Diseases of the Urinogenital System - The prostate gland

The prostate gland , which contributes to the production of semen, encircles the base of the male urethra where it joins the bladder. When it begins to enlarge, it compresses the urethra and causes difficulty in voiding. Urination may be difficult to start, and when the urine stream appears it may be thinner than normal.

Because urine may remain in the bladder, there is the possibility of local infection that may spread to the kidneys. If the kidneys become enlarged because of this type of obstruction, a condition of hydronephrosis is said to exist. This disease can cause impaired kidney function and lead to uremia.

Benign Prostatic Enlargement

Enlargement of the prostate gland occurs in about half the male population over 50, and the incidence increases with increasing age. The condition is called benign prostatic enlargement and must be treated surgically if sufficient obstruction is present. For temporary relief, a catheter can be inserted into the bladder through the urethra, allowing the urine to drain through the catheter and out of the body. If surgery is necessary, the entire prostate may be removed or only that part of it that surrounds the urethra.

Symptoms of benign prostatic enlargement are quite distinctive: increased difficulty in voiding; an urge to continue to urinate after voiding has been completed; burning and frequent urination, caused in part by infection from urine retained in the bladder.

The cause of benign prostatic enlargement is thought to be a change during the aging process in the hormones that affect prostate tissue, but the exact nature of the change and its effect is not clear. It is likely that hormone-containing medicines will eventually be developed that will prevent or reverse prostate tissue growth.

Acute Prostatitis

Acute prostatitis occurs typically in young men. Symptoms include pain on urinating, sometimes a discharge of pus from the penis, pain in the lower back or abdomen indicating a tender and enlarged prostate, and fever. It is caused by a bacterial infection and usually responds promptly to antibiotics.

Cancer of the Prostate

Cancer of the prostate is a common type of malignancy in older men. It accounts for about 10 percent of male deaths from cancer in the United States. The disease may be present without any symptoms or interference with normal function and is therefore difficult to diagnose. A very high proportion of men over 80—probably more than 50 percent—has been found to have had cancer of the prostate at autopsy.

When symptoms are present, they are likely to be the same as those of benign prostatic enlargement. The disease can be diagnosed only by a biopsy examination of a tissue sample taken from the prostate during surgery. If malignancy is found, the gland is surgically removed when feasible to do so; the testes are sometimes removed too so that the level of male hormones in the body is lowered.

Male hormones increase the growth of malignant prostate tissue, but because female hormones slow it down, they may be administered after a diagnosis of prostate malignancy. If the tumor has spread to bone tissue, radiation treatment of the affected areas may slow down cancerous growth and relieve pain.

Men over 50 should have a rectal examination and a prostate-specific antigen blood test once a year, since tumors of the prostate and benign prostatic enlargement can often be diagnosed early in this way.