Prostate Health

by Food and Drug Administration (FDA)

To screen, or not to screen: that is the question. Whether men should get tested for prostate cancer when they have no symptoms is a long-running debate within the medical community.

There is good evidence, according to the CDC that the current prostate specific antigen test approved in 1986 by the Food and Drug Administration to screen for prostate cancer can detect the disease in its early stages. Evidence, however, is mixed and inconclusive about whether early detection actually saves lives. A study published in the Jan. 9, 2006, issue of the Archives of Internal Medicine found that screening with the PSA test does not cut down on deaths from the disease. Moreover, it is not clear whether the benefits of screening outweigh the risks of follow-up testing and cancer treatments.

At the same time, evidence, such as a drop in the prostate cancer death rate - which some say could be due to improved treatments - suggests that early PSA testing may be saving lives. There are no definitive answers.

According to the NCI other than skin cancer, prostate cancer is the most common form of cancer and the second leading cause of cancer-related deaths among men in the United States. But doctors' recommendations on screening for the disease vary. Some encourage annual screenings for men older than age 50; others recommend against routine screening. American Cancer Society Screening Director Robert Smith, Ph.D., says that the January Archives of Internal Medicine study "isn't strong enough to say definitively that prostate cancer screening isn't valuable."

The controversy, meanwhile, is contributing to a growing quandary for doctors and their patients: what's a man to do?

Until there is more evidence and, perhaps, a scientific consensus of the screening benefits, most doctors and medical organizations, including the NCI, the ACS, and the CDC, agree that men should learn all they can about what is known and what is not known of the benefits and limitations of early detection and treatment for prostate cancer, so that they can make their own informed decisions.

Cancer screening is just one health concern related to the prostate - a very important part of the male reproductive system. As men age, the prostate may become a source of troubling, often inconvenient problems that can, but don't necessarily, include cancer. And since the symptoms of some noncancerous prostate conditions can mimic cancer, many men who learn they have a problem often assume the worst. In general, growing older raises a man's risk for prostate problems, including cancer.

For these reasons, it is important that men know and understand, in the earliest stages, the changes that can occur in the prostate and could, ultimately, affect their health.

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; 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.

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.

About the Author

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