MiniDictionary
Prostate gland
A structure about the shape of a walnut that wraps around the urethra, where it exits the base of a man’s bladder. The prostate gland has three lobes and produces fluid that joins the semen (which the seminal glands produce), the viscous substance that transports sperm through the man’s reproductive system and out of the body during ejaculation. For reasons researchers do not understand, the prostate gland gradually enlarges with age, a condition called benign prostatic hypertrophy (BPH). An enlarged prostate gland can compress the urethra, interfering with the flow of urine. Common health conditions affecting the prostate gland include prostatitis. The prostate gland also is a common site for cancer. Prostate cancer is more common after age 60, with an increasing risk with advancing age. A physician can palpate (explore through touch) the prostate gland through digital rectal examination (DRE). DRE can permit the detection of prostate enlargement and sometimes of growths or tumors.
Prostatic massage
Gentle pressure applied to the prostate gland to expel accumulations of fluid, generally performed when there is chronic prostatitis (repeated or ongoing infection of the prostate gland). A physician performs prostatic massage, inserting a gloved and lubricated finger into the rectum to apply pressure to the lobes of the prostate gland. The procedure may be uncomfortable though generally does not cause pain. Expelled prostatic fluid is then cultured to identify any pathogens. Regular prostatic massage (two or three times weekly) during the course of treatment with antibiotic medications often resolves resistant prostatitis. Prostatic massage is not as commonly performed by physicians currently as it was in the past. See also benign prostatic hypertrophy.
Prostate specific antigen (PSA)
A protein the prostate gland releases when it becomes enlarged or develops tumors. There is a high correlation between the PSA level and the likelihood or severity of prostate cancer, though benign growths of the prostate gland also produce PSA. Because of the range of prostate conditions that can elevate PSA, doctors do not agree on the PSA test’s value as a screening tool for prostate cancer. However most doctors who treat men who have prostate cancer use PSA as a measure of treatment effectiveness. Any elevation of PSA warrants further investigation to rule out prostate cancer. See also prostatitis.
Prostatectomy
Surgical removal of the prostate gland, typically as treatment for prostate cancer though sometimes for occlusive benign prostatic hypertrophy (BPH). Because the surgery is extensive and the recovery period lengthy, doctors generally consider prostatectomy when a man is under age 70, has no other health conditions that might complicate the surgery (such as diabetes or heart disease), and would be expected to live 10 years or longer. There are several methods for performing prostatectomy.
• Radical prostatectomy involves removal of the prostate gland and surrounding tissues as a treatment for prostate cancer. Nerve-sparing radical prostatectomy is somewhat more conservative in approach to preserve the nerves that are necessary for erectile function. The incision for radical prostatectomy typically extends from the navel to the pubic bone, though it may be retropubic (in the lower abdomen just above the pubic bone) or retroperineal (in the perineum). A catheter placed in the urethra remains for three weeks while healing takes place around it.
• Laparoscopic radical prostatectomy requires a less extensive incision than conventional radical prostatectomy, allowing faster recovery and helping to preserve the nerves that supply the penis. However, laparoscopic radical prostatectomy is significantly more difficult for a surgeon to perform and is not an appropriate option for all men. The urologist typically can remove the catheter placed in the urethra in about seven days.
• Transurethral resection of the prostate (TURP) uses a cystoscope to enter the urethra, making the incision into the area of the prostate gland at the base of the bladder. TURP is more commonly used to treat BPH because it allows for removal of prostate tissue to relieve pressure on the urethra as well as the entire prostate gland.
The risks of prostatectomy include bleeding (during and after surgery), infection, extended recuperation period, urinary incontinence, and loss of erectile function. Prostatectomy always results in sterility as the procedure removes the seminal vesicles that manufacture sperm. Most men make a full and complete recovery in about three months (six to eight weeks for laparoscopic prostatectomy).
Prostatitis
Inflammation or infection of the prostate gland. Most prostatitis is bacterial and can result from sexually transmitted diseases (STDs) such as gonorrhea as well as urinary tract infections. Acute prostatitis comes on suddenly, typically with pain in the lower pelvis and a sensation of perineal or rectal pressure, and is more common in men under age 50. A three to four week course (and sometimes longer) of treatment with antibiotic medications cures most acute prostatitis.
Chronic prostatitis is a persistent low-grade infection or inflammation that may or may not have symptoms, though many men who have it experience a sensation of pelvic heaviness, and is more common in men over age 50. Urinary urgency, frequency, and incontinence may accompany chronic prostatitis though be thought of as symptoms related to benign prostatic hypertrophy (BPH), which often is present to some degree in men over age 50. Chronic prostatitis may require extended treatment with antibiotics along with prostatic massage and rarely corticosteroid medications to reduce inflammation.
Antibiotic medications commonly prescribed for either acute or chronic prostatitis include trimethoprim-sulfamethoxazole (TMP-SMX, Bactrim, Septra), doxycycline (Vibramycin), ciprofloxacin (Cipro), and ofloxacin (Floxin). Chronic prostatitis often raises prostate specific antigen (PSA) levels in the blood, which may give concern for prostate cancer. In the absence of other indications for prostate cancer, however, an elevated PSA is not diagnostic.
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