from the Greek word, prostates, meaning “guardian” or “protector.” And if a guy comes to a doctor with signs of a sick prostate, attention must be paid because this was not an easy thing for him to do.

The prostate gland is an almond-sized organ that sits under the urinary bladder. The uretha, which channels the urine from the bladder to the outside environment, passes through the prostate, as if the prostate is “protecting” the urethra.

The prostate gland’s main function is the production of a slightly alkaline fluid that forms majority of the volume of semen. The alkalinity of semen neutralizes the acidity of the vaginal tract, which helps the sperm survive the trip. Prostatic secretions also seem to improve the motility of sperm and helps protect the genetic material stored within.


Prostate problems

The prostate, on occasion, can become diseased. The three most common diseases of the prostate are: prostatitis, benign prostatic hyperplasia and prostate cancer.

Prostatitis

Prostatitis is when the prostate gland becomes inflamed. Men with prostatitis can suffer from pain in the pelvis or perineum—the area around the anus and genitals. The pain may radiate to the back. Occasionally, patients may also complain of a burning sensation during urination, mimicking urinary tract infection (UTI). Those with UTI, however, also have frequent urination and increased urgency to urinate, which aren’t present in prostatitis. Others complain of low libido, trouble getting erections, or pain after ejaculation.

Sometimes, prostatitis is caused by a bacterial infection, but a majority of cases show no inflammation. A urinalysis can help differentiate a UTI from prostatitis. Furthermore, your doctor can do a digital rectal examination, during which the prostate can be massaged to express prostatic secretions that can be examined for pus or bacteria.

When infection is present, prescription antibiotics will be prescribed. However, in the absence of an infection, your doctor can recommend a variety of approaches to reduce the inflammation and pain. These approaches include prescription medications, physical therapy, psychotherapy or surgery.


Benign prostatic hyperplasia (BPH)

BPH is a disease of the elderly. In BPH, the prostate enlarges to the point that the urethra that runs through it is compressed, obstructing urine flow and making urination difficult. Others complain about frequent urination, or difficulty initiating urination. A rectal exam or a transrectal ultrasound can reveal an enlarged prostate.

Patients with BPH should avoid alcohol and caffeine, to help regulate urination. Oral prescription medications to relax the smooth muscles within the prostate, and to help slow down enlargement, may help.

In some instances, medications don’t work. For these, non-surgical methods using sclerotherapy, microwave treatment or radiofrequency energy may help reduce the size of the prostate and widen the urethra. If these methods fail, surgery can be a last resort.

Some alternative treatments, such as saw palmetto, seem to hold promise, but more studies are needed to fully evaluate their efficacy.

Lastly, eating a diet low in fat and red meat, and high in protein and vegetables seems to protect against BPH.


Prostate cancer

The prostate can also develop cancer. Prostate cancer is one of the leading causes of death among elderly men. The only test that can fully confirm prostate cancer is a biopsy, wherein a small part of the prostate is removed and examined under the microscope. The official position of the American Cancer Society when it comes to screening—testing among males who have no symptoms—for prostate cancer is, “Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment.” It recommends that men aged 50—or 45 if a brother or father suffered from prostate cancer before age 65—should discuss the risks and benefits of screening with a doctor. Before a biopsy can be done, less invasive tests such as a rectal exam, transrectal ultrasound, or a blood test for prostate specific antigen can help show the likelihood of having prostate cancer to help you decide if a biopsy should be done.

Treatment of prostate cancer depends on the stage of the disease and the aggressiveness of the tumor. Those with slow-growing, low-grade forms—which happens in approximately half of the cases—may not even need treatment. Those with severe disease or aggressive tumors, however, may require surgery, radiation therapy and chemotherapy or hormonal therapy.


If you suspect that you could have a problematic prostate, remember that it isn’t macho to see your doctor when it’s already too late. Find out more about prevention and screening options in the June issue of
HealthToday magazine, available at bookstores and magazine stands.







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