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Problems with the prostate

The Prostate and Its Problems

Just about everybody probably knows where the male prostate gland is, but in case it's a mystery to you we've attached diagrams you can see its location inside the male body. The important point to note is that the your wreath, along which urine flows before it leaves the body, passes right through the middle of the gland. That's unfortunate, because the prostate is very prone to enlargement as a man grows older, with entirely predictable results on his ability to pass urine.

So what does the prostate gland actually do?

Its function is to secrete liquid that forms part of semen, and which helps to protect and preserve sperm before they are ejaculated from the body. In general, the fluid produced by the prostate gland is actually milky or white in appearance and slightly alkaline, and makes up about a third of the volume of semen (the remainder being sperm and fluid from the seminal vesicles).

Apparently the alkaline nature of semen helps to neutralize the acidity of the vagina, which preserves the lifespan of the sperm so that they have the opportunity to move through the cervix and fertilize the woman's egg. The first part of an ejaculation mainly consists of prostatic fluid and live spermatozoa; the remainder is fluid from the seminal vesicles, and the sperm that are ejaculated in this portion of the fluid seem to have a much lower chance of survival. So it's clear that the prostate gland is important – it helps sperm to survive on their journey to the uterus.

The secretions are mostly simple sugars which sustain the sperm as they swim up the vaginal tract, through the cervix and on up the Fallopian Tubes; there's also a small amount of protein and various chemical compounds including zinc, which is found in prostatic fluid at a concentration several hundred times greater than in the bloodstream.

The prostate gland is usually said to be about the size of a walnut, but in fact it's slightly larger than the average walnut. It is located around the urethra just below the bladder, and is commonly felt during a rectal examination. Inside the prostate gland where the urethra emerges from the bladder, the urethra merges with the two ejaculatory ducts. The whole structure is sheathed in muscles which contract during ejaculation.

Problems with the prostate

These include prostatitis, benign prostatic hyperplasia or BPH, and prostate cancer.

Prostatitis is a inflammation of the prostate gland, sometimes caused by bacterial infection which can be treated by the use of antibiotics. In the majority of cases there appears to be no obvious infection, and the inflammation is treated with a variety of methods including antihistamines, surgery, alpha blockers and other medical formulations.

Benign prostatic hyperplasia - as may be deduced from the name, a benign enlargement of the gland - occurs in the majority of men at some point over the age of 40, and involves enlargement of the prostate gland to the point where the urethra may be blocked and urination becomes difficult. Symptoms of this condition include needing to urinate frequently, difficulty in starting the flow, a sense of incomplete emptying of the bladder, and a sense of urgency around the need to relieve the bladder. One of the most distressing aspects of this condition is the disturbed sleep patterns which ensue when a man finds that he has to get out of bed several times in the night feeling the need to relieve his bladder.

Treatment of BPH can be started with medication which relaxes the muscles of the prostate gland ad reduces the swelling. There are various forms of surgery to remove the overgrown tissue blocking the urethra, including excision of the tissue, transurethral needle ablation of the prostate, and transurethral microwave thermotherapy. Transurethral resection of the prostate (or TURP) is a technique in which an instrument is inserted up the urethra and used to excise the prostate tissue blocking the upper part of the urethra.

It's important not to confuse urinary frequency due to bladder spasms with prostatic hyperplasia.

Many men have turned to natural remedies for the prostate rather than using one prostate drug or another, or the use of medically formulated prostate pills, and there is considerable evidence that these natural herbal remedies do have an impact on the prostate gland: the most common is Saw Palmetto, closely followed by extract of Pygeum, a native African tree.

Cancer of the prostate

This is one of the most common cancers in the Western world and accounts for the death of around 3% of men; however, most elderly men have slow-growing prostate cancer, and a diagnosis of prostate cancer is not, in itself, indicative of the need for surgery – it depends on the individual case. There are various treatments available. In its early stages, prostate cancer usually is devoid of symptoms, and may be diagnosed through an elevated level of PSA (prostate specific antigen) in the bloodstream. However on occasion prostate cancer will be symptomatic, in which case the symptoms are likely to be similar to those of benign prostatic hyperplasia. (Frequent urination, urgency of the need to urinate, difficulty with passing urine, and so on.) There may also be blood in the urine and painful ejaculation.

The primary risk factors for prostate cancer are age and family history, and it is very uncommon indeed in men under the age of 45: the average age of diagnosis is in fact around 70. As we said before, epidemiological studies of men who had died of other causes has revealed prostate cancer in about a third of men between the age of 50 and 60, and as many as 8 out of 10 men between the ages of 70 and 80. Those men who have very close male family relations who develop prostate cancer seem to have an increased risk of developing the disease. Various studies over the years have suggested that compounds as diverse as selenium, cruciferous vegetables such as broccoli, green tea and lycopene can protect a man against prostate cancer, but the evidence remains weak.

It's important to know that the PSA test is not definitive: the only test that can fully confirm the presence of prostate cancer is a biopsy, although a digital rectal examination or ultrasound probe in the rectum may be used to establish any abnormalities in the structure of the prostate gland as a precursor to biopsy.

Without seeking to make light of the issue of cancer, you might be relieved to know that it has been suggested that more frequent ejaculation can apparently decrease the risk of developing the disease. It's been claimed in one study that men who ejaculated five times a week when they were aged between 20 and 30 had a decreased rate prostate cancer later in life… although, sadly, it has to be said that no other studies confirm this.

You can read more about the various ways in which you might be able to reduce the likelihood of developing prostate cancer here - prostate cancer - although I should say that the information is so vague and uncertain that you're not likely to be able to come up with a meaningful plan.

Finally, it's been suggested that high levels of testosterone might have some association with prostate cancer, which is why many doctors are reluctant to prescribe testosterone supplements to andropausal men. However, if there is any hormonal association with prostate cancer, it is not between testosterone and cancer, it is between the testosterone derivative dihydrotestosterone and cancer. Certainly the benefits of testosterone replacement for men undergoing a male midlife crisis or the andropause appear to be greater than the drawbacks.

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