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A function of age

The prostate is a male reproductive gland that produces the fluid that assists in the transportation and nourishment of sperm. As men age, the prostate, normally about the size of a walnut, may undergo two independent changes. The first, called benign prostatic hypertrophy or BPH, is a noncancerous enlargement of the prostate that can develop in men beginning around age 45. Considered normal, it can result in difficulty urinating.

"Balding and graying hair are normal changes most men go through as they age," says Dr. Donald Goldman, vice chair of Urology at Community Hospital.

"An enlarged prostate is normal in the sense that it happens to most men; but unlike other changes, it may cause significant medical problems that should be addressed."

Although its cause is largely unknown, the enlarged prostate is a phenomenon that occurs in the late 40s to early 50s, resulting in discomfort and a less efficient process of urination. Relief is available with medications or several minimally invasive procedures such as microwave thermo therapy, radio ablation, or laser therapy, a relatively new outpatient procedure that seems to have a better and more consistent result than the others, according to Goldman.

The second potential change, independent of the BPH process, is the development of prostate cancer, a common problem that occurs at a rate of 350,000 new diagnoses every year.

Just because prostate cancer is considered the slowest-growing cancer doesn't mean you can ignore it. Doctors recommend that all men 50 or older undergo a prostate examination and a prostate specific antigen (PSA) blood test annually. Patients with a family history of prostate cancer should have an annual checkup beginning at age 40.

"PSA is a chemical made by the prostate and then released into the bloodstream," says Goldman. "If the PSA is higher than normal, it raises the possibility that a man has prostate cancer. Normal is the number 4, but it is age-specific. In older men, we accept as high as 6.5; and in younger men, we become concerned if it's higher than 2.5 or 3."

Not all men with elevated PSAs have prostate cancer. The other possibilities would be a noncancerous enlargement of the prostate, a prostate infection, or a recent manipulation of the prostate such as a catheter in the bladder. On the other hand, patients with prostate cancer don't always have an elevated PSA, which is why a physical examination is also important.

"If the prostate feels firmer than normal," says Goldman, "we must be suspicious about the presence of prostate cancer. When there is suspicion, either by palpation or an elevated PSA, the next step is to do a biopsy of the prostate, a five-minute office procedure that is not a lot of fun but is important. With the aid of an ultrasound machine, we take small cores of tissue from the prostate and have them evaluated microscopically, looking for the presence of cancer."

The risk of developing prostate cancer increases with age. Although many older men will die with prostate cancer, far fewer of them, says Goldman, will actually die from prostate cancer. Nevertheless, the key to successful treatment or cure is early detection, especially with a disease that in its early stages has no symptoms. Men, particularly between the ages of 50 and 80, should participate in an annual screening process.

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