prostate-tips.com eCourse - Part 1: Meet Your Prostate

Article by: Allan Sharpe
September 30, 2006


If you’re reading this article due to prostate problems, it might just be what you need to answer some of your questions about the prostate changes that occur with aging, including:

• What is the prostate?
• What common prostate changes occur as I age?
• How can I deal with these changes?
• What should I know about tests for prostate changes, including cancer?

What is the prostate?

The prostate is a very small gland in men, the size and shape of a walnut. Your prostate actually surrounds a part of your urethra. The urethra is a tube that transports urine from the bladder out of the body the penis.

The prostate is part of the male reproductive system. It resides low in the pelvis, just under the bladder and in front of the rectum. The purpose of the prostate is to assist in the manu­facture of semen, the milky/creamy fluid that helps transport sperm from your testicles through your penis when you ejaculate.

The prostate is also referred to as the male G-spot because of the pleasant sexual feeling you get when you stimulate it. In later articles we’ll talk about how to locate it, and how to manipulate it for sexual pleasure and prostate orgasm. But, for now we’re going to talk about the health and aging process, the changes that occur, and what to do when you notice these changes.


How does the prostate change as men get older?

The prostate surrounds the urethra (a tubular system) that carries urine out of the body. As a man ages the prostate normally increases in size and can cause problems urinating.

The prostate can put pressure against the urethra making urination difficult or even painful. And, a tumor can also make the prostate grow bigger. There are many alternatives that can help avoid or reduce the changes and reduce the potential of developing tumors, but that will be discussed in a later article.

The increase in size of the prostate, caused by normal aging, or an infection (or inflamma­tion) that passes into the prostate, can cause problems for you while urinating. On occasion men who are in their 30s or 40s may begin to sense urinary symptoms and require medical attention.

Sometimes the symptoms aren’t realized until men are much older. If you have any of these symptoms, you must tell them to your doctor as soon as possible:

• Are urinating more during the day than you used to?
• Do you feel a urgent need to urinate?
• Do you have a reduced urine flow?
• Do you sense a burning feeling when you urinate?
• Do you get up more than once during the night to urinate?

What changes in your prostate should you look out for?

As you grow older your risk of prostate problems increases. The 3 most common prostate problems are:

1. Infection of the prostate (prostatitis). This is prostate inflammation/infection.

2. Enlarged prostate also known as BPH (benign prostatic hyperplasia). This is a benign (noncancerous) condition where an increased growth of the prostate presses against the urethra and/or bladder. This restricts the urinary flow. Another name for this is benign prostatic hypertrophy.

3. Prostate cancer.

Most men will have normal prostate changes that are not cancerous. Having one problem does not lead to another problem. If you have prostatitis or prostate enlargement (BPH) it won’t increase your risk of getting prostate cancer. But, you may have more than one prostate problem at the same time. For example, you might have prostatitis and BPH simul­taneously.

This first step, of course, is to speak to your doctor and help him understand the "story" of your prostate concerns. You'll be asked about whether you have symptoms, how long you've had them, and how much they affect your lifestyle. Your health history also includes any risk factors, pain, fever, or trouble passing urine. You may be asked to give a urine sample for testing.


What common medical tests exist to detect changes in the prostate?

Three types of medicals tests can help to detect what changes are taking place in the prostate. If you get abnormal test results your doctor will be able to help diagnose the problem and help you determine the appropriate steps to take next to treat the problem.

These tests include:

DRE (digital rectal exam) is a medical test to feel the prostate. The DRE is the standard way to check the prostate. With a latex-gloved and lubricated finger, your doctor feels the prostate by inserting his finger in your the rectum. The test lasts about 10-15 seconds.

This exam checks for:

• The size, firmness, and texture of the prostate.
• Any hard areas, lumps, or growth spreading beyond the prostate.
• Any pain caused by touching or pressing the prostate.

Note: The DRE allows the doctor to feel only one side of the prostate.

A PSA test (prostate-specific antigen) test -- is a blood test to help your doctor evaluate your prostate condition. A Prostate Specific Antigen is a protein produced by normal cells and prostate cancer cells. PSA is found in the blood and can be easily measured with a simple blood test.

PSA testing is still being evaluated by medical researchers to see if early cancer detection will lower the mortality factor for prostate cancer.

PSA levels rise if a man has prostate cancer, but an elevated PSA is absolutely not proof of cancer and many other things can also make PSA levels go up. PSA tests can give false positive test results caused by having BPH, prostatitis, or if the prostate gland is disturbed in any way.

This includes riding a bicycle or motorcycle, a digital rectal exam, having an prostate massage, having an orgasm within the past 24 hours, a urinary tract infection causing inflammation, having a urinary catheter inserted, or even by a prostate biopsy or urinary tract surgery. These can all disturb the prostate and increase your PSA levels.

African-American men tend to have higher normal PSA levels in general than men of other races. And there are people who have prostate glands that naturally produce more PSA than others. PSA levels go up with age.

Medical research continues to try to discover more answers regarding:

1. The PSA test's ability to tell cancer from benign prostate problems.

2. The best approach to treatment if a man has a elevated PSA level.

At this time in medical history, male patients and their physicians are relying upon PSA results, taken several weeks to months apart, to determine if treatment or biopsies and further evaluations are needed. Rapid increases in PSA readings usually suggest cancer. If you have a mildly elevated PSA, your doctor may choose to check your PSA levels on a scheduled basis and watch for any change in the PSA velocity.


What do PSA exam results mean to patients?

PSA levels are determined in measurement of units per volume of fluid tested:
· 0 to 2.5 ng/ml is low · 2.6 to 10 ng/ml is slightly to moderately elevated · 10 to 19.9 ng/ml is moderately elevated · 20 ng/ml or more is significantly elevated.

There is no specific normal or abnormal PSA level. However, the higher a man’s PSA level, the more likely it is that cancer is present. But because various factors can cause PSA levels to fluctuate, one abnormal PSA test does not necessarily indicate a need for other diagnostic tests. When PSA levels continue to rise over time, other tests may be needed.


Prostate Biopsy--a test to check for cancer.

If any of your prostate symptoms or PSA results indicate any potential for cancer, your medical doctor will refer you to a urologist for a prostate biopsy. A biopsy is usually done in the doctor's office.

A biopsy consists of small tissue samples being directly removed from the prostate in a minor surgical procedure done in the doctors office.

An urologist will remove small tissue samples from several parts of the prostate gland. This procedure helps lower the risk of missing areas of the prostate that may have cancer cells. Just like with other forms of cancer, accurate diagnosis of cancer can only be reached examining tissue under a microscope.

Most men who have biopsies after routine exams do not have cancer.
Do you need to repeat the prostate biopsy? Not necessarily. Another test that can help your doctor decide if you need a repeat biopsy is called the free PSA. This test is used for men who have higher than normal PSA values. The test looks at a specific types of PSA in the blood. Free PSA is linked to BPH but not cancer. Free PSA is figured as a percentage of the total PSA.

If both total PSA and free PSA are higher than normal, this usually is indicative that a BPH is, and not cancer, is present. BPH is easily treated. If a regular PSA is high but free PSA is not elevated, it is more likely that cancer is present and more testing is indicated.

Your doctor’s use of a free PSA can help you discover precisely what type of problem with your prostate you have. This can guide your urologist in seeking the proper right treatment. Speak with your doctor about personal risk and free PSA results. Together you can deter­mine whether follow-up biopsies are needed and when.


What to do if a biopsy is positive?

Having a positive biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less likely the tumor is aggressive and may spread.

Treatment options depend on the stage (or extent) of the cancer (stages range from 1 to 4), Gleason score, PSA level, and your age and general health. These items will be available from your doctor and are listed on your pathology report.

Reaching a treatment decision for prostate cancer is a complex process. Many men realize they need to talk with their doctors, family, friends, and other men who have faced similar decisions. There are many organizations that can provide more information and support to you, your partner, and family.


Summary

We’ve talked, so far, about the medical aspects. In our guide to Prostate Health and Plea­sure, we give complete anatomy, diagnostics, treatments and alternatives therapies for prostate health improvement. But we want to make clear to you that many things cause high PSA test scores.

As one contributor mentioned to me he had an undiagnosed and untreated urinary infection that made it difficult for him to urinate. One day he urinated only a few drops, and it was blood. He ran to the hospital and they catheterized him, did a digital rectal exam, and did a PSA.

One year prior his PSA was 2.1 and in the hospital with the catheter in him, the PSA result was 15.9. Needless to say the doctors began to prepare him for a biopsy and prostate removal.

One doctor said “STOP! Let’s just treat this as infection, and give him a special diet, and let him use relaxation therapy”.

Since the patient knew relaxation therapy, and didn’t mind the diet, he went along with the treatment for 3 weeks and retested at 5.1 and over time the PSA normalized.
Remember, there are alternatives: diet, exercise, relaxation and stress management, herbs, nutrients, and more.

In future articles we will talk about some alternatives, prostate massage, locating the male G-spot, and how to milk the prostate for pleasure and improved prostate health.