A gland within the male reproductive system that is located just below the bladder. Chestnut shaped, the prostate surrounds the beginning of the urethra, the canal that empties the bladder. The prostate is actually not one but many glands, 30-50 in number, between which is abundant tissue containing many bundles of smooth muscle. The secretion of the prostate is a milky fluid that is discharged into the urethra at the time of the ejaculation of semen. The origin of the name "prostate" is quite curious. The word is from the Greek "prostates", to stand before. The anatomist Herophilus called it the prostate because, as he saw matters, it stands before the testes.
There are three distinct types of disease of the prostate gland. These diseases share many symptoms, but have different causes.
Benign Prostatic Hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that affects approximately 50% of all men before the age of 50 and greater than 75% percent of men over the age of 60. Symptoms include difficulties associated with urinating, an urge to urinate even when the bladder is empty (urgency), frequent urination, especially at night, and a weak or intermittent stream or a feeling of incomplete emptying of the bladder and/or dribbling of urine.
Prostatitis is an inflammation of the prostate that may be caused by a bacterial infection. This disease may affect men of any age and can occur in any prostate whether small or enlarged. Symptoms of prostatitis are similar to those caused by an enlarged prostate and include urge frequency with difficulty in emptying the bladder. Prostatitis may be indicated by chills, fever and by pain or burning during urination.
Prostate cancer is the second leading cause of cancer deaths among men. However early detection often leads to the effective treatment of prostate cancer. In the majority of cases, prostate cancer will be detected while it is still localized, rather than metastasized (spread). When prostate cancer is detected early and treated, the five-year outcome is generally very successful. The prostate cancer screening process is critical in early detection.
Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancer’s stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.
Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy (external-beam or brachytherapy) or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended.
Locally advanced prostate cancer may be treated with external-beam radiation therapy and concurrent hormonal therapy or with surgery alone that doctors consider hormonal therapy to stop testosterone production plus abiraterone and prednisolone when patients can receive this approach. If abiraterone is not an option, combined androgen blockade using an AR inhibitor may be recommended. Treatments may be given in different combinations to stop the cancer from growing and spreading. Active surveillance is also an option. For those who have not received previous local treatment, including surgery, and who are unwilling or unable to receive radiation therapy, early (immediate) hormonal therapy may be offered.
It is widely accepted that at least 24 months of hormonal therapy is needed to control the disease, but 18 months may also be enough. For those who have a radical prostatectomy, radiation therapy is given after the surgery. This is called adjuvant or salvage radiation therapy. It is a standard of care for prostate cancer with extraprostatic extension, which is when the tumor has spread to nearby areas outside the prostate gland. Those with a high risk of bone fractures may be given a bone-modifying drug on an osteoporosis treatment dose and schedule (see "Bone-modifying drugs” above)
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. High-risk or locally advanced prostate cancers have a higher chance of becoming metastatic cancer. If prostate cancer has a high risk of becoming metastatic or is already metastatic, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option
For many people, a diagnosis of advanced cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients
There is no cure for metastatic prostate cancer, but it is often treatable for quite some time. Many people outlive their prostate cancer, even those who have advanced disease. Often, the prostate cancer grows slowly, and there are now effective treatment options that extend life even further. In this way, it can be like living with a chronic disease like heart disease or diabetes, requiring ongoing treatment to minimize symptoms and maintain well-being.
Supportive, or palliative, care to help relieve symptoms and side effects is an important part of the care of advanced prostate cancer. Supportive care options include:
Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate. An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow. TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication.
While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP.
TURP helps reduce urinary symptoms caused by benign prostatic hyperplasia (BPH), including:
TURP might also be done to treat or prevent complications due to blocked urine flow, such as:
Risks of TURP can include:
Holmium laser prostate surgery is a minimally invasive treatment for an enlarged prostate. Also called holmium laser enucleation of the prostate (HoLEP), the procedure uses a laser to remove tissue that is blocking urine flow through the prostate. A separate instrument is then used to cut the prostate tissue into easily removable fragments.
HoLEP is similar to open prostate surgery but requires no incisions. HoLEP removes the entire portion of the prostate that can block urine flow. It can be an option to treat a severely enlarged prostate. The treatment provides a lasting solution for an enlarged prostate — a condition known as benign prostatic hyperplasia (BPH). HoLEP also preserves removed tissue so that it can be examined in the laboratory for other conditions, including prostate cancer. As with other types of prostate laser surgery, HoLEP can offer faster recovery and symptom relief compared with traditional prostate surgery. Rarely, re-treatment with HoLEP may be needed for urinary symptoms.
