FAQ Prostate Gland

1. Q: How can a person tell if the prostate gland is healthy or not?

A: The prostate is not healthy if the man is having symptoms or if the PSA is elevated. The symptoms are: urinary frequency, urgency, getting up at night frequently, slow stream, and hesitancy in the starting stream.

2. Q: What is prostate cancer and do other conditions cause symptoms similar to prostate cancer?

A: Prostate cancer, the most common cancer in men is a malignancy of the prostate gland, a gland which men need for fertility. The gland is located at the base of the bladder and is involved with the urinary system as well as the transportation of semen outside the body. Early on, prostate cancer does not cause symptoms. It tends to arise silently, pass through a curable stage silently and then become incurable silently. But when it does cause symptoms, it usually causes difficulty with urination, a slow urinary stream, having to get up frequently at night , and difficulty in starting the urinary stream. A number of conditions can cause symptoms identical to prostate cancer. Benign enlargement of the prostate, inflammation in the prostate, and sometimes even a bladder stone can cause similar symptoms. A physician should examine men who have these symptoms and prostate cancer should be ruled out.

3. Q: What can I expect in my doctor’s office when I go for prostate check-up?

A: For the PSA blood test, blood is drawn from the vein just as with a blood sugar, cholesterol or any other blood test. After that, the doctor does a digital rectal examination, which involves putting a gloved finger in the rectum and feeling the prostate gland for degree of hardness, for any lumps, and for any abnormalities. Some men dread the thought of the examination, but it’s really not much and it can be a lifesaver.

4. Q: Is it true that all men at some point in their lives will develop prostate cancer?

A: No, even though you might often hear that myth. It is true that if the prostate gland were removed and carefully examined under the microscope, up to 80 percent of men in their 80s would have some microscopic traces of prostate cancer, but only about 16% of men are actually diagnosed with prostate cancer during their lifetime. Prostate cancer will be large enough to detect with a biopsy in only 16% of men.

5. Q: Is frequent ejaculation beneficial to a healthy prostate?

A: It is not clear but many believe this is true. It certainly does NO harm.

Other Prostate Questions

1. Q: What are other prostate diseases besides cancer?

A: The two main prostate diseases besides cancer are inflammation (prostatitis) and benign enlargement (BPH). Both of these can elevate the PSA level. Benign enlargement is treated with alpha-blocker drugs, hormonal therapy, or surgery (transurethral or open surgery of the prostate). Inflammation can sometimes effectively treated with antibiotics, but sometimes patients just have to live with it.

2. Q: What is benign enlargement of the prostate (BPH)?

A: BPH: Benign (non-cancerous) prostatic hyperplasia is an enlargement or growth of the area in the prostate gland that is nearest the urethra. This growth can block or constrict the urethra, causing urination problems.

3. Q: What is PIN? Is it a precursor to cancer? Do you recommend routine biopsies on men with High-Grade PIN (HGPIN)?

A: About 6% of prostatic biopsies show PIN (prostatic intraepithelial neoplasia) or atypia (atypical hyperplasia). Prostate cancer is caused by changes (mutations) in the DNA that affect the regulation of the growth of normal prostate cells. It is probable that several mutations (at least 5 or 6) have to occur before a full-blown cancer occurs. These mutations may accumulate over time, causing the gradual progression to prostate cancer. It is likely that certain mutations may cause a precancerous condition, PIN. PIN is also found as a satellite lesion surrounding a prostate cancer or elsewhere in a cancerous prostate gland. Approximately 25% to 50% of men who have an elevated PSA level and high-grade PIN are subsequently found to have prostate cancer within four years. Accordingly, repeat biopsies are routinely recommended in men with PIN. Recent studies show that the risk for finding cancer after findings of PIN is less than previously thought, especially with extended biopsies (taking 12 or more samples) being performed. However, the information is still incomplete on the long-term risk for prostate cancer in men with high-grade PIN.

4. Q: What information do you have regarding the increased risk of high-grade prostate cancer when taking Proscar or Propecia (finasteride)?

A: Proscar is in the family of drugs commonly used to treat or prevent benign enlargement of the prostate gland and to restore hair growth. It inhibits an enzyme that converts the principal male hormone, testosterone, to its more potent form, dihydrotestosterone. Thus, it is a mild form of hormonal therapy. Proscar has adverse effects on sexual function in some men. Recent studies have reported that men taking Proscar and drugs like it had a 25% lower rate of prostate cancer during 7 years of follow-up but a significantly higher rate of high-grade aggressive appearing prostate cancer. Various explanations have been offered to explain this paradox. Some believe the most likely explanation is that Proscar might be able to mask low-grade cancer better than high-grade cancer and it also shrinks the prostate gland. So, when men taking Proscar undergo prostate biopsy, it is more likely that high-grade prostate cancer will be found and less likely that low-grade prostate cancer will be found. Some doctors recommend taking Proscar to prevent prostate cancer; however, we do not. In our opinion, more research is needed before the safety of Proscar, Propecia or another similar drug, called Avodart, in the prevention of prostate cancer can be established. We would not recommend taking these for preventing prostate cancer or even as a first-line therapy for baldness (Propecia). Other classes of drugs, called alpha-blockers, are helpful in relieving the symptoms of an enlarged prostate in many patients, and they do not carry a risk of masking prostate cancer. Some examples of these are Flomax, Cardura, and Hytrin.

5. Q: If Flomax and other alpha blockers work to eliminate the symptoms of an enlarged prostate, why do doctors prescribe finesteride (Proscar) when Flomax doesn't hide or affect a PSA rise and Proscar does? What are the different effects on an enlarged prostate between Flomax and Proscar?

A: Flomax or similar drugs, called alpha blockers, do work well in many patients, but not in all. Studies have shown that the combination of an alpha blocker and an antiandrogen, such as Proscar or Avodart work better. The downside of the antiandrogens is that they lower PSA levels and might mask important changes indicating the development of prostate cancer if they are not monitored and interpreted carefully.

6. Q: I have heard that taking Flomax can cause complications in cataract surgery. Since taking Flomax is not uncommon for older men and neither is cataract surgery, what is your opinion about what to do?

A: What you write is true. Studies show Flomax appears to cause excessive muscle relaxation in the iris, resulting in something called small pupil or intraoperative floppy iris syndrome (IFIS) during cataract surgery. Any man taking Flomax should inform his ophthalmologist before undergoing cataract surgery.

7. Q: Are enlarged prostates genetic? Do they run in families?

A: Yes, benign prostatic hyperplasia does run in families.

8. Q: My last urologist recommended Cardura for symptoms of an enlarged prostate. My new urologist said my prostate was normal and prescribed Detrol for an over active bladder. What would account for the difference in diagnosis and the difference in prescriptions?

A: Cardura is a drug that relaxes the muscle fibers in the prostate and allows the urine to flow through more easily. It’s most troublesome side effect can be light-headedness due to lowering of the blood pressure. Detrol relaxes the bladder muscle for patients who have an overactive bladder. The problem is that sometimes an overactive bladder can occur because of obstruction from an enlarged prostate. In this case, there is a risk of Detrol relaxing the bladder to the extent that the patient might not be able to void.

9. Q: Once a prostate gland has been removed because of cancer, can diet help prevent the cancer from recurring?

A: Nobody knows for certain. Obviously, if all the cancer cells and prostate cells have been removed by surgery, then dietary supplements would not be needed to prevent recurrence. If any cancer cells were left behind, perhaps, they could help prevent these cancer cells from accumulating more mutations and becoming more aggressive.

10. Q: What exercises do you recommend both before and after retropubic prostate surgery?
 A: In addition to Kegel exercises, we recommend overall physical fitness exercises. Good physical conditioning is helpful in recovery from prostate cancer surgery. 3. Q: How much does family history of prostate cancer increase the risk for it?

A: In the general population, about one in six men is diagnosed with prostate cancer, and we recommend screening for prostate cancer at age 40 for the general population. But for men with a primary relative with prostate cancer (a brother or father), the risk is two-fold higher. Accordingly, in my opinion, it is especially important for men with a primary relative who had prostate cancer to have regular checkups. Men with familial prostate cancer might develop the disease at an earlier age, so screening should be considered earlier, at age 35.

11. Q: Can the sport of bicycle riding increase the likelihood of BPH, prostate cancer or other prostate problems?

A: Prolonged cycling on a hard seat is thought by a few urologists to affect potency by injuring the pudendal arteries that supply blood to the penis. This is very doubtful unless there has been an accident or injury on the bike. Cycling can also traumatize the prostate, causing an elevation in the PSA level. No evidence, to our knowledge, shows that cycling can increase the risk for benign prostate enlargement or prostate cancer.

12. Q: Is ejaculation good for prostate health?

A: The short answer is “yes.” The prostate has innumerable tiny glands located in its periphery. Their function is to drain prostatic secretions through the tiny prostatic ducts into the urethra. Approximately 90% of the fluid that comes out with ejaculation is prostatic fluid. With long periods of abstinence from ejaculation, the prostate may become filled with secretions. This condition is called congestion of the prostate. Symptoms associated with prostatic congestion can include voiding difficulties and discomfort in the region of the prostate. In some instances, accumulation and stagnation of prostatic fluid can contribute to the development of infection in the prostate (prostatitis). Regular ejaculation has the effect of keeping the prostate “flushed out” and healthy.

13. Q: What are your thoughts on the recent study linking multi-vitamin use to increased prostate cancer risk? I was under the impression that vitamin D and vitamin E were beneficial to those of us who have had RP surgery. Now I wonder if I should continue taking these supplements based on the results of this recent study.

A: The place of diet, vitamins and supplements for prostate health is in limbo. New studies are showing that even foods we thought were helpful, such as those with lycopene, seem to have no benefit. And some of them, such as heavy doses of beta-carotene are proving harmful. Recently, the National Cancer Institute reported on a study tracking the diet and health of 300,000 men. A third of those men took daily multivitamins and 5 percent of them were heavy users. In the men from that study who were diagnosed with prostate cancer, heavy multivitamin users were about twice as likely to get a more aggressive prostate cancer. The study found no connection between multivitamin use and early stage prostate cancer. Researchers proposed that possibly high-dose vitamins had little effect until a tumor appeared and then they might somehow encourage or stimulate the cancer growth. Clearly, more research is needed in this area. But there is a possibility that increased use of supplements could cause harm rather than help in prostate health. The key word appears to be moderation. We currently recommend that you can eat anything in moderation, but if you eat meat, white meat is better than red meat. A diet high in fruits and vegetables is preferable. Fats that are liquid at room temperature (olive oil or corn oil) are healthier than those that are solids, such as cheese or butter.

14. Q: Do you think taking soy protein could be effective in the prevention of prostate cancer?

A: Not necessarily in the prevention, but there is evidence discovered by some that soy protein contains a substance that might reduce the tendency for prostate cancer cells to spread and metastasize. Research is pending on this topic.