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Prostate Disorders

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Men's Health

The prostate is a glandular organ in men that secretes between 0.5 mL and 2 mL of fluid per day. This fluid consists of citric acid, prostaglandins and fibrinogen. Prostatic epithelial cells secrete a glycoprotein called prostate-specific antigen (PSA).

The prostate lies at the base of the bladder and weighs about 20 grams. It consists of five lobes: the right and left lateral lobes, the right and left posterior lobes, and the medial lobe.1

Common prostate problems include prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer. Prostatitis is an inflammation and/or infection of the prostate gland.1 BPH is a glandular hyperplasia that causes an increase in epithelial cells. Two mechanisms of obstruction in BPH are static and dynamic constriction. Static constriction is caused by the increased volume of prostatic tissue that directly obstructs the bladder neck. Dynamic constriction is an increase in prostatic muscle tone through adrenergic stimulation that also constricts the bladder neck.1-3 Prostate cancer results from genetic abnormalities that lead to neoplasia of prostatic tissue. The left and right posterior prostate lobes are the most predisposed sites of malignancy.1

Clinical Presentation

Irritant urinary symptoms are the primary complaints of men who seek healthcare for prostate conditions. Table 1 outlines the primary urinary symptoms for each of the prostate conditions. Prostatitis and BPH produce primary urinary symptoms that result from urinary restriction of outflow from the bladder. Prostatitis, BPH and prostate cancer may produce deep perineal prostate pain.3-5

Diagnosis

The diagnosis of prostatitis and BPH are primarily based on history and physical examination findings. The history should include past medical history, sexual history, social history and past and recent symptoms. The physical examination should include a review of systems, but its primary focus should be on the male genital and prostate exam.

The prostate examination is typically referred to as the digital rectal exam (DRE). The DRE consist of a visual inspection of the perineal area and anal sphincter and palpation of the anal sphincter and canal. During the DRE, the prostate should be palpated for size, symmetry, consistency and contour. DRE with prostatic massage should not be performed in the patient with suspected acute prostatitis.2-4

Diagnostic testing helps distinguish the type of prostatitis present. Prostate cancer diagnosis is further supported by PSA and biopsy.

Table 2 outlines common diagnostic tests used to differentially diagnose prostate conditions. Common disorders to consider in the differential diagnosis include: prostatitis, BPH, prostate cancer, acute cystitis, prostatic abscess, voiding dysfunction, urinary tract infection, and bladder cancer.2-4 Table 3 summarizes recommendations from professional organizations or associations about prostate cancer screening.5

Management

Prostatitis can resemble various urologic and other medical conditions, but accurate classification and a pharmacologic understanding of the medications can lead to effective treatment strategies. Medical treatment is the first choice in the management of prostatitis, and multiple options are available. Ultimately, the goal is realistic symptom improvement and control rather than eradication. This can be achieved with straightforward diagnostic and therapeutic strategies.6 The choice lies solely at the discretion of the prescribing provider.7

BPH is a chronic and complex progressive disease. Patients with mild symptoms often require no treatment, but those with moderate to severe symptomatology benefit significantly from therapy. Medical treatment is the first-line therapy; surgical interventions are reserved for patients who have poor responses to pharmacologic measures.7

Prostate cancer remains an indolent male disease.7 Management modalities can vary; each has its own limitations and benefits. Treatment selection depends on the age of the patient, the disease stage, comorbidities, lifestyle and overall life expectancy.

Individualized Therapy Needed

In summary, the diagnosis of prostate conditions is based primarily on history and physical examination. Several effective treatments are available for the management of prostate conditions. To select the best treatment option, the healthcare provider and patient will consider particular symptoms, prostate size, other health concerns, and patient preferences.

Leslie F. Nolden and Todd Tartavoulle are instructors of clinical nursing in the School of Nursing at Louisiana State University Health Sciences Center-New Orleans. Demetrius J. Porche is dean and professor of nursing in the School of Nursing at Louisiana State University Health Sciences Center-New Orleans.


References

1.      Thomas D, Porter B. Men's health problems. In: Dunphy L, et al. Primary Care: The Art and Science of Advanced Practice Nursing. 3rd ed. Philadelphia, PA: F.A. Davis; 2011: 625-660.

2.      Edwards J. Diagnosis and management of benign prostatic hyperplasia. Am Fam Physician. 2010;82(4):397-406.
3.      Sharp V, Takacs E. Prostatitis: diagnosis and treatment. Am Fam Physician. 2010;82(4):397-406.

4.      Mohan R, Schellhammer P. Treatment options for localized prostate cancer. Am Fam Physician. 2011;84(4):413-420.

5.      Wilbur J. Prostate cancer screening: the continuing controversy. Am Fam Physician. 2008;78(12):1377-1384.

6.      Naikoo M, et al. Medical management of benign prostatic hyperplasia in the light of available evidence. Turkish J Urol. 2010;36(4):418-429.

7.      Vaidyanathan R, Misha V. Chronic prostatitis: current concepts. Ind J Urol. 2008;24(1):22-27.




     

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