Medical doctor holding a blue ribbon.

User’s Guide to the Prostate

Table of Contents

 

The prostate gland, AKA “the prostate.” What is it? What does it do? HOW does it do what it does? And where the heck is it, anyway?

According to the University of Tennessee Medical Center, most men have no idea how to answer any of these questions.

We men take our prostates for granted. In fact, most times we only become aware of the prostate’s existence when it starts causing trouble later in life. 

We at eDrgustore intend to fix that. In this guide, we’re going to drop the prostate knowledge on you that you probably didn’t get in 9th grade health class, or even a decade or two afterward.

You’ll learn the important role of this special piece of reproductive equipment, its location, what can go wrong with it, and how to keep it healthy and working.

A Prostate Primer

Why does this stuff matter? Because the things that can go wrong with the prostate aren’t limited to the difficulty urinating many men experience as they get older. There are also warning signs that indicate the presence of prostate cancer, one of the most common and dangerous forms of cancer in men.

Where Is the Prostate Located?

The prostate gland is shaped like a fat, conical donut that wraps around the urethra, which is the shared “exit tube” for both urine and semen in men. 

Male anatomy diagram.

Here’s a quick exploration for you to illustrate: Find your pubic bone, the hard part about two or three inches above the base of your penis. 

The prostate is located just behind that bone, under the bladder. It’s normally about the size of a walnut, or if you aren’t into nuts, it’s about the size of a golf ball. You can sort of detect it by pressing on your perineum (the “gooch” or “taint,” that spot between your scrotum and your anus), but to fully access it, you need to go through the backdoor entrance.

What Does the Prostate Do?

We always think of sperm cells as being highly motivated and mobile; after all, they’re often referred to as “little swimmers.” And they definitely are, except for one problem.

Have you ever tried to swim in an empty swimming pool? We’ll spoil the surprise for you: you can’t. Sperm are the same way, because just like you, they can’t swim in air. 

Sperm cells are a little picky, with an added dose of lazy (which I suppose goes for us human males too). They require nutrition, a liquid medium to swim in, and most importantly, a way to neutralize the acidic environment of the vagina that would otherwise destroy them.

This may be news to you, but a healthy vaginal pH for pre-menopausal women averages around 4.0 to 4.5 — in the acidic range of the pH scale. While the main purpose of this acidity is to suppress the growth of bacteria and yeast, it also happens to make life difficult for any little swimmers migrating upward, attempting to fertilize an egg cell. 

In fact, the vagina’s acidity slaughters sperm wholesale, as sperm cells rapidly lose their ability to move and survive in pH levels under 6.0.

Prostate: Defending Your Swimmers

Fortunately for our species, men have evolved an important way to solve this problem: the prostate gland.

The prostate’s main function is to make seminal fluid, the liquid component of the semen that is released when you ejaculate. This fluid is basically Ensure for your sperm cells. Not only does it provide them with a nice liquid environment to start swimming in, but it also provides them with the nutrients they need to sustain them on their lengthy journey to their intended goal: fertilizing an egg cell. 

So Close, Yet So Far

The distance they need to travel to find an egg seems small, but for a bit more perspective, here’s what BabyCentre has to say on the matter:

“In all, they [sperm cells] need to travel about 18 cm [about seven inches] from the cervix through the womb to the fallopian tubes. That’s the equivalent of a human being swimming 100 lengths of an Olympic swimming pool! The fastest swimmers may find the egg in as little as 45 minutes. It can take the slowest up to 12 hours.”

Preparing For an Extended Excursion

Sperm swimming to an egg.

Suffice it to say, your fellas need to “eat” and “drink,” like any other cell, as they try to make this enormous trek. Not only do they have a long trip ahead of them, but they’re also competing with each other for sperm supremacy in an acidic, hostile environment. They need their nutrition.

The prostate provides this nutrition. Most importantly, though, the fluid made by the prostate has an alkaline pH (greater than 7.0). This characteristic helps to neutralize the acidic pH of the vagina, maximizing the chances of your sperm making it to the finish line. Otherwise, they wouldn’t stand a chance. 

Common Non-cancerous Prostate Conditions

Let’s face it: The prostate gland is a body part most guys don’t really think (or even know) about until something goes wrong with it. In that sense, it’s like the brake system on your car: We know it’s there, and we know it’s important, but we take it for granted until the car starts shaking every time we press the brake pedal.

Car talk aside, the things that can go wrong with this seemingly simple part of the male anatomy also happen to cause some of the most common men’s health problems. 

Yet the Men’s Health Network reports that a lack of awareness and education about their health, along with cultural beliefs about masculinity, are leading to an increasing number of men suffering unnecessarily — even dying prematurely — from these problems.

Recall from earlier that the prostate is a donut-shaped gland surrounding the urethra, the tube that, in men, carries both urine and semen through the penis and out of the body. While urine obviously comes from the bladder and only passes through the prostate via the urethra, semen is a combination of sperms cells and the prostate fluid that carries them.

Keeping this little anatomical reminder in mind, here are the three most common prostate problems:

  • Benign prostatic hyperplasia (BPH)
  • Prostatitis 
  • Prostate cancer

These conditions are all more likely to occur with increasing age, and unfortunately, they aren’t mutually exclusive; it’s possible to experience one or more at the same time. Because they cause similar symptoms, it makes it even more important that men over 40 keep up with doctor’s visits and lab tests, and report any new or bothersome symptoms instead of ignoring them or trying to “tough it out.” 

Benign Prostatic Hyperplasia

Benign prostatic hyperplasia may be a mouthful to say, but it’s not as complicated as it sounds. 

  • prostatic means “related to the prostate” 
  • hyperplasia means “excessive growth” — a body part gets bigger because the cells in it are reproducing too fast
  • benign means that the hyperplasia isn’t cancerous 

Putting them together, we see that BPH is a form of prostate enlargement that isn’t thought to be cancer. It’s extremely common, with more than 3 million cases in the United States per year.

Doctors aren’t entirely sure what causes BPH, but it’s thought to be related to changes in male hormone levels that come with aging, inflammation, and fibrosis. (Fibrosis is when extra tissue grows around your organs, making them thick and stiff, creating a “fibrous” texture similar to gristle on a cut of meat.) 

While the origins of BPH aren’t fully understood, we do know that while men younger than 40 rarely experience BPH issues, BPH becomes the most common prostate problem in men over age 50, and the chance of developing it increases with age. 

Your chances of developing BPH also increase if you have a family history of BPH (for example, if your father or brother have prostate issues) or certain medical conditions, especially type 2 diabetes, obesity, high cholesterol/triglycerides, high blood pressure (hypertension), etc. Check out this link for more on metabolic syndrome and how it can affect your health and longevity.

Symptoms of BPH

Benign prostatic hyperplasia diagram.

Because the prostate surrounds the urethra, as it grows, it pinches the urethra shut. This makes it much harder for urine to pass through the narrowed opening and causes the main symptoms of BPH. Winchester Hospital describes the symptoms very neatly:

  • Incomplete emptying— a feeling that the bladder is not empty after urinating
  • Frequency — needing to urinate again less than two hours after urinating
  • Urgency — the urge to urinate is very strong and hard to postpone
  • Nocturia — having to wake and get up out of bed to urinate

Recent studies suggest that the presence of lower urinary tract symptoms like these are also associated with an increased chance of erectile dysfunction and sexual dissatisfaction

Diagnosing BPH

If the above symptoms sound familiar, it’s time for a visit to your physician. Symptoms of BPH often occur with other urinary tract issues, which can range from infections to cancer. 

While additional tests may be done to rule out other conditions, BPH is most easily diagnosed by checking the size of your prostate. And the most common (and inexpensive) way to do that is via digital rectal exam— that is, inserting a (gloved) finger into your rectum. 

If you’ve never experienced such a personal exam, and if the idea makes you cringe a little, you’re not alone. Before you write it off though, understand that this exam is incredibly helpful for your doctor or urologist to understand what’s going on with your equipment. But it’s not painful, and it’s over in 20 seconds.

BPH Treatment

Although the symptoms of BPH aren’t life-threatening, they can be uncomfortable and inconvenient. And even though there’s no shame in the symptoms, the fact is that urinary problems are embarrassing for many men.

Fortunately, of the three major prostate issues men face, BPH is the most treatable. Two types of medications are used to manage BPH (in order of effectiveness): 

  • Drugs that relax the muscles around the prostate to make urinating easier. These drugs, called alpha-blockers, block alpha receptors, which are found in blood vessels throughout the body and in the muscles that control the bladder. Blocking these receptors allows the muscles around the bladder and prostate to relax so urine can pass out more easily.

    While most alpha-blockers can improve BPH symptoms, most of them cause very low blood pressure. Some though, like alfuzosin (Uroxatral) and tamsulosin (Flomax), are specific for the alpha receptors in the muscles of the bladder and prostate. These drugs make it easier to urinate without causing drastic changes in blood pressure.
  • Drugs that shrink the prostate. BPH can also be treated with drugs like finasteride (Proscar) and dutasteride, which gradually shrink the size of the prostate gland by blocking the effects of certain androgens (male sex hormones). These drugs are less effective than alpha-blockers and can take up to six weeks to begin working.

Treatment for BPH is initially guided by patient preference. If your symptoms aren’t too bothersome or inconvenient, you may prefer to just watch and wait to see if they improve on their own.

That said, if you do decide to seek treatment, your doctor will probably start you on an alpha-blocker like tamsulosin (Flomax). This has been shown to be the most effective treatment to relieve BPH symptoms. It starts to work within 48 hours, with maximum effects occurring within two to six weeks.  

If that isn’t enough, doctors will often try doubling the dose of tamsulosin first, then consider adding finasteride or dutasteride to provide additional relief.

Prostatitis

Prostatitis is any inflammation of the prostate gland. It can result from traumatic injury (physical damage) to the prostate or bacteria that get into the prostate via the urinary tract or after sex, but sometimes the cause is unknown. 

Main with pain in his groin.

More than half of men experience the symptoms of prostatitis at some point in their lives. It’s the most common urinary tract issue in men under 50, and the third most common in men over 50.

Prostatitis is classified in a few different categories, depending on whether it’s acute or chronic. The Cleveland Clinic summarizes these categories as: 

Acute bacterial prostatitis (category 1): A urinary tract infection (UTI) causes an infection in the prostate gland. Symptoms include fever and chills. You may experience painful and frequent urination or have trouble urinating. Acute bacterial prostatitis requires immediate medical treatment.

Chronic bacterial prostatitis (category 2): Bacteria become trapped in the prostate gland, causing recurrent UTIs that are difficult to treat.

Chronic pelvic pain syndrome, or CPPS (category 3): CPPS is the most common prostatitis type. Prostate gland inflammation occurs in approximately 1 out of 3 men. As the name implies, this type causes chronic pain in the pelvis, perineum (the area between the scrotum and anus), and genitals.

Asymptomatic inflammatory prostatitis (category 4): This condition causes prostate gland inflammation but no symptoms. You may learn you have this condition after getting tests to find the cause of other problems. For example, a semen analysis for infertility may detect asymptomatic inflammatory prostatitis. This type of prostatitis doesn’t need treatment.

Symptoms of Prostatitis 

Prostatitis shares some of the symptoms of BPH, like difficulty urinating or the feeling your bladder isn’t completely empty. However, prostatitis also tends to cause:

  • Pain or burning during urination or orgasm
  • Pain in the groin or pelvic areas or in the genitals (penis and testicles)
  • Fever/chills
  • Pus-like discharge from the penis 

Diagnosing Prostatitis

Prostatitis is diagnosed a lot like BPH. After discussing your symptoms with you, your doctor may order lab tests, including blood and urinalysis tests. 

Your doctor may also perform a digital rectal exam to check the size of your prostate. To check for bacterial infection, they may also massage the prostate gland during the exam. This causes the prostate to release some of the fluid it contains, which will then be caught in a urine sample you provide so the laboratory can check for bacteria.

Prostatitis Treatment

Treatment for prostatitis depends on the cause. If you’ve never been treated for prostatitis symptoms with antibiotics, or if your urine culture tests are positive for bacterial infection, antibiotics are commonly the first approach. 

Your doctor will determine the appropriate antibiotic based on your urine culture results, but a typical course for prostatitis is about four weeks. This may be combined with an alpha-blocker like Flomax or Uroxatral. 

If antibiotics don’t help your symptoms, or if your symptoms persist despite negative urine culture, your doctor may prescribe anti-inflammatory medications like Celebrex (celecoxib) or anti-inflammatory supplements like quercetin or bee pollen. They may also put you on an alpha-blocker if you weren’t already taking one. 

Chronic Pelvic Pain Syndrome

Holding hands over a groin.

Unfortunately, if you have recurring episodes of prostatitis that don’t respond to treatments, it may indicate that you have a condition called chronic pelvic pain syndrome (CPPS). 

CPPS is diagnosed when you have chronic symptoms of prostatitis without any obvious bacterial cause. The symptoms vary but often include persistent, irritating, or obstructive (blocked) urine flow accompanied by moderate to severe pain in the pelvis, lower back, perineum (gooch or taint), or genitals. 

Unfortunately, most men with chronic prostatitis only seek medical attention for it when they experience erectile dysfunction as a result. Even more concerning is that during their medical exam, most men wait until the end of the exam to mention their urinary/pelvic pain issues, if they mention them at all. 

That’s not a very encouraging statistic, so we will reiterate: Tell your doctor what’s going on with you. They aren’t there to cast judgment or make you feel bad. They just want to help you live your life well. But you need to be honest with them so they can do their jobs properly.

Prostate Cancer

The first two prostate issues we’ve discussed — BPH and prostatitis — can be uncomfortable, inconvenient, and frustrating. But even untreated, they don’t have the potential to kill you.

Prostate cancer, however, does not mess around. After skin cancer, it’s the second most common cancer in American men, with 1 in 8 men being diagnosed with it in his lifetime.

It’s also the second most frequent cause of cancer death in American men, and 1 in 41 men will die of prostate cancer. 

While those statistics certainly sound unsettling, it’s also true that because of modern medical advances in chemotherapy, immunotherapy, and surgical procedures to treat it, almost 100% of men diagnosed with prostate cancer are alive after five years. However, survival rates go down quickly if the cancer isn’t diagnosed relatively early, before it spreads elsewhere in the body.

While a complete discussion of prostate cancer is beyond the scope of this article, we’re going to cover the basics: risk factors, symptoms, diagnosis, and treatment.

Who Gets Prostate Cancer? What Are the Risk Factors?

Group of people.

Given how common prostate cancer is, all men have at least some risk of developing it. There are some more specific risk factors though, including:

Age. Your risk of developing prostate cancer increases as you age, with 60% of cases being diagnosed in men who are 65 and older. Prostate cancer is rare in men under 40, and the average age at diagnosis is around 66. 

This association with aging is caused by genetic mutations that accumulate from exposure to things like ultraviolet (UV) light, certain chemicals, environmental factors, and random mutations. It takes time for these to build up and cause the changes that lead to cancer.

African American heritage. Non-Hispanic Black men are more likely to get prostate cancer, more likely to get it at an earlier age, and more likely to die from it. The reasons for this aren’t well understood. It’s thought to be the result of a complex mix of genetics, diet/exercise habits, and socioeconomic factors like lack of access to healthcare.

Genetics/family history. If you have a family history of prostate cancer, you may have inherited an increased risk of developing the disease. Similar to breast cancer in women, inherited mutations in genes called BRCA1 and BRCA2 increase your risk of developing prostate cancer, and make it more likely that the cancer will be aggressive. 

Your doctor can easily test for these mutations, but if you have a family history of prostate cancer, you should get tested sooner than standard recommendations suggest.

For the latest advances in genetic risk testing for prostate cancer, check out this page from the American Cancer Society.

Reducing Your Risk of Prostate Cancer 

With some cancers, you can take action to reduce your risk. The best example is lung cancer, where men and women who smoke are 23 and 13 times more likely, respectively, to develop lung cancer than people who have never or rarely smoked.

Prostate cancer, unfortunately, doesn’t really have any clear risk-reduction opportunities. There are studies that suggest all sorts of things that supposedly reduce prostate cancer risk; however, a meta-analysis of fourteen different studies on the effect of various vitamins and supplements found no convincing evidence to support the use of any specific vitamin, mineral, or nutritional supplement to reduce the risk of prostate cancer.

In short, there isn’t a whole lot you can do to reduce your risk of prostate cancer. Try to maintain a healthy weight and eat a diet that’s not high in red meat, but more importantly, once you hit 40, get to the doctor’s at least once a year and get checked out. 

Symptoms of Prostate Cancer

The good news is that most prostate cancers are slow-growing compared to other types of cancer. The bad news is that it’s usually the case that early-stage prostate cancer often doesn’t cause noticeable symptoms. That means that a man can have prostate cancer for quite a while without knowing it or having any symptoms. 

Later stages of prostate cancer can cause symptoms similar to BPH or prostatitis, such as painful or difficult urination, blood in the urine, or pain in the pelvis or back. 

However, the longer the cancer goes undetected, the more likely it will get to the point of spreading to other parts of the body, called metastasizing. Once prostate cancer cells break out from the main tumor in the prostate, they’re likely to spread to the bones and lymph nodes, and eventually to the rectum and bladder, where it causes different symptoms, namely pain.

Once that happens, prostate cancer becomes much harder to treat, and the likelihood of survival drops off fast. 

Early Detection Is the Key to Stopping Prostate Cancer

Doctor holding a blue ribbon.

Advances in medical and laboratory sciences help doctors detect prostate cancer in the early stages, before it has a chance to take root, spread, and become life-threatening/untreatable.

But it’s on you to visit your doctor and get screened for prostate cancer. Take a page out of women’s book: The campaigns and efforts to promote mammograms have greatly increased early detection of breast cancer, which in turn allows the cancer to be treated earlier and increases the chances of survival.

Testing and Diagnosing Prostate Cancer

The only way to definitively diagnose prostate cancer is a biopsy, which is a procedure performed by a urologist that takes tiny samples of suspicious tissue from your prostate gland and sends them to a laboratory for analysis. 

However, doctors don’t just biopsy prostates indiscriminately. Biopsy is an invasive procedure, so it’s only performed after your doctor pieces together the results of a few other tests that lead them to suspect prostate cancer.

The main two pieces of information your doc will use before ordering a biopsy are the classic digital rectal exam (which we’ve already covered), and a blood test for a protein made by prostate cells called prostate-specific antigen (PSA).

Normally, all men make some amount of PSA, just by virtue of having a prostate. Its main job is to follow along with semen that is ejaculated, where it helps to keep it liquid so sperm can keep swimming toward their target. 

But some PSA does spill into the bloodstream. In men under 50, blood PSA levels are usually under 2.5 nanograms per milliliter (ng/mL). Levels naturally increase after age 50 but still tend to stay below 4.0 ng/mL

PSA Screening Isn’t the Standard Anymore

PSA test tube.

Until recently, experts thought that high PSA levels were the be-all-and-end-all as a marker for prostate cancer. Recent studies have shown, though, that elevated PSA is far from conclusive. That said, PSA testing still has a place as a kind of early-warning system. 

While sometimes prostate cancer causes increased PSA levels, men who have prostate cancer may have a completely normal PSA level. On top of that, a lot of men who don’t have prostate cancer can have elevated PSA levels. 

These elevated levels (over 4.0 ng/mL) can be caused by conditions other than prostate cancer, including prostatitis, urinary tract infection, recent tests involving the bladder or prostate, a recent colonoscopy, recent intercourse or ejaculation, and medications commonly used to treat hair loss (finasteride) or BPH (finasteride or dutasteride).

If your lab work shows an elevated PSA level, your doctor may order another PSA test to confirm. Even if the level is still high on the second test, your doctor may recommend simply continuing with regular PSA testing and digital rectal exams (DREs) to monitor for changes over time. 

If your PSA level continues to rise, or if your doctor feels a suspicious lump during a DRE, they may order follow-up tests such as a transrectal ultrasound, urine test (to check for UTI), x-ray, or cystoscopy (a scope that’s inserted through your urethra to look at your bladder). 

Prostate Cancer Treatment

Diagnosis document.

Treating prostate cancer is a really, really complicated topic. That’s because there are a lot of different paths you can take to treat it, and there are several factors that can determine the best treatment. The good news is that prostate cancer is slow-growing

Depending on the characteristics of your cancer, you may have several options to treat your prostate concerns, including:

  • Surveillance 
  • Radiation therapy
  • Prostate surgery
  • Hormone therapy
  • Chemotherapy

Let’s explore each of these options and their risks and benefits in more detail.

Surveillance

If your cancer is growing slowly and not an immediate concern, your doctor may recommend what’s called surveillance. 

There are two main types of surveillance, observation and active surveillance.

Observation: If you are doing observation, you will undergo periodic testing and observe your symptoms over time to see if there are any changes. 

Active surveillance: The next step up from observation is active surveillance. This can involve more consistent PSA testing and regular doctor’s visits. If there is something concerning in your test results, your doctor may want to biopsy your prostate or examine it using a transrectal ultrasound. 

Surveillance risks and benefits: The benefit of surveillance is that you aren’t undergoing any intense or invasive procedures, like with radiation or surgery. You can monitor your symptoms at home and shouldn’t experience much pain or discomfort, and there are no side effects to this method.

Radiation Therapy

Radiation therapy.

Radiation is a type of therapy that uses rays to kill cancer cells. Your doctor may treat your prostate cancer with radiation therapy alone, with a combination of radiation therapy and hormone therapy before surgery, or as further treatment after surgery if the cancer cells were not completely killed off. 

There are two main types of radiation therapy used to treat prostate cancer, internal radiation therapy and external beam radiation therapy.

Internal Radiation Therapy

With internal radiation therapy, also known as brachytherapy, doctors place small radioactive pellets or “seeds” into the prostate. This allows the doctors to target the cancerous areas directly. This treatment is also called seed implantation or interstitial radiation therapy

Doctors may recommend internal radiation therapy if your cancer is in the early stages and is growing slowly. It may also be used at the same time as external beam radiation therapy. (Read more on that below.)  

There are two types of internal radiation therapy, permanent (low dose rate, or LDR) brachytherapy and temporary (high dose rate, or HDR) brachytherapy.

Internal radiation process:With internal radiation therapy, doctors use scanning technologies like MRIs, ultrasounds, or CT scans to properly place the pellets in the cancerous areas. You will be under anesthesia and in the operating room during the procedure. You may either be discharged from the hospital on the same day or have to stay overnight to monitor how you recover.

Internal radiation risks and benefits:You should know that if you already have urinary issues, this procedure could make them worse. Also, because doctors need to carefully place the pellets where the cancer is, this procedure may not be a good choice for men with very large prostates. If you do have a larger prostate, your doctor may give you hormones to shrink the gland before doing this type of radiation therapy.  

Other risks to consider:

  • Radiation exposure (especially with permanent brachytherapy)
  • Seed migration (if the pellets move from their original position)
  • Bowel problems
  • Erectile dysfunction (ED)

There are two major benefits to internal radiation therapy. Because the seeds are very small, you shouldn’t feel discomfort after they are placed. What’s more, the treatment starts working immediately. You don’t have to go in for weekly treatments like you would with external beam radiation therapy. 

External Beam Radiation Therapy 

External beam radiation therapy uses radiation beams to target the cancer from outside the body, as opposed to placing pellets inside the prostate. 

Types of external beam radiation therapy include:

  • Three-dimensional conformal radiation therapy (3D-CRT)
  • Intensity modulated radiation therapy (IMRT)
  • Stereotactic body radiation therapy (SBRT)
  • Proton beam radiation therapy 

External beam radiation therapy process: You will go to your doctor five days per week for at least a few weeks to get radiation treatment. Your doctor will use a machine like an x-ray to direct radiation beams to kill the cancerous areas of your prostate. The procedure itself is pretty quick; it will take you longer to get checked in and prepped for the treatment than to undergo the treatment itself.

External beam radiation therapy risks and benefits: The good news is that this procedure is usually quick and painless. One benefit of this type of therapy is it can also be helpful in reducing bone pain if the cancer has spread to your bones. The downside is that the treatment course is longer than with internal radiation therapy. 

Other risks of external beam radiation therapy include:

  • Bowel problems
  • Urinary problems
  • Erectile dysfunction (ED)
  • Fatigue
  • Lymphedema

Prostate Surgery

Prostate surgery.

A quick way to remove your prostate cancer is to undergo prostate surgery. The most commonly performed type of prostate surgery is the radical prostatectomy, but there several ways to perform the surgery:

  • Radical retropubic prostatectomy
  • Radical perineal prostatectomy
  • Laparoscopic radical prostatectomy
  • Robotic-assisted laparoscopic radical prostatectomy.

Another type of prostate surgery, called a transurethral resection of the prostate (TURP) does not remove the prostate entirely. Instead, it removes tissue inside the prostate but leaves the outside of the prostate intact, much like scooping out the inside of an orange but leaving the peel.

Prostate surgery process:With a prostatectomy, you will undergo surgery to remove the cancerous prostate gland. The difference between the procedures is how the surgeon accesses the prostate during surgery. 

The two most invasive procedures are the retropubic prostatectomy and the perineal prostatectomy. With the retropubic surgery, your doctor will cut below your belly button and above your penis. In the perineal surgery, your doctor will make an incision between the anus and the scrotum. 

There are also less-invasive options for removing the prostate, known as laparoscopic surgeries. In these procedures, several small incisions are made, and long tools are used to access the prostate through the incisions. One of the tools has a camera on the end so the doctor can see what he’s doing while the instruments are inside of you. 

Your doctor can do this himself or with the help of a robot, referred to as a robotic-assisted laparoscopic radical prostatectomy.

Finally, with the TURP method, your doctor will insert an instrument called a resectoscope through your urethra to get to the prostate. Then, heat or laser rays will be used to destroy the cancerous tissue. While it is invasive, this procedure doesn’t require any incisions.  

Transurethral resection of the prostate diagram.

Prostate surgery risks and benefits:Like every surgery, there are risks to prostate surgical procedures. These risks include:

  • Reactions to anesthesia
  • Bleeding from the surgery
  • Blood clots in the legs or lungs
  • Damage to nearby organs
  • Infections at the surgery site

Other side effects can include urinary issues, erectile dysfunction (ED), changes in orgasms, loss of fertility, lymphedema, changes in penis length, and inguinal hernias. 

The benefit to prostatectomies can include minimal healing time if incisions are small or nonexistent, like with laparoscopic surgeries or the TURP procedure. This is also a shorter treatment course than external beam radiation therapy. If your cancer has spread or is growing fast, surgery is a quick way to eliminate the cancer. 

Hormone Therapy

Hormone therapy treatment.

Your doctor may recommend hormone therapy as an option if your cancer hasn’t responded to surgery or radiation, or if cancer returns after treatment. In high-risk cases, it may be used in combination with radiation as early treatment. 

With hormone therapy, doctors use medications to stop certain hormones, called androgens, from feeding prostate cancer cells. Hormone therapy works by limiting the amounts of androgens (like testosterone) your body creates, which should stop your prostate cancer from spreading. 

Types of hormone therapies available:

  • Androgen deprivation therapy (ADT)
  • Orchiectomy (surgical castration)
  • Luteinizing hormone-releasing hormone (LHRH) agonists
  • Luteinizing hormone-releasing hormone (LHRH) antagonists

Hormone therapy process:Some of the therapies, like ADT and surgical castration, use surgical processes to target the androgens in your body. With surgical castration, your doctor will remove your testicles, since this is where most androgens are produced. Though it sounds intimidating, this surgery is done as an outpatient procedure.

LHRH agonists will shrink your testicles as a way to stop androgens from being produced. Your doctor will place the medication under your skin either once a month or once a year, depending on how serious your cancer growth is. 

LHRH antagonists, which are used to treat advanced prostate cancer, are similar to the agonists, but they work faster and have fewer side effects than their agonist counterparts.  

Risks and benefits of hormone therapy:Just as with other prostate cancer treatments, there are side effects to hormone therapy. 

These side effects can include:

  • Reduced sexual desire
  • Erectile dysfunction (ED) 
  • Penile and testicular shrinkage
  • Hot flashes
  • Weight gain
  • Fatigue and/or muscle pain

The good news here is that your doctor can treat many of these side effects. Plus, you don’t necessarily have to have an invasive procedure. Some treatments known as anti-androgens, like abiraterone (Zytiga), can be taken as a daily pill. 

Chemotherapy

Chemotherapy treatment.

Chemotherapy is not a standard treatment for prostate cancer. However, doctors will sometimes recommend it if the cancer has spread outside of the prostate or if hormone therapy hasn’t worked. 

Ultimately, it is up to you and your doctor to determine the best method or methods to treat your prostate cancer. 

Chemotherapy process:Chemotherapy works by killing the cancer cells in your body.

There are several chemotherapy drugs that can be used to treat prostate cancer, including:

  • Docetaxel (Taxotere)
  • Cabazitaxel (Jevtana)
  • Mitoxantrone (Novantrone)
  • Estramustine (Emcyt) 

You can either take these drugs in pill form or through an IV. If you get chemo through IV, you can do this at your doctor’s office, a clinic specifically for chemotherapy, or at a hospital. Typically, you will go through rounds of chemotherapy (usually 2-3 weeks at a time) to give your body time to rest from the side effects. You may go through several rounds of treatment, depending on how your prostate cancer is growing.

Chemotherapy risks and benefits: Chemotherapy treatments can be hard on the body. Chemo can cause fatigue, nausea, and vomiting. You can also lose your hair and your appetite.

Chemotherapy sounds brutal, but it is effective at reducing or completely killing off cancer cells. The good news is that these side effects should clear up once you stop taking the chemotherapy drugs. Plus, there are medications you can take, like anti-nausea medications, to curb some of these side effects.  

A Final Word

By now, you’re probably realizing that there’s a lot more to the prostate than you knew. The truth is, it’s a pretty amazing little gland. 

We realize that we’ve hit you with a lot of information in this guide, but if you take away only one thing from it, let it be this: 

If you’re having prostate symptoms, get checked early and often. Your long-term sexual health (and possibly your life) may depend on it. 

Cancer prevention is the key to a long and healthy relationship with your prostate. Talk to your doctor about prostate cancer screening, and follow their advice. Like most cancers, the earlier it is detected, the better the outcome is likely to be. 

eDrugstore Has Your Back

If you’re struggling with erectile dysfunction after prostate surgery or from prostate disease, we can help. We offer all FDA-approved ED medications, including Cialis for daily use, the only ED med specifically approved for men who have both benign prostatic hyperplasia (BPH) and ED. 

Check out our ED medication guide, or call 1-800-467-5146 for a complimentary medical consultation with one of our U.S.-licensed physicians. We can help you decide which ED medication is right for you and issue a prescription. We will then ship your medication at no charge in discreet packaging, straight to your door. 

To learn more about the prostate and other men’s health issues, follow our blog

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