Prostate Disease

Several of my friends have been told that they have prostate disease. How common is prostate disease? What is it, and how do I know if I have it? H The prostate is a small gland (normally about the size of a walnut and weighing about an ounce) located between a man's urinary bladder and penis, but in front of the rectal area. The urethra, the tube that carries urine, goes from the bladder through the prostate and penis. Most older men have some type of prostate disease. The most common - benign prostatic hyperplasia - affects more than 70 percent of men over age 60. Frequently, this form of the disease goes undiagnosed and requires no treatment.

There are three ways to check for prostate disease - history and physical examination, blood test, and biopsy. During a physical examination, a physician takes a patient's medical history and asks about any urinary problems. The patient may need to complete a written questionnaire to flag any other health problems.

The prostate is checked during the digital rectal examination. A physician inserts his or her gloved and lubricated finger into the anus and palpates the area. This enables the physician to feel the size of the prostate (to see if it's enlarged) and determine its shape and consistency to see if it's hard or has any nodules or other masses.

Men also can have a blood test, the prostate-specific antigen (PSA) test. PSA is a protein produced by prostate tissue, and its levels increase slightly with age. However, with prostate cancer, the protein levels can increase very quickly. Men older than 50 and high-risk men older than 40 (those with a positive family history of prostate cancer and those of African-American descent) should ask their doctor about this test. This is only a screening test; an increased PSA level doesn't necessarily indicate cancer - it only means more tests are needed.

Abnormal results from a rectal examination or PSA test usually call for a transrectal ultrasound-guided biopsy. An ultrasound can further assess the prostate and help the physician know from which part of the prostate biopsy specimens should be taken. A biopsy is done in the doctor's office under local anesthesia and includes eight to 12 small samples from specific areas of the prostate.

Once the specimens are removed, a pathologist evaluates them under a microscope to detect benign prostatic hyperplasia, inflammation, precancerous conditions, cancer, or other abnormalities. If you are an eligible military beneficiary and want an appointment with the Department of Defense's Center for Prostate Disease Research, call (202) 782-4000, or visit its Web site via TROA's links page, www.troa.org/magazine/links.asp.