You may have heard that if you were male and lived long enough, you would likely get prostate cancer. You may have also heard that males are more likely to die with prostate cancer than to die from it. There are some things we can do to improve the likelihood that prostate problems can be found earlier, hopefully resulting in improved outcomes.

Location and function

The size of a walnut, wrapped like a cuff around the urethra (the tube leading from the base of the bladder to the penis) this little organ is important for reproduction. The journey that spermatozoa must travel to fertilize the ripe ova is perilous, through acidic vaginal secretions, up the cervical passage, into the uterus and through the openings of the fallopian tubes. These delicate, mobile cells need a safe medium in which they can easily move without being damaged. Like the fire-retardant foam sprayed on the runway to cushion the aircraft's contact during a forced crash landing, during ejaculation the prostate secretes an alkaline, nutritive fluid into the urethra to be mixed with sperm traveling from testicular tubules, to create semen which is deposited in the female genital tract.

Types of prostate problems

Growth and activities of prostate cells are under the influence of sex hormones, such as testosterone. Like old men's noses and ears, the prostate gets bigger with age, a process called benign prostatic hypertrophy (BPH). As the gland enlarges, it pushes on nearby structures, including the urethra. This can block bladder emptying and might require treatment, medical or surgical, to remove the obstruction. The prostate may become infected, resulting in a painful condition sometimes difficult to eradicate. Infections cause inflammation and swelling, resulting in partial or complete urinary obstruction, pain and fever. Because the fatty tissues of the prostate are poorly infused with blood, antibiotics are needed for several weeks or more to eradicate the infection.

Much like the glandular cells of the female breast, prostate cells, influenced by hormones, can become cancerous. At first these cancer cells stay put and replicate slowly, resulting in gradual enlargement of the tumour. Once the cancer mass reaches a certain size it can be detected by rectal exam. After a period of in-situ growth the cancer spreads or metastasizes to other parts of the body, especially to bone.

Prostate cells put out a small amount of protein, called prostatic specific antigen (PSA), that may be detected using a blood test. Since the amount of prostate tissue increases with age, PSA levels normally increase with age, so the normal range gradually increases from under 0.7 ng/ml between the ages of 40 and 50 to as high as 1.5 ng/ml for men in their 60s. Elevated levels of PSA can be caused by prostatic enlargement, infection, manipulation or prostate cancer. More recent techniques have been able to separate and identify two kinds of PSA: free PSA and a complexed PSA that is attached to other molecules. In prostate cancer the ratio of free PSA to total PSA is much lower than in other prostate conditions, so this ratio provides important information to plan further investigations and treatment.

Treatments and side effects

There is a wide variety of treatment available for benign prostatic hypertrophy. The traditional treatment of choice has been removal of a small amount of the glandular tissue via the cystoscope, inserted through the penis; an operation called transurethral prostatic resection (TUPR). Possible side effects include temporary obstruction requiring catheterization, infection and, occasionally, erectile dysfunction.

Medication is the most common treatment for mild-to-moderate symptoms of BPH. There are drugs that help relax muscles in the prostate, and others that block the nerve and hormonal stimulation of prostate cells, allowing them to decrease in size. Depending on the case, medications can be used in combination. Side effects are different for each medication, ranging from dizziness to retrograde ejaculation (a harmless condition where semen goes back into the bladder instead of out the tip of the penis).

Prostate cancer can be treated with surgery to remove the cancer tissue, castration to remove the hormones that stimulate tumour growth, drugs that inhibit production, secretion or the activity of tumour-stimulating hormones, radiation and chemotherapy. As well as the common side effects of surgery and chemotherapy, temporary urinary tract obstruction, erectile dysfunction and loss of libido are frequently caused by these treatments. Detected early, improved rates of long-term remission are obtained for patients with prostate cancer.

The bottom line

Prostate cancer is the most common cancer experienced by men. Although there is no standard test for prostate cancer, two tests are commonly used: a PSA test and a rectal exam. Whether you go with a PSA test or a rectal exam, there is general agreement that earlier detection results in better outcomes.

Watch for changes in urinary stream: difficulty beginning the urine stream in the morning, slower bladder emptying, pain or discomfort. Get regular physical exams, and if you are a man over 50, expect both a digital rectal exam and a PSA test.