Prostate Health: Screening, Diagnosis, and Treatment Options

The prostate is a small but vital gland in the male reproductive system that requires attention, especially as men age. Prostatitis is a condition where the prostate gland becomes swollen or inflamed. In India, around 1 million men are diagnosed with prostatitis each year. For chronic prostatitis, which lasts a long time, treatment works in 64% to 88% of cases.

In 2020, 1.41 million men were newly diagnosed with prostate cancer worldwide, and it caused 375,304 deaths. This makes it the second most common cancer among men globally, with an incidence of 36 per 100,000 men. In India, prostate cancer is becoming a serious health issue. In 2020, there were 34,540 new cases and 16,783 deaths from prostate cancer.

Understanding how to screen for, diagnose, and treat prostate issues is essential for maintaining long-term health and well-being. Let's focus on the importance of prostate treatment and the proactive measures you can take to screen for prostate problems. But first, let’s learn about prostate health basics.

Prostate Health Basics

The prostate gland, located below the bladder and surrounding the urethra, produces seminal fluid and plays a key role in male reproductive health. As men age, this gland can develop issues like:

• Benign Prostatic Hyperplasia (BPH), which is a non-cancerous enlargement causing urinary problems
• Prostatitis, an inflammation of the prostate gland often caused by infection
• And prostate cancer, a common cancer among men, especially those over 50. 

Being aware of these conditions and getting regular screenings can help detect problems early, leading to better and more effective treatments.

Prostate Health Screening

1. Prostate-Specific Antigen (PSA) Test

The PSA test is a simple blood test that measures the level of prostate-specific antigen (PSA) in your blood. PSA is a protein produced by the prostate gland. High levels of PSA can signal prostate cancer or other prostate issues like Benign Prostatic Hyperplasia (BPH) or prostatitis. However, high PSA levels don’t always mean cancer. They can also be due to non-cancerous conditions or even recent physical activity like cycling or ejaculation. Because of this, if your PSA levels are elevated, your doctor may recommend further tests to find out the cause.

2. Digital Rectal Exam (DRE)

In a Digital Rectal Exam (DRE), a doctor gently inserts a gloved, lubricated finger into the rectum to feel the prostate. This helps to check for any lumps, hardness, or enlargement of the prostate that might indicate a problem. DRE is a quick and effective way to detect early signs of prostate issues.

3. Imaging Tests

Imaging tests provide detailed pictures of the prostate and are often used to further investigate any abnormalities found in initial screenings. Here are two common types:

• Transrectal Ultrasound (TRUS): This test uses sound waves to create images of the prostate. During the test, a small probe is inserted into the rectum. TRUS is often used if there's a need to guide a biopsy.
• Magnetic Resonance Imaging (MRI): MRI scans provide detailed images of the prostate and surrounding tissues. They help in diagnosing prostate conditions and planning treatments, especially if cancer is suspected or needs to be precisely located.

Diagnosing Prostate Conditions

When screening tests like PSA or DRE indicate potential prostate issues, doctors use additional diagnostic methods to confirm the diagnosis and understand its severity. Here are the key diagnostic procedures for prostate conditions:

Prostate Biopsy

A prostate biopsy is a procedure where small samples of prostate tissue are collected for examination under a microscope. This is the most definitive way to diagnose prostate cancer. During the biopsy, a doctor typically uses imaging techniques like Transrectal Ultrasound (TRUS) or MRI to guide the needle and ensure samples are taken from the most suspicious areas. The tissue samples are then analysed to determine if cancer cells are present and, if so, to assess how aggressive the cancer might be.

Urine Tests

Urine tests are used to detect infections or other conditions that might cause symptoms similar to prostate problems, such as urinary tract infections or bladder issues. These tests can also identify markers that may indicate the presence of cancer or other abnormalities. For instance, the PCA3 urine test looks for a specific genetic marker that is often elevated in men with prostate cancer.

Urodynamic Tests

Urodynamic tests measure how well the bladder and urethra store and release urine. These tests can help diagnose urinary symptoms commonly associated with Benign Prostatic Hyperplasia (BPH), such as difficulty starting a urine stream or frequent urination. During these tests, various sensors measure the pressure in the bladder and the flow of urine, providing detailed information about how the bladder and urethra function.

Cystoscopy

Cystoscopy involves inserting a thin, flexible tube called a cystoscope through the urethra into the bladder. The cystoscope has a camera and light, allowing the doctor to see inside the bladder and urethra. This procedure helps identify blockages, such as an enlarged prostate pressing against the urethra or other abnormalities like bladder stones or tumours.

Genetic Testing

For men with a strong family history of prostate cancer, genetic testing can help assess the risk by analysing specific genes linked to the disease. Certain inherited genetic mutations, such as those in the BRCA1 and BRCA2 genes, can increase the risk of prostate cancer. Knowing your genetic risk can guide decisions about screening and preventive measures. 

Treatment Options for Prostate Conditions

Treatment varies depending on the specific prostate condition, its severity, and the patient's overall health. Here are the primary treatment options:

Benign Prostatic Hyperplasia (BPH)

For managing Benign Prostatic Hyperplasia (BPH), making simple lifestyle changes, like cutting down on caffeine and alcohol and watching fluid intake before bedtime, can ease symptoms. Medications such as alpha-blockers can help relax the prostate muscles for better urine flow, and 5-alpha-reductase inhibitors can shrink the prostate. If needed, minimally invasive procedures like transurethral microwave therapy (TUMT) and transurethral needle ablation (TUNA) can reduce prostate size. In more severe cases, surgeries like transurethral resection of the prostate (TURP) or laser surgery might be necessary to remove part of the prostate.

Prostatitis

For prostatitis, treatment depends on the cause. If it’s bacterial, antibiotics are needed. Anti-inflammatory medications can help reduce pain and swelling. Alpha-blockers may be prescribed to relax the muscles around the bladder and relieve symptoms. Simple changes like drinking more water and avoiding spicy foods and caffeine can also help.

Prostate Cancer

Prostate cancer treatment varies based on how fast the cancer is growing. For slow-growing cancers, regular check-ups are needed. Surgery like radical prostatectomy is used to remove the prostate gland as an option for more serious cases. Radiation therapy can target and kill cancer cells. Hormone therapy slows cancer growth by lowering testosterone levels. Chemotherapy is used for advanced cancer that has spread. New treatments like targeted therapy and immunotherapy focus on attacking specific cancer cells or boosting the immune system to fight the cancer.

Conclusion

Prostate health is essential for men’s well-being. Regular check-ups and early detection of issues like prostatitis, BPH, or prostate cancer can lead to effective treatment and a better quality of life. This Men’s Health Week, let’s prioritise prostate health and take proactive steps to stay healthy. For more information about common men’s health problems and their treatment options, check out MASSH. We specialise in effective treatment for prostate as well as men’s sexual health problems. Check out our website to learn more or visit us today to consult with our specialists.