The prostate, a small gland located just below the bladder, is a central component of male reproductive anatomy that often goes unnoticed until it begins to cause problems. As men age, the prostate is susceptible to several conditions, ranging from benign enlargement to aggressive cancer. Understanding these issues, knowing the screening guidelines, and being aware of modern treatment options are fundamental aspects of lifelong men’s health.
The most common prostate-related issue is Benign Prostatic Hyperplasia (BPH), a non-cancerous enlargement of the gland that affects approximately 50% of men by age 60 and up to 90% by age 85. As the prostate grows, it can squeeze the urethra, leading to a host of disruptive urinary symptoms: a frequent or urgent need to urinate (especially at night), a weak urine stream, difficulty starting urination, and the sensation that the bladder is never fully empty. While BPH is not life-threatening, its impact on quality of life can be significant. Treatments range from lifestyle changes and medications like alpha-blockers (e.g., tamsulosin), which relax the bladder neck muscles, to surgical procedures like transurethral resection of the prostate (TURP) or minimally invasive options like UroLift.
More serious is prostate cancer, the second most common cancer in men worldwide. The debate around screening has been contentious, but a consensus is emerging that emphasizes shared decision-making. The American Cancer Society recommends that men have a conversation with their doctor about the pros and cons of testing starting at age 50 for those at average risk, and earlier (age 40 or 45) for those at higher risk, including African American men and men with a family history of the disease.
The primary screening tools are the prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE). The PSA test measures the level of a protein produced by the prostate; elevated levels can indicate cancer but can also be caused by BPH, infection, or inflammation. This ambiguity can lead to over-diagnosis and unnecessary, invasive biopsies. Therefore, a high PSA level is no longer an automatic trigger for a biopsy. Instead, doctors now use a more nuanced approach, considering factors like PSA velocity (how fast the levels are rising), free PSA percentage, and increasingly, new biomarkers and MRI imaging to better assess risk before recommending a biopsy.
If cancer is detected, treatment options vary widely based on the cancer’s aggressiveness (indicated by the Gleason score) and stage. For low-grade, slow-growing cancers, “active surveillance” is now a standard of care. This involves monitoring the cancer with regular PSA tests and biopsies, thereby avoiding the side effects of treatment—such as erectile dysfunction and incontinence—for as long as possible. For more aggressive cancers, treatments include radiation therapy or a radical prostatectomy (removal of the prostate). The latter is now commonly performed using the da Vinci robotic surgical system, which allows for greater precision, smaller incisions, and potentially faster recovery times compared to traditional open surgery. Maintaining a healthy lifestyle with a balanced diet rich in antioxidants and regular exercise has also been shown to support overall prostate health and may reduce the risk of aggressive disease.
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