What is prostatitis and how is it treated?
What is enlarged prostate or BPH?
How can BPH be treated?

What is prostatitis and how is it treated?

Prostatitis (pronounced "PRAH-stuh-TYE-tis") is an inflammation or infection of the prostate gland. It affects at least half of all men at some time in their lives. Having this condition does not increase your risk of any other prostate disease.

Prostatitis is not contagious. It is not spread through sexual contact. Your partner cannot catch this infection from you.

Several tests, such as DRE and a urine test, can be done to see if you have prostatitis. Getting the right diagnosis of your exact type of prostatitis is the key to getting the best treatment. Even if you have no symptoms, you should follow your doctor's suggestion to complete treatment.

There are four types of prostatitis:

• Acute bacterial prostatitis

  This infection comes on suddenly (acute) and is caused by bacteria. Symptoms include severe chills and fever. There is often blood in the urine. You must go to the doctor's office or emergency room for treatment. It's the least common of the four types, yet it's the easiest to diagnose and treat.

  Treatment:

  Most cases can be cured with a high dose of antibiotics, taken for 7 to 14 days, and then lower doses for several weeks. You may also need drugs to help with pain or discomfort.

• Chronic bacterial prostatitis

  Also caused by bacteria, this condition doesn't come on suddenly, but it can be bothersome. The only symptom you may have is bladder infections that keep coming back. The cause may be a defect in the prostate that lets bacteria collect in the urinary tract.

  Treatment:

  Antibiotic treatment over a longer period of time is best for this type. Treatment lasts from 4 to 12 weeks. This type of treatment clears up about 60 percent of cases. Long-term, low-dose antibiotics may help relieve symptoms in cases that won't clear up.

• Chronic prostatitis or chronic pelvic pain syndrome

  This disorder is the most common but least understood form of the disease. Found in men of any age from late teens to elderly, its symptoms go away and then return without warning. There can be pain or discomfort in the groin or bladder area.

  Treatment:

  There are several different treatments for this problem, based on your symptoms. These include antibiotics and other medicines, such as alpha-blockers. Alpha-blockers relax muscle tissue in the prostate to make passing urine easier.

• Asymptomatic inflammatory prostatitis

  You usually don't have symptoms with this condition. It is often found when your doctor is looking for other conditions like infertility or prostate cancer. If you have this problem, often your PSA test (see The PSA Test) will show a higher number than normal. It does not necessarily mean that you have cancer.

  Treatment:

  Men with this condition are usually given antibiotics for 4 to 6 weeks, and then have another PSA test.

"Changes happen so slowly that you don't even realize they're happening."

What is enlarged prostate or BPH?

BPH stands for benign prostatic hyperplasia (pronounced "be-NINE prah-STAT-ik HY-per-PLAY-zha").

Benign means "not cancer," and hyperplasia means too much growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not raise your chances of getting prostate cancer--yet the symptoms for BPH and prostate cancer can be similar.

BPH affects most men as they get older. It 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.

The prostate starts out about the size of a walnut. By the time a man is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon.

As a normal part of aging, the prostate enlarges and can press against the bladder and the urethra. This can slow down or block urine flow. Some men might find it hard to start a urine stream, even though they feel the need to go. Once the urine stream has started, it may be hard to stop. Other men may feel like they need to pass urine all the time or are awakened during sleep with the sudden need to pass urine.

Early BPH symptoms take many years to turn into bothersome problems. These early symptoms are a cue to see your doctor.

Urine flow of normal (left) and enlarged prostate (right). In diagram on the left, urine flows freely. On the right, urine flow is affected because of the prostate pressing on the bladder and urethra.

How can BPH be treated?

About half the men with BPH eventually have symptoms that are bothersome enough to need treatment. BPH cannot be cured, but drugs or surgery can often relieve its symptoms. BPH symptoms do not always grow worse.

There are three ways to manage BPH:

• Watchful waiting (regular follow-up with your doctor)
• Drug therapy
• Surgery

Talk with your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes.

Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach.

Watchful waiting means getting annual checkups. The checkups can include DREs and other tests (see "Types of Tests"). Treatment is started only if symptoms become too much of a problem.

If you choose to live with symptoms, these simple steps can help:

• Limit drinking in the evening, especially drinks with alcohol or caffeine.
• Empty the bladder all the way when you pass urine.
• Use the restroom often. Don't wait for long periods without passing urine.

"My doctor and I decide visit by visit about how long I should stay on watchful waiting for my BPH.

Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:

• Over-the-counter cold and cough medicines (especially antihistamines)
• Tranquilizers
• Antidepressants
• Blood pressure medicine

Drug therapy

Millions of American men with mild-to-moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s.

There are two main types of drugs used. One type relaxes muscles near the prostate while the other type shrinks the prostate gland. There is evidence that shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

Alpha-blockers

These drugs help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, the drug can improve urine flow and reduce symptoms within days. Possible side effects include dizziness, headache, and fatigue.

5 alpha-reductase inhibitor

Taking this drug for at least 6 months to 1 year can increase urine flow and reduce your symptoms. It seems to work best for men with very large prostates. You must continue to take the drug to prevent symptoms from coming back.

This drug is also used to treat baldness in men. It can cause these side effects in a small percentage of men:

• Decreased interest in sex
• Trouble getting or keeping an erection
• Smaller amount of semen with ejaculation

It's important to note that taking this drug can lower your PSA test levels. There is also evidence that finasteride lowers the risk of getting prostate cancer, but whether it lowers the risk of dying from prostate cancer is still unclear.

BPH surgery

The number of prostate surgeries has gone down over the years. But operations for BPH are still one of the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked well.

Types of surgeries include:

• TURP (transurethral resection of the prostate) is the most common surgery for BPH. It accounts for 90 percent of all BPH surgeries. It takes about 90 minutes. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer.

  TURP generally avoids the two main dangers linked to other prostate surgeries:

  • Incontinence (not being able to hold in urine)
  • Impotence (not being able to have an erection)

  The recovery period for TURP is much shorter as well.

• TUIP (transurethral incision of the prostate) is similar to TURP. It is used on slightly enlarged prostate glands. The surgeon places one or two small cuts in the prostate. This relieves pressure without trimming away tissue. It has a low risk of side effects. Like TURP, this treatment helps with urine flow by widening the urethra.

• TUNA (transurethral needle ablation) burns away excess prostate tissue using radio waves. It helps with urine flow, relieves symptoms, and may have fewer side effects than TURP. Most men need a catheter to drain urine for a period of time after the procedure.

• TUMT (transurethral microwave thermotherapy) uses microwaves sent through a catheter to destroy excess prostate tissue. This can be an option for men who should not have major surgery because they have other medical problems.

• TUVP (transurethral electroevaporation of the prostate) uses electrical current to vaporize prostate tissue.

• Open prostatectomy means the surgeon removes the prostate through a cut in the lower abdomen. This is done only in very rare cases when obstruction is severe, the prostate is very large, or other procedures can't be done. General or spinal anesthesia is used and a catheter remains for 3 to 7 days after the surgery. This surgery carries a higher risk of complications than medical treatment. Tissue is sent to the laboratory to check for prostate cancer.

Be sure to discuss options with your doctor and ask about the potential short- and long-term benefits and risks with each procedure. For a list of questions to ask, see Checklist of Questions for Your Doctor.

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