FRIDAY, Feb. 10 (HealthDay News) — The size of a man’s prostate gland may help doctors predict the severity of his prostate cancer, according to a new study.
Researchers from the Vanderbilt-Ingram Cancer Center in Nashville, Tenn., found smaller prostates that produce higher levels of prostate specific antigen (PSA) in the blood are more often linked to serious forms of prostate cancer that require aggressive treatment.
“There’s nothing about size that would necessarily predict a bad outcome. What it’s really about is the ratio of PSA to size, or PSA density, meaning that a small prostate that is making a lot of PSA is likely to be due to a bad tumor, whereas a large prostate making a lot of PSA is likely to be due to benign enlargement of the prostate (BPH),” said the study’s senior author, Dr. Daniel Barocas, an assistant professor of urologic surgery, in a university news release.
The study’s authors suggest the findings could help doctors determine the best course of treatment for patients with prostate cancer. For instance, low-risk patients with a small prostate might benefit from aggressive treatment.
In conducting the study, they analyzed about 1,250 cases of prostate cancer among men who had their prostate gland removed but were considered to be low-risk because their cancer was classified as low grade.
Within that group, the researchers zeroed in on patients whose risk was considered so low that they might have qualified for less aggressive treatment, including watching and waiting. The study found that in 31 percent of cases considered low-risk in pre-surgical analysis, the prostate cancer was upgraded to more serious once pathologists examined the tissue removed during surgery. The researchers found men with smaller prostates were more likely to be among this group.
The study was recently published in the Journal of Urology.
The researchers pointed out that the findings are significant since men with prostate cancer who are considered low-risk may receive less aggressive treatment or just be placed under observation.
“Our field suffers from this great confusion because in half of men you can find prostate cancer in microscopic amounts that may not be clinically significant and yet it’s the second leading cause of cancer death among men,” Barocas noted. “The more you look for it, the more you find it but that doesn’t help us figure out who needs treatment and who doesn’t.”
The researchers cautioned that more accurate tests are still needed to determine which cancers are actually threatening to patients.
“The imaging for prostate cancer is relatively weak because the disease tends to be diffuse, rather than growing in what we think of as a tumor — a spherical nodule. Prostate cancer tends to grow along the glands in a sort of flat pattern, so it’s a little harder to detect. A better test, which we don’t yet have, would reliably image or identify where in the prostate the tumor lies,” Barocas added.
— Mary Elizabeth Dallas
Copyright © 2012 HealthDay. All rights reserved.
SOURCE: Vanderbilt University Medical Center, news release, Jan. 30, 2012
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A man’s prostate gland usually starts to enlarge after he reaches 40 years of age. This condition is called benign prostatic hyperplasia (BPH). This is considered a natural process of aging, and attempts to stop or reverse it so far have been unsuccessful.
The prostate gland serves a fertility function as it secretes the seminal fluid that helps to nourish and transport the sperm that comes from the testicles. The fluid is then stored in the seminal vesicles. The gland itself surrounds the urethra, which is the tube that carries urine from the bladder out through the tip of the penis (see multimedia file 1). As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men older than 60 years of age.
The prostate gland, which is normally about the size and shape of a walnut, wraps around the urethra between the pubic bone and the rectum, below the bladder. In the early stage of prostate enlargement, the bladder muscle becomes thicker and forces urine through the narrowed urethra by contracting more powerfully. As a result, the bladder muscle may become more sensitive, causing a need to urinate more often and more suddenly.
The prostate grows larger due to an increase in the number of cells (hyperplasia). However, the precise reason for this increase is unknown. A variety of factors may be involved, including androgens (male hormones), estrogens, and growth factors and other cell signaling pathways (cell-to-cell communication).
As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty. In some cases, blockage from prostate enlargement may result in stagnation and backing up of urine, which in turn may cause repeated urinary tract infections, bladder stones, bladder diverticulae (outpouchings or pockets inside the bladder), and gradually result in bladder or kidney damage. It may also cause a sudden inability to urinate (acute urinary retention) — a painful medical emergency that requires urgent drainage.
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Many men with an enlarged prostate have no symptoms or signs. If symptoms are present, they commonly include
Urinary symptoms related to enlarging prostate initially affect the quality of life, and if no complications exist, as mentioned above (urinary infections, bladder stones, bleeding), the decision to treat is optional and is left to the patient. This means that if you don’t feel bothered enough to take a medicine or undergo a procedure for it, you’ll need to follow up with your doctor to ensure the symptoms are stable, and the bladder empties well. This can be assessed by prostate symptom questionnaires and a measure of the strength of the urinary stream (flow test) and residual urine in the bladder. If complications develop, however, or if the bladder starts holding increasing amounts of residual urine after urination, treatment should be started.
If you experience bladder pain or burning with urination, blood in the urine associated with fever/chills or nausea/vomiting, or if the prostate enlargement condition worsens and symptoms such as blood in the urine or lower back pain are present, consult a doctor immediately. If you cannot reach your doctor when these symptoms are present, seek evaluation at a hospital’s emergency department.
For acute symptoms such as acute urinary retention (you feel uncomfortably full but cannot urinate), you should immediately go to the closest emergency medical facility for bladder drainage, usually with a catheter, which is a tube inserted into the bladder.
Men over 50 years of age should have their prostate checked annually by their physician even if they have no symptoms.
The two essential causes of urinary retention are (1) blockage of the urethra and (2) disruption of the delicate and complex system of nerves that connects the urinary tract with the brain and the nervous system (as described earlier).
Once the diagnosis of prostate enlargement is made, your doctor may not recommend immediate treatment if symptoms are mild. Likely, one or more exams will be conducted per year to be sure that you are not developing any complications from prostate enlargement. Should your symptoms become more severe, both medical and surgical treatments are available.
Some precautions can help to avoid worsening of symptoms of prostate enlargement and complications.
Do not delay urination once you experience an urge. Urinate as soon as you feel the urge, and empty the bladder completely.
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Watchful waiting: This conservative and often wise program of care is used because, for many men, symptoms can lessen without treatment. On the other hand, medications should be started early for moderate symptoms. Also, if there are complications or if symptoms are severe, your doctor may recommend surgery. For most men, the decision to treat the symptoms of an enlarged prostate is based on the patient’s desire to improve his quality of life.
Several types of medications have been approved for treatment of urinary symptoms secondary to prostate enlargement. Men with severe symptoms may require treatment with a combination of these medications. Your doctor will determine the optimal combination for your condition:
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Once your doctor has given you a medical plan, you should stick to it and follow up as recommended. Sometimes men need follow-up with a urologist.
There is no known way to prevent prostate enlargement. It is a common part of aging.
Your condition may improve, remain the same, or become worse. Serious urinary problems from prostate enlargement affect one in 10 older men. If the bladder is permanently damaged from prostate enlargement, treatment may not be as effective.
Prostate enlargement is not cancer, nor does it seem to increase your chances of developing prostate cancer. You can, however, have both prostate enlargement and prostate cancer at the same time.
Many men aren’t sure what their prostate is, what it does, or when to call a doctor if they think they might have a problem. So, information is the best tool you have in dealing with this aspect of men’s health.
It is a small gland that is part of the male reproductive system. It’s supposed to be about the shape and size of a walnut.
It rests below your bladder and in front of your rectum. It surrounds part of the urethra, the tube in your penis that carries pee from your bladder.
The prostate helps make some of the fluid in semen, which carries sperm from your testicles when you ejaculate.
As you age, your prostate can become larger. It’s a normal part of aging for most men.
By the time you reach age 40, your prostate might have gone from the size of a walnut to the size of an apricot. By the time you reach 60, it might be the size of a lemon.
Because it surrounds part of the urethra, the enlarged prostate can squeeze that tube. This causes problems when you try to pee. Typically, you won’t see these problems until you’re 50 or older, but they can start earlier.
You might hear a doctor or nurse call this condition benign prostatic hyperplasia, or BPH for short. It is not cancerous.
BPH is common and cannot be prevented. Age and a family history of BPH are two things that increase the chances you might get it. A few stats on that:
If you have trouble starting to urinate or have to go a lot, especially at night, these could be signals that you have an enlarged prostate. Other signs and symptoms include:
It’s important that you see your doctor if you have early symptoms of BPH. Although rare, it can lead to serious problems such as kidney or bladder damage.
A larger prostate doesn’t mean you’ll have more or worse symptoms. It’s different for each person. In fact, some men with very large prostates have few, if any, issues. But your doctor should be aware either way.
How your doctor handles your condition depends on the details of your case — your age, how much trouble it’s causing, and more. Treatments may include:
Watchful waiting. If you have an enlarged prostate but are not bothered by symptoms, you may be advised merely to get an annual checkup, which might include a variety of tests.
Lifestyle changes. This includes cutting back on how much you drink at night and before bedtime, especially drinks with alcohol or caffeine.
Medicine. Common treatments for BPH are alpha-blockers, which ease BPH symptoms, and what’s called 5-alpha reductase inhibitors, or 5-ARIs, which help shrink the prostate. Many men may take them together.
The FDA now requires labels on the 5-ARIs to include a warning that they may be linked to an increased chance of a serious form of prostate cancer. These medications are dutasteride (Avodart) and finasteride (Propecia and Proscar). The combination pill Jalyn also contains dutasteride as one of its ingredients.
Surgery. Men with severe symptoms who haven’t been helped by other treatments might have to turn to surgery. Talk to your doctor about possible risks and outcomes.
This is an infection or inflammation of the prostate; it’s not the same thing as BPH, though some of the symptoms are similar.
It can affect men from their late teens well into old age. Symptoms include:
Treatment usually includes antibiotics.
If you have recently had a catheter or other medical instrument put into your urethra, you have a higher chance of getting bacterial prostatitis. Some sexually transmitted diseases, such as chlamydia, may also cause ongoing infection and inflammation.
Your doctor can use a variety of tests to check on the condition of your prostate. A few of them include:
Digital rectal exam: Your doctor puts on a glove and gently inserts one finger into your rectum to check the size and shape of your prostate. He checks for things such as size, firmness, and any lumps.
Prostate-specific antigen test: This blood test checks the amount of a protein called PSA that is produced by prostate cells. Higher levels may be a sign of cancer. By themselves, they are not proof you have prostate cancer.
Higher levels could also point to an enlarged prostate or prostatitis. But, levels may be low even with men who have prostate cancer, so discuss the results with your doctor.
Prostate biopsy: Men with high PSA results or other symptoms of cancer may have a tissue sample taken of their prostate to determine whether cancer is present.
Screening for prostate cancer is controversial. You may read different kinds of advice and guidance from various sources. Talk to your doctor about what is best for you.
The American Cancer Society: It says men should talk to their doctors about the benefits, risks, and limits of prostate cancer screening before deciding whether to be tested. This discussion should take place:
The American Urological Association: It recommends that men age 55 to 69 who are considering screening should talk with their doctor about the risks and benefits of testing and make the decision based on their personal situation and needs.
The group does not suggest screening for:
A routine interval of 2 years or more may be preferred over yearly tests in those men who have decided on screening after talking with their doctor.
Compared with annual screening, it is expected that 2-year intervals give you most of the benefits and reduce false positive results.
Routine PSA screening is not recommended for men older than 70 or for any man who is expected to live only 10 to 15 more years.
The U.S. Preventive Services Task Force: It doesn’t recommend routine PSA screening for men in the general population, regardless of age.
They say the tests often may find cancers that are so slow-growing that medical treatments, which can have serious side effects, may offer no benefit.
U.S. Food & Drug Administration website.
National Cancer Institute: “Prostate Cancer.”
UrologyHealth.org: “Adult Conditions: Prostate,” “BPH Treatment.”
Urological Science Research Foundation.
American Cancer Society: “Detailed Guide: Prostate Cancer.”