Understanding Prostate Changes

The prostate is a walnut-shaped gland found only in men. It lies in front of the rectum, sits just below the bladder where urine is stored, and surrounds the tube that carries urine from the body (urethra). The gland functions as part of the male reproductive system by making a fluid that becomes part of semen, the white fluid that contains sperm.
Three main problems can occur in the prostate gland: inflammation or infection, called prostatitis; enlargement, called benign prostatic hyperplasia (BPH); and cancer.
Prostatitis is a clinical term used to describe a wide spectrum of disorders ranging from acute bacterial infection to chronic pain syndromes affecting the prostate, says Regina Alivisatos, M.D., a medical officer in the FDA's Center for Drug Evaluation and Research (CDER).
There are four main types of prostate syndromes. Acute bacterial prostatitis, although the least common of the four types, is the easiest to diagnose and treat. This form, Alivisatos says, is caused by bacteria and comes on suddenly. "It's not something a doctor or patient would miss. It hurts, and there are a lot of white blood cells and bacteria in the urine," she says. Symptoms include chills and fever, pain in the lower back and genital area, and burning or painful urination.
Chronic bacterial prostatitis also is caused by bacteria, but does not come on suddenly. The only symptom a man may have is bladder infections with the same bacteria that keep coming back. The cause may be a defect in the prostate that allows bacteria to collect in the urinary tract. Usually, the prostate is normal or somewhat tender on exam.
Chronic (nonbacterial) prostatitis-chronic pelvic pain syndrome is the most common, but least understood, form of prostatitis. Found in men of any age from the late teens on, the symptoms go away and then return without warning, and may be inflammatory or noninflammatory. In the inflammatory form, urine, semen, and other fluids from the prostate show no evidence of a known infecting organism, but do contain the kinds of cells the body usually produces to fight infection. In the noninflammatory form, no evidence of inflammation, including infection-fighting cells, is present.
Asymptomatic inflammatory prostatitis is the diagnosis when there are no symptoms, but the patient has infection-fighting cells in the semen. It is often found when a doctor is looking for causes of infertility or is testing for prostate cancer.
According to the NCI, prostatitis is not contagious, and the vast majority of cases are not spread through sexual contact. Only a doctor can tell one form of prostatitis from another.
BPH, or benign prostatic hyperplasia, is the second main problem that can occur in the prostate. "Benign" means "not cancerous"; "hyperplasia" means "too much growth." The result is that the prostate becomes enlarged. The gland tends to expand in an area that doesn't expand with it, causing pressure on the urethra, which can lead to urinary problems.
The urge to urinate frequently, a weak urine flow, breaks in urine stream, and dribbling are all symptoms of an enlarged prostate. Because the prostate normally continues to grow as a boy matures to manhood, BPH is the most common prostate problem for men older than 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.
A doctor will do a digital rectal exam (DRE) to check the size and condition of the prostate by inserting a gloved finger into the rectum. The doctor also may need to do special X-rays or scans to check the urethra, prostate, and bladder. BPH can lead to urinary problems like those with prostatitis. By age 60, many men have signs of BPH. By age 70, almost all men have some prostate enlargement. At its worst, BPH can lead to a weak bladder, bladder or kidney infections, complete blockage in the flow of urine, and kidney failure.
It is true that some men with prostate cancer also have BPH, but the two conditions are not automatically linked. Most men with BPH do not develop prostate cancer. But because the early symptoms for both conditions could be the same, a doctor would need to evaluate them.
Different prostate problems sometimes have similar symptoms, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). For example, one man with prostatitis and another with BPH may both have a frequent, urgent need to urinate. A man with BPH may have trouble beginning a stream of urine; another may have to urinate frequently at night. Or, a man in the early stages of prostate cancer may have no symptoms at all.
But according to the NCI, one prostate change does not lead to another. For example, having prostatitis or an enlarged prostate does not increase the chance for prostate cancer. It is also possible to have more than one condition at a time. This confusing array of potential scenarios makes a case for the importance of all men, especially after age 45, to have a thorough medical exam that includes the PSA test and DRE every year.
Adam S. Kibel, M.D., associate professor of urologic surgery at Washington University in St. Louis, says that in his practice, the most common concerns of men with prostate problems include the frequent need to urinate (particularly at night), the inability to delay urination (urgency), and the inability to urinate at all.
"Getting up to go three, four, or even five times every night or having to get up in the middle of a movie--these things can interfere with a man's lifestyle," Kibel says. "And since all treatments [for prostate problems] have side effects, it's important for men to evaluate the effects of the different therapies so they can know what to expect."