Prostate Health

Treatments
by Food and Drug Administration (FDA)

(Page 2 of 4)

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 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. 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."

A Roundup of Treatments

For men who are having prostate problems, the good news is that many new and effective treatments are available.

For prostatitis, getting the right diagnosis of the exact type is key to getting the best treatment. George Benson, M.D., a medical reviewer in the FDA's CDER, says that prostatitis caused by an infection is treated with antibiotics, "but there are no drugs approved to treat chronic pelvic pain syndrome. This condition is often treated with anti-inflammatory drugs and analgesics," he says.

Although BPH cannot be cured, FDA-approved drugs can often relieve its symptoms. Such drugs to treat BPH currently include two major classes. The 5 alpha-reductase inhibitors shrink the prostate gland and include Proscar (finasteride) and Avodart (dutasteride). These drugs work by blocking an enzyme that acts on the male hormone, testosterone, to boost organ growth. When the enzyme is blocked, growth slows down and the gland may shrink. This treatment may not produce a positive effect until after six to 12 months of treatment. It also works best for the larger prostate.

Alpha-adrenergic receptor blockers, which work by blocking adrenergic nerve receptors in the lower urinary tract, basically help relax the smooth muscle of the prostate and bladder neck to relieve pressure and to improve urine flow. These drugs, which do not shrink the size of the prostate, include: Cardura (doxazosin), Flomax (tamsulosin), Hytrin (terazosin), and Uroxatral (alfuzosin). For many men, these alpha-blockers can improve urine flow and can reduce symptoms within days. Possible side effects include dizziness, headache, fatigue, and a lowering of blood pressure.

About the Author

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