The prostate is part of a man's reproductive (genitourinary) system and is located in front of the rectum and under the bladder. It surrounds the urethra, the tube through which urine flows.
A healthy prostate is about the size of a walnut. Male hormones (androgens, particularly testosterone) normally produced by the body stimulate the growth of the prostate. The testicles are the main source of male hormones, including testosterone. The prostate changes size very little from birth until puberty, but at puberty it increases in weight and doubles in size. In general, the size of the prostate remains constant after puberty for the next 30 or more years. In some men, in fact, the prostate never again increases in size. Unfortunately, however, this is not the case for most men, who will develop some form of non-cancerous enlargement of the prostate, medically known as benign prostatic hyperplasia or BPH. Half of all men in their 50s and 80% of men in their 80s have some symptoms of BPH.
The prostate makes part of the seminal fluid. During ejaculation, seminal fluid helps carry sperm out of the man's body as part of semen. In the adult male, the glandular tissue of the prostate secretes a fluid that contributes 20-30% of the total volume of the seminal fluid released when a man ejaculates. This prostate fluid is continuously generated by the prostate but increases during sexual excitement. The combination of spermatozoa, seminal vesicle fluid, and prostatic fluid, in addition to a tiny amount of fluid from some minor glands, constitutes semen. The prostate gland fluid is a thin, milky substance that gives semen its characteristic color and odor.
Some common prostate problems include prostatitis (inflammation of the prostate, usually caused by bacterial infection), benign prostatic hyperplasia or BPH (an enlarged prostate, which may cause dribbling after urination or a need to urinate often, especially at night), and prostate cancer (a common cancer that responds best to treatment when detected early).
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types and causes of prostate conditions
Prostatitis is inflammation of the prostate gland usually caused by an infection that often affects younger men. With treatment, prostatitis should generally be alleviated within several days to two weeks. Treatment of chronic (long-term) bacterial prostatitis usually involves antimicrobial medication for four to 12 weeks. This type of prostatitis is difficult to treat and recurrence is possible.
Prostatitis usually results from blockage or irritation of some of the ducts within the prostate gland, and the cause may be mechanical (such as narrowing of the urethra) or infectious. The infectious causes may be viral or bacterial, including E. coli or sexually transmitted infections such as Chlamydia.
There are four types of prostatitis: acute bacterial prostatitis (the least common of the four types, but the most common in men under 35); chronic bacterial (not very common, but affects mostly men between 40-70 years); asymptomatic inflammatory prostatitis (produces no outward symptoms and occurs mainly in men aged 60 and over); and chronic nonbacterial/prostadynia (most common type). Prostadynia, also known as chronic pelvic pain syndrome, is a condition associated with similar symptoms as chronic nonbacterial prostatitis, but which has no evidence of prostate inflammation.
Benign prostatic hyperplasia (BPH): Benign prostatic hyperplasia (BPH) is a normal, gradual enlargement of the prostate caused by hormonal fluctuations, such as decreases in testosterone and increases in dihydrotestosterone (DHT) and estrogen in prostate tissue. BPH usually beings in middle age. BPH does not lead to cancer. BPH does not generally cause pain, but discomfort (a feeling of pressure) in the groin area is generally found.
As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated and begins to contract, even when it contains small amounts of urine, which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely leaving some urine behind. Blocking or narrowing of the urethra by the prostate and partial emptying of the bladder cause many of the problems associated with BPH.
BPH affects about half of men aged over 60 and 80% of men aged 80 or older; it is considered to be a condition related to aging. Almost every man over 45 has some prostate enlargement, but symptoms are rarely felt before the age of 60. BPH affects all men differently and therefore treatment varies.
Prostate cancer: As men get older (after age 50), their risk of prostate cancer increases. Men above 50 years of age should be checked for prostate cancer routinely by their doctor, and men with risk factors for developing prostate cancer (including family history of prostate cancer, multiple family members with prostate cancer, and/or African heritage), should talk to their doctor about starting this screening at a younger age such as 40.
Prostate cancer exhibits tremendous differences in incidence among populations worldwide. Asian men typically have a very low incidence of prostate cancer, with age-adjusted incidence rates ranging from 2-10 per 100,000 men. Higher incidence rates are generally observed in northern European countries. African men, however, have the highest incidence of prostate cancer in the world. In the United States, African American men have a 60% higher incidence rate compared with Caucasian men.
Prostate cancer is the most common non-skin cancer in America, affecting one in six men. More than 218,000 men in the United States will be diagnosed with prostate cancer in 2007. Healthcare professionals recommend men 50 years of age and older get screened for prostate cancer.
If an immediate family member such as a father or brother has prostate cancer, the risk of developing the disease is greater than that of the average American man. Between 5-10% of prostate cancer cases are believed to be due primarily to high-risk inherited genetic factors or prostate cancer susceptibility genes. The survival rate indicates the percentage of patients who live a specific number of years after the cancer is diagnosed. For prostate cancer, the 10-year survival rate is 93% and the 15-year survival rate is 77%.
A high-fat diet and obesity may increase the risk of prostate cancer. Researchers theorize that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells. Obese men who are diagnosed with prostate cancer have more than two-and-a-half times the risk of dying from the disease as compared to men of normal weight at the time of diagnosis. Scientists believe that obesity increases the risk of prostate cancer by increasing inflammation and steroid hormones, such as testosterone.
Because testosterone naturally stimulates the growth of the prostate gland, men who have high levels of testosterone and men who use testosterone (steroid) therapy are more likely to develop prostate cancer than are men who have lower levels of testosterone. Long-term testosterone treatment could cause prostate gland enlargement (benign prostatic hyperplasia or BPH). Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present.