There’s More to Prostate Health than Cancer Screenings

No doubt, prostate cancer is a serious health concern in the United States. The American Cancer Society (ACS) estimates that one of every seven men will get prostate cancer during his lifetime.

Yet other prostate conditions warrant attention, too. Eight out of 10 men will develop an enlarged prostate, also known as benign prostatic hyperplasia (BPH). Also, about one out of 10 adult men will be treated in their lifetime for prostatitis – an inflammation of the prostate usually caused by an infection. To help educate men about prostate diseases, the Prostate Health Council of the American Foundation for Urologic Disease inaugurated the first Prostate Health Month in September 1999.

Prostate Enlargement—New Treatment Options

“Most of the time when a man experiences symptoms such as urinary frequency or an urgent need to urinate, BPH is a more likely cause than cancer,” says Mark Saleh, MD, a urologist with Washington Township Medical Foundation.

Other symptoms of BPH may include: weak urine stream, increased frequency of urination at night, difficulty starting or stopping urination, inability to completely empty the bladder or blood in the urine.

“The symptoms of BPH are not necessarily a natural part of aging,” Dr. Saleh notes. “BPH can and should be treated to improve the patient’s quality of life. While these symptoms most likely indicate BPH, a man with such problems also should be examined to rule out cancer.”

Treatment options for BPH might include medications, minimally invasive therapies such as “Rezum” or the “Urolift” procedure, or – for more severe symptoms – endoscopic surgical procedures such as Aquablation. Dr. Saleh has begun performing Aquablation procedures at Washington Hospital. Aquablation therapy is an advanced, minimally invasive treatment. It uses the power of water delivered with robotic precision to provide best-in-class and long-lasting symptom relief with low rates of irreversible complications, regardless of prostate size or shape.

Prostatitis

Prostatitis may be caused by a bacterial infection. Acute bacterial prostatitis often produces a rapid onset of symptoms, including fever and chills, pain in the lower back and aching muscles, fatigue, or frequent or painful urination.

Chronic bacterial prostatitis develops slowly over several months or even years and may produce no symptoms other than those similar to a recurring urinary tract infection or advanced BPH symptoms. “Bacterial prostatitis can be treated with antibiotics, but it usually requires a course of treatment lasting from two to six weeks,” Dr. Saleh says.

Nonbacterial prostatitis is more complicated to diagnose and treat. Symptoms may include:

• Discomfort in the testicles, urethra, lower abdomen or back

• Discharge from the urethra

• Blood or urine in ejaculate

• Low sperm count

• Sexual difficulties

• Frequent urination

“We don’t really know what causes nonbacterial prostatitis,” Dr. Saleh explains. “The diagnosis is one of exclusion, ruling out other potential causes. Since the condition is not caused by bacteria, we cannot treat it with antibiotics, so the primary treatment is to use anti-inflammatory medications.”

Prostate Cancer

Because early prostate cancer generally causes no symptoms, regular screenings have been considered an important diagnostic tool. Such screenings generally include a digital rectal exam (DRE) and a blood test to measure the level of prostate specific antigen (PSA), a protein made by prostate cells.

Dr. Saleh notes that if a patient’s PSA is high and remains elevated, or if the DRE detects any swelling, nodules or lumps in the prostate, a biopsy might be needed to determine if cancer is present. A prostate MRI may also be used to detect nodules deep in the prostate that may not be felt by a DRE. “Today we generally perform minimally invasive, ultrasound-guided needle biopsies, and we always take care to reduce the risk of post-biopsy infection or inflammation,” he says. “Complications from biopsies are rare, and they are much less onerous than complications of late-stage prostate cancer.”

Treatment options for prostate cancer generally depend on how aggressive the tumor is and the patient’s personal preference. “For men with low-grade, early stage tumors, the recommendation likely would be ‘watchful waiting,’ with more frequent regular screenings and biopsies as indicated,” Dr. Saleh explains. “Hormone therapy to stop production of testosterone, which promotes cancer growth, might also be considered. Hormone therapy alone does not cure the cancer, but it can help relieve symptoms and can be used in combination with radiation therapy to improve outcomes.”

If active treatment is desired, the patient may choose radiation therapy, surgery, cryotherapy (freezing of the prostate), or HIFU (high-intensity focused ultrasound). Radiation therapy could be in the form of external beam radiation therapy or brachytherapy – implantation of radioactive “seeds” into the prostate.

“Surgery for prostate cancer could be traditional open prostatectomy or laparoscopic/robotic surgery with smaller incisions,” Dr. Saleh says. “In the right surgeon’s hands, the results of robotic surgery and open surgery are equivalent, with good cancer control and few complications. Current surgical techniques allow us to preserve the nerves necessary for erectile function and maintaining urinary continence in the majority of patients.”

For more information about Dr. Saleh or the Urology Department at WTMF, visit mywtmf.com/urology. To learn more about the advanced technique, Aquablation, see whhs.com/aquablation.