Acute Prostatitis:

              A common disorder in men older than 30 years. It is characterized by discomfort behind the scrotum,
urgency to urinate, weak urinary stream, dribbling after urination, rectal pain on defecation, increased urinary
frequency because of incomplete emptying of the bladder. The prostate is located beneath the bladder and in front
of the rectum. The urethra pierces the prostate, then connects with the penis. When the prostate is inflammed and
swollen, the segment of the urethra within it is compressed, giving rise to the symptoms above. To pinpoint the
causative agent requires culturing prostatic fluid directly which is difficult. Performing a digital ( with the finger )
rectal exam and pressing on the prostate can express prostatic fluid into the urethra. The uirne culture then will
have a higher yield in revealing the bacterial agent. Chlamydia and E. Coli are the most common agents.
 Treatment is with antibiotics for 2 to 4 weeks. Hot baths and anti-inflammatory drugs ( naprosyn, ibuprofen ) can
alleviate the discomfort. Decongestants and antihistamines have to be avoided, since they can worsen blockage
of the urethra and urinary retention ( inability of the bladder to empty at all, leading to accumulation of urine,
bladder distention and pain above the pubic area ). Emergency catheterization is sometimes necessary to relieve
the urinary retention.

Benign Prostatic Enlargement:

              As the name implies, this is not cancer. In fact it is not even a disease. It is a natural process of aging.
The prostate gland enlarges and presses against the urethral segment passing thru it. It proceeds slowly with
age and shows itself merely as frequent nighttime urination. Why nighttime? Sleep is a diuretic, meaning that
our kidneys filter more water out of our blood stream when our bodies are resting at night. Older men go to bed
with their bladder partially full due to their incomplete emptying and so it quickly fills leading to nighttime
urination. When a person gets up more than two or three times a night to urinate, it can lead to poor quality
of sleep, daytime fatigue, declining productivity and sometimes depression.  Treatment is with medication
when it is early and mild, later with surgery if the medications fail.

Prostate Cancer:

               Prostate cancer can occur in men as early as the mid 40's. After the age of 40, men have to have annual
digital rectal exams, and after 50 annual PSA ( prostatic specific antigen ). PSA is a blood marker for prostate
cancer. In patients with strong family history of prostate cancer, screening with PSA should begin at 45. There
are no reliable signs and symptoms for prostate cancer, rather men are encouraged to simply get checked
annually. If the digital rectal exam reveals a suspicious nodule on the prostate, or if the PSA is elevated, the
patient is then referred to a Urologist for a prostate biopsy which is performed with the guidance of an ultrasound
in order to sample the precise area where the abnormality is detected. Treatment of prostate cancer depends
on the aggressive nature of the tissue and the extent of its spread. It can range from medications to surgery.