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DESCRIPTION
BASIC ANATOMY & PHYSIOLOGY
The prostate is part of the male reproductive system. The prostate is a walnut-sized, doughnut shaped gland at the base of the bladder (beneath the bladder) that encircles the urethra, the tube through which urine is voided and in front of the rectum. The prostate's purpose is to help with the male reproductive system, The prostate produces prostatic (seminal) fluid, which makes up the bulk (up to 70 percent) of the male ejaculate which nourishes and transports the sperm out of the man's body as part of semen. Contraction of the muscles during sexual intercourse occurs in the prostate, squeezing prostatic fluid from the prostate into the urethral tract during semen ejaculation. The prostate contractions at the time of ejaculation prevents retrograde (or backward) flow of semen into the bladder.
The prostate is the most common site of disorders in the male genito-urinary system. Generally speaking, there are 3 conditions that cause problems with the prostate:
- Prostatitis, which is inflammation of the prostate.
- Benign prostatic hypertrophy (BPH), which is an enlarged prostate with no signs of cancer.
- Prostate cancer.
Male hormones (androgens) make the prostate grow. The testicles are the main source of male hormones, including testosterone. The adrenal gland also makes testosterone, but in small amounts. If the prostate grows too large, it squeezes the urethra. This may slow or stop the flow of urine from the bladder to the penis.
PROSTATITIS (INFLAMED PROSTATE)
Prostatitis is swelling or infection of the prostate gland. It often hurts. The prostate gland sits just below a man's bladder and makes part of the fluid for semen. In young men, the prostate is about the size of a walnut. It usually grows larger as you grow older. There are several types of prostatitis. They vary based on how long a man has had the problem and what kind of symptoms he has.
ENLARGED PROSTATE (BENIGN PROSTATIC HYPERTROPHY [BPH])
A man's prostate gland usually starts to enlarge after he reaches 40 years of age. This condition is called benign prostatic hyperplasia (BPH). The prostate gland secretes a fluid that helps to nourish sperm. The gland itself surrounds the urethra, which is the tube that carries urine from the bladder out through the tip of the penis. As the prostate grows larger, it may press on the urethra. This narrowing of the urethra can cause some men with prostate enlargement to have trouble with urination. Prostate enlargement may be the most common health problem in men older than 60 years of age.
PROSTATE CANCER
Cancer of the prostate gland is the second leading cause of cancer death among men in this country. Only skin cancer is more common. Out of every 3 men who are diagnosed with cancer each year, one is diagnosed with prostate cancer. It is primarily a disease of aging. Men in their 30s and 40s rarely develop prostate cancer, but the incidence increases steadily after the age of 50. Approximately 80 percent of all cases occur in men over the age of 65, and by the age of 80 years of age, 80 percent of all men have prostate cancer to some degree. The American Cancer Society estimates that over 220,000 new cases of prostate cancer are diagnosed annually, and over 29,000 men die from the disease. A male baby born today has a 13 percent chance of developing prostate cancer at some time in his life, and a 3 percent chance of dying from the disease. Many experts feel that every man will eventually develop prostate cancer if he lives long enough.
According to the National Cancer Institute: Estimated new cases and deaths from prostate cancer in the United States in 2008:
- New cases: 186,320
- Deaths: 28,660
It is good news that prostate cancer deaths have been declining for the last 10 years, which many experts believe to be the result of better screening and earlier diagnosis. If diagnosed early enough, 99.3 percent of the men diagnosed survive.
MoonDragon's Health & Wellness: Prostate Cancer
SIGNS & SYMPTOMS
Prostatitis accounts for 25 percent of genito-urinary complaints involving the genital and urinary systems from young and middle-aged men. Estimates are that 10 to 12 percent of men experience prostatitis-like symptoms. In fact, chronic prostatitis (which means it does not go away) is the number-one reason men under the age of 50 visit a urologist (urinary tract specialist). In some cases, chronic prostatitis follows an attack of acute prostatitis. Chronic prostatitis may also be related to other urinary tract infections.
The term prostatitis means inflammation of the prostate, but health care providers use the term to describe 4 different disorders. Prostatitis can result in 4 significant symptoms: pain, urination problems, sexual dysfunction, and general health problems, such as feeling tired and depressed.
There are 4 types or categories of prostatitis:
1. ACUTE INFECTIOUS (BACTERIAL) PROSTATITIS
Acute infectious or bacterial prostatitis is the least common of the four types and is potentially life-threatening. Fortunately, it is the easiest to diagnose and treat effectively. Acute infectious prostatitis is usually caused by bacteria. The onset is sudden. Symptoms may include:
- Pain between the scrotum and rectum (groin or genital area) or lower back.
- Fever & Chills.
- Body aches, flu-like symptoms.
- Frequent urination accompanied by a burning or painful sensation.
- Urinary urgency, often at night.
- Urinary difficulty
- A feeling of fullness in the bladder.
- Infection of the urinary tract as evidenced by white blood cells and bacteria in the urine.
- Blood or pus in the urine.
Acute prostatitis can be a serious condition and requires immediate medical treatment. See your health care provider right away if you develop any of these signs and symptoms. The treatment is an antimicrobial, a medicine that kills microbes and organisms that can only be seen with a microscope, including bacteria, viruses, and fungi. Antimicrobials include antibiotics and related medicines. If left untreated, the condition can cause confusion and low blood pressure, and may be fatal. The condition is usually treated in the hospital with intravenous antibiotics, pain relievers and fluids.
Other uncommon types of infectious prostatitis include:
- Gonococcal Prostatitis (Neisseria Gonorrhea).
- Tuberculous Prostatitis (Tuberculosis).
- Parasitic Prostatitis.
- Mycotic Prostatitis (Fungal organisms).
2. CHRONIC INFECTIOUS (BACTERIAL) PROSTATITIS
Chronic (long-term) prostatitis is also a bacterial infection. Prostatitis is considered chronic if it lasts more than 3 months. Chronic bacterial prostatitis, also relatively uncommon, occurs when bacteria find a spot on the prostate where they can survive. Men have urinary tract infections that seem to go away but then come back with the same bacteria. The signs and symptoms of this type of prostatitis develop more slowly and usually are not as severe as those of acute prostatitis. In addition, times when symptoms are better tend to alternate with times when symptoms are worse, fluctuating in intensity. Treatment usually requires the use of antimicrobials/antibiotics for a prolonged period of time (usually 4 to 12 weeks) and treatment for pain. However, antimicrobials do not always cure this condition. Sometimes men are given suppressive low-dose, long-duration antibiotic therapy.
Symptoms may include nothing more than a recurring bladder infection. Signs and symptoms of chronic bacterial prostatitis include:
- A frequent and urgent need to urinate.
- Pain or a burning sensation when urinating (dysuria).
- Pain in the pelvic area.
- Excessive urination during the night (nocturia).
- Pain in the lower back and genital area.
- Difficulty starting to urinate, or diminished urine flow.
- Occasional blood in semen or in urine (hematuria).
- Pain with sexual intercourse, pain during ejaculation.
- A slight fever.
- Recurring bladder infections.
3. NON-INFECTIOUS (NON-BACTERIAL) PROSTATITIS / PROSTATODYNIA / CHRONIC PELVIC PAIN SYNDROME
Chronic prostatitis or chronic pelvic pain syndrome is the most common, accounting for 90 percent of the cases, but least understood form of prostatitis. It may be found in men of any age. The signs and symptoms of non-bacterial prostatitis are similar to those of chronic bacterial prostatitis, although you probably will not have a fever. The condition is marked by urinary and genital pain for at least 3 of the last 6 months. Its symptoms go away and then return without warning, and it may be inflammatory or non-inflammatory.
In the inflammatory form, urine, semen, and prostatic fluid contain the kinds of cells the body usually produces to fight infection, but no bacteria can be found. In the non-inflammatory form, not even the infection-fighting cells are present. The only way to determine whether prostatitis symptoms are caused by a bacterial infection or are non-bacterial is through lab tests to find out whether bacteria is present in the urine or prostate gland fluid. The condition can be confused with interstitial cystitis (a chronic inflammation of the bladder).
Non-infectious prostatitis is inflammation of the prostate and is not caused by an infection. It occurs primarily in young or middle aged men (under the age of 50 years). Symptoms can include:
- Frequent urination possibly accompanied by pain.
- Urine hesitancy and urine interruption (voiding in pulses).
- Decreased urine stream and weak flow.
- Post-void dribbling.
- Pain after ejaculation.
- Lower abdominal pain.
- Prostate minimally tender of normal on digital rectal exam.
- Erectile dysfunction (inability to obtain or maintain an erection) may occur.
4. ASYMPTOMATIC INFLAMMATORY PROSTATITIS
Asymptomatic inflammatory prostatitis is the diagnosis given when the patient does not complain of pain or discomfort but has infection-fighting cells in his prostate fluid and semen. Health care providers usually find this form of prostatitis when looking for causes of infertility or testing for prostate cancer.
Pain relievers and several weeks of treatment with antibiotic are typically needed for category 1 and 2 prostatitis, which are bacterial infections. A variety of treatments as well as self-care measures also can provide relief. Treatment for category 3 prostatitis (nonbacterial) is less clear and mainly involves relieving symptoms. Category 4 prostatitis is usually found during examination for another reason and often does not require treatment.
OTHER CONDITIONS
Prostatitis can be difficult to diagnose, in part because its signs and symptoms often resemble those of other conditions, such as bladder infections, bladder cancer or prostate enlargement due to benign or cancerous growth of the prostate. All types of prostatitis, if left untreated, can lead to impotence and difficulty with urination.
BENIGN PROSTATIC HYPERTROPHY (BPH)
Benign prostatic hypertrophy, also known as BPH, is the gradual enlargement of the prostate. The major symptom of enlargement of the prostate is the need to pass urine frequently, with frequency increasing as time passes. A man may find himself rising several times during the night to urinate. There can also be pain, burning, and difficulty starting and stopping urination. The presence of blood in the urine is not uncommon.
Many men with an enlarged prostate have no symptoms. Common symptoms may include the following:
- A weak stream of urine.
- Difficulty staring urination.
- Dribbling of urine, especially after urinating.
- A sense of not fully emptying the bladder.
- Leaking of urine.
- More frequent urination and a strong and sudden desire to urinate, especially at night.
- Blood in the urine.
PROSTATE CANCER
- Pain or a burning sensation during urination.
- Frequent urination.
- A decrease in the size and force of urine flow.
- An inability to urinate.
- Blood in the urine.
Other common symptoms besides urinary problems may include:
- Difficulty having an erection.
- Blood in the semen.
- Continuing discomfort in the regions of the lower back, suprapubic (above the pubis), pelvis or hips, or upper thighs.
However, the disease often causes no symptoms at all until it reaches the advanced stage and/or spreads outside the gland. In addition, these symptoms most often are caused not by the cancer, but by an enlarged prostate, benign prostatic hyperplasia (BPH), an infection, or other health problem.
Any man with any of these symptoms should consult with his health care provider so that problems can be diagnosed and treated as early as possible. He may need to see his regular practitioner or a urologist. A urologist is a practitioner whose specialty is diseases of the urinary system.
CAUSES
Prostatitis, common in men of all ages, is the inflammation of the prostate gland.
ACUTE INFECTIOUS (BACTERIAL) PROSTATITIS
The usual cause of prostatitis is infectious bacteria that invade the prostate from another area of the body. Bacteria normally found in your large intestine typically cause acute prostatitis. Approximately 80 percent of bacterial are gram-negative organisms. Bacteria may include E. Coli, Enterobacter, Serratia, Pseudomonas, Enterococcus, Klebsiella, and Proteus. Mixed bacterial infections are uncommon. One case report of prostatitis was caused by methicillin-resistant Staphylococcus aureus in a diabetic patient. Most commonly, acute prostatitis originates in the prostate, but occasionally the infection can spread from a bladder or urethral infection.
Infectious prostatitis can be a result of sexually transmitted diseases (STDs).
Hormonal changes associated with aging may also be a cause.
The inflammation can result in urine retention. This causes the bladder to become distended, weak, tender, and itself susceptible to infection, Infection in the bladder is in turn easily transmitted up the ureters to the kidneys.
The infection can also spread to the prostate through the blood stream, directly from an adjacent organ, or as a complication of prostate biopsy.
CHRONIC INFECTIOUS (BACTERIAL) PROSTATITIS
It is not entirely clear what causes a chronic bacterial infection. Sometimes it develops after an episode of acute prostatitis when bacteria remain in the prostate. Chronic bacterial prostatitis may be due to the following:
- Catheter tubes used to drain the urinary bladder.
- Injury to the urinary system (such as from bike riding or horseback riding).
- A primary voiding dysfunction, either structurally or functionally.
- Infections in other parts of the body can be the source of bacteria. E. coli is responsible for 75-80 percent of chronic bacterial prostatitis cases. Enterococci and gram-negative aerobes such as Pseudomonas are usually isolated the remainder of the time. C. trachomatis, Ureaplasma species, and Trichomonas vaginalis may be a cause. Uncommon organisms, such as M. tuberculosis and Coccidioides, Histoplasma, and Candida species, must also be considered. Tuberculous prostatitis may be found in patients with renal tuberculosis.
- Human immunodeficiency virus (HIV).
- Cytomegalovirus.
- Inflammatory conditions such as sarcoidosis.
CHRONIC NON-INFECTIOUS (NON-BACTERIAL) PROSTATITIS
Non-infectious prostatitis is, as the name suggests, not caused by a bacterial infection. The cause or causes for this inflammation is not known or well defined. Some of the theories regarding the causes of this type of prostatitis include:
- Other infectious agents. Some medical experts believe non-bacterial prostatitis may be caused by an infectious agent or agents that do not show up in standard laboratory tests. About 5-8 percent of men with this syndrome eventually have a bacterial pathogen isolated from their urine or prostate fluid.
- Heavy lifting. Lifting heavy objects when you have a full bladder may cause urine to back up into your prostate causing inflammation.
- Interstitial cystitis. This is a condition that is more frequently diagnosed as a chronic cause of pelvic pain in women and is being more frequently recognized in men.
- Physical activity. Although regular exercise, especially jogging or biking, is great for the rest of the body, it may irritate your prostate gland.
- Pelvic muscle spasm. Urinating in an uncoordinated fashion with the sphincter muscle not relaxed may lead to high pressure in the prostate and the development of inflammation and prostatitis symptoms.
- Urinary tract structural or functional abnormalities. Narrowings or strictures of the urethra may cause increased pressure during urination and result in symptoms of prostate inflammation. These may include primary vesical neck obstruction, pseudodyssymergia (failure of the external sphincter to relax during voiding), impaired detrusor contractility, or acontractile detrusor muscle.
- Ejaculatory duct obstruction.
- Increased pelvic side wall tension.
- Non-specific prostate inflammation.
Prostatitis is not contagious and is not a sexually transmitted disease.
ASYMPTOMATIC INFLAMMATORY PROSTATITIS
Causes are similar to chronic inflammatory prostatitis without symptoms.
BENIGN PROSTATITIC HYPERTROPHY (BPH)
The prostate gland, which is normally about the size and shape of a walnut, wraps around the urethra between the pubic bone and the rectum, below the bladder. In the early stage of prostate enlargement, the bladder muscle becomes thicker and forces urine through the narrowed urethra by contracting more powerfully. As a result, the bladder muscle may become more sensitive, causing a need to urinate more often and more suddenly. As the prostate grows larger and the urethra is squeezed more tightly, the bladder might not be able to fully compensate for the problem and completely empty. In some cases, blockage from prostate enlargement may cause repeated urinary tract infections and gradually result in bladder or kidney damage. It may also cause a sudden inability to urinate (acute urinary retention). This is a medical emergency.
BPH, the gradual enlargement of the prostate occurs in approximately half of all men over the age of 50 and 3/4 of the men over the age of 70 years of age. A total of 10 million American men and is largely attributable to hormonal changes associated with aging. After the age of 50 or so, a man's testosterone and free testosterone levels decrease, while the levels of other hormones, such as prolactin and estradiol (a type of estrogen), increase. This creates an increase in the amount of dihydrotesterone - a very potent form of testosterone - within the prostate. This causes a hyperplasia (overproduction) of prostate cells, which ultimately results in prostate enlargement.
While not cancerous, an enlarged prostate can nevertheless cause problems. If it becomes too large, it obstructs the urethral canal, interfering with urination and the ability to empty the bladder completely. Because the bladder cannot empty completely, the kidneys may become damaged both by pressure and by substances in the urine. Bladder infections are associated with both prostatitis and enlarged prostate.
RISK FACTORS
Unlike other prostate problems, you are more likely to develop prostatitis when you are younger, even before the age of 40 years old. Certain conditions and medical procedures increase the risk of developing prostatitis. You may also be at increased risk if you:
- Recently had a bladder infection or an infection of your urethra.
- Recently had a urinary catheter inserted during a medical procedure. A urinary catheter is a soft, lubricated tube used to drain urine from the bladder.
- Engage in rectal intercourse.
- Have an abnormal urinary tract.
- Do not empty your bladder frequently enough and you perform vigorous activities with a full bladder.
- Have an enlarged prostate (benign prostatic hypertrophy [BPH]).
- Jog or bicycle on a regular basis or ride horses.
- Men with HIV also are at increased risk of bacterial prostatitis. It's not clear why. However, it may be due to a compromised immune system.
- Have an prostate-related autoimmune disease (an abnormal reaction of the body to the prostate gland).
OTHER RISK FACTORS TO CONSIDER
Men who have recurring prostate infection (prostatitis) are at an increased risk of developing prostate cancer.
A history of sexually transmitted disease (STD) can increase the risk of prostatitis and prostate cancer.
Taking testosterone supplements to raise testosterone levels. Male sex hormones such as testosterone make prostate tumors grow.
Exposure to cancer-causing (carcinogenic) chemicals increases the risk of prostate cancer.
Researchers have found a link between a diet high animal fat and/or meat and low in fruits & Vegetables may be at an increased risk for prostate cancer. This type of diet raises testosterone levels, which could then stimulate growth of the prostate, including any cancer cells it may be harboring.
In the past, some studies have suggested that vasectomy may increase the risk of developing prostate cancer, although other studies contradict this hypothesis. Today, most studies have not found an increased risk of prostate cancer for men who have had a vasectomy. A vasectomy is surgery to cut or tie off the tubes that carry sperm out of the testicles. It is a form of permanent contraception (birth control).
Many of these risk factors can be avoided. Others, such as family history, cannot be avoided. You can help protect yourself by staying away from known risk factors whenever possible.
Scientists have also studied whether BPH, obesity, smoking, a virus passed through sex, or lack of exercise might increase the risk for prostate cancer. At this time, these are not clear risk factors.
Most men who have known risk factors do not get prostate cancer. On the other hand, men who do get the disease often have no known risk factors, except for growing older.
If you think you may be at risk, you should talk with your health care provider. Your health care provider may be able to suggest ways to reduce your risk and can plan a schedule for checkups.
PREVENTION
Protection against STDs also provides protection against many of the organisms associated with acute bacterial prostatitis, development of chronic prostatitis, and suspected causes of nonbacterial prostatitis.
Psychological stress has been associated with men who report symptoms of chronic prostatitis. Recognition of underlying psychosomatic disease in chronic cases and appropriate psychiatric referral and treatment lessens the recurrence rate.
PROSTATE ENLARGEMENT
There is no known way to prevent prostate enlargement. It is a common part of aging.
- Avoid drinking liquids after 6 p.m. to reduce the need to urinate frequently during the night.
- Drinking more fluid, up to eight glasses of water per day, may help prevent infection. However, for men already suffering with increased urinary frequency, this may only exacerbate the problem. In most cases, drinking a normal amount of fluid based on thirst is all that is necessary.
- There is evidence that cranberry juice may be helpful in the prevention of urinary tract infections in those who are prone to developing these.
COMPLICATIONS
There is no evidence that having acute or chronic prostatitis increases your risk of prostate cancer, but it may increase the level of prostate-specific antigen (PSA) in your bloodstream. PSA is a substance naturally produced in your prostate gland, and high levels in your blood may sometimes - but not always - be a sign of prostate cancer. For that reason, if you have an elevated PSA level and also have acute prostatitis, you should be rechecked after you have been treated with antibiotics and all prostate inflammation has resolved.
Because prostatitis interferes with the transport of sperm cells and may interfere with normal ejaculation, it can sometimes affect fertility. In addition, untreated acute prostatitis can lead to an inability to urinate, and in severe cases may result in bacteria in your bloodstream (bacteremia). Infertility may occur due to scarring of the urethra.
Chronic prostatitis. Approximately 1/3 of patients with chronic bacterial prostatitis experience recurrence following initial treatment.
Bladder outlet obstruction/urinary retention.
Abscess typically occurs in immunocompromised patients.
Recurrent cystitis (bladder infections).
Pyelonephritis (kidney infection).
Renal (kidney) damage may result in renal failure.
Sepsis, a serious medical condition characterized by a whole-body (systemic) inflammation.
TREATMENT
TYPES OF TUMORS & PROSTATE CANCER
Growing older raises your risk of prostate problems. The 3 most common prostate problems are:
- Infection (prostatitis).
- Enlarged prostate (BPH or benign prostatic hyperplasia).
- Prostate cancer (malignant tumor).
BENIGN TUMORS
Benign tumors are not cancer.
Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed. They usually do not grow back.
Cells from benign tumors do not invade the tissues around them.
Cells from benign tumors do not spread to other parts of the body.
Benign prostatic hyperplasia (BPH), also known as an enlarged prostate, is the abnormal growth of benign prostate cells. The prostate grows larger as a man ages and may squeeze the urethra. This prevents the normal flow of urine. BPH is a very common problem. A tumor can make the prostate bigger. In the United States, most men over the age of 50 have symptoms of BPH. For some men, symptoms may be severe enough to need treatment.
These changes, or an infection, can cause problems passing urine. Sometimes men in their 30s and 40s may begin to have these urinary symptoms and need medical attention. For others, symptoms are not noticed until much later in life. Be sure to tell your health care provider if you have any urinary symptoms:
- If you are passing urine more during the day.
- If you have an urgent need to pass urine.
- If you have less urine flow.
- If you feel burning with you pass urine.
- If you need to get up many times during the night to pass urine.
MALIGNANT TUMORS
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Malignant tumors are cancer.
Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
Malignant tumors often can be removed. But sometimes they grow back.
Cells from malignant tumors can invade and damage nearby tissues and organs.
Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
When prostate cancer spreads, cancer is often found in nearby lymph nodes. If cancer has reached these nodes, it also may have spread to other lymph nodes, the bones, or other organs. When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to bones, the cancer cells in the bones are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer. For that reason, it is treated as prostate cancer, not bone cancer. Health care providers call the new tumor "distant" or metastatic disease.
DIAGNOSIS
Estimates on the number of males in the United States who will experience prostatitis during their lifetimes range up to 50 percent. Many urologic disease experts feel that from 5 to 10 percent of males will be experiencing prostatitis at a particular time, making it one of the most common urologic diseases in the U.S. If your health care provider suspects that you have prostatitis or another prostate problem, he or she may refer you to a urologist (a practitioner who specializes in diseases of the urinary tract and the male reproductive system) to confirm the diagnosis.
Your health care provider will likely begin by taking a medical history. This history may include past health problems, current health issues including past and present infections, sexually transmitted diseases and related sexual history. Family history questions may be asked and whether your father or any male siblings have had similar problems as well as other family health problems. You may be asked to fill out a questionnaire with several questions about your specific symptoms and onset of the symptoms.
Your health care provider will perform a physical exam. The physical exam may include checking your abdomen and pelvic area for tenderness and a digital exam of your prostate.
Diagnosing prostatitis and other prostate problems involves ruling out any other conditions that may be causing your urinary signs and symptoms and then determining if and what kind of prostatitis or other prostate-related condition you may have. Some urinary conditions to be ruled out may include such disorders such as kidney stones, bladder disorders, and infections. Then, depending upon the clinical situation and presentation and if your health care provider is still not sure what you have, more tests may be done, such as a prostate fluid analysis for signs of infection, ultrasound such as a transrectal ultrasound, x-ray, magnetic resonance imaging (MRI), computerized tomography (CT), biopsy, blood tests, and tests of bladder function or voiding studies. If all other possible causes of a patient's symptoms are ruled out, your health care provider may then diagnose chronic prostatitis/chronic pelvic pain syndrome.
BASIC LABORATORY STUDIES
Complete Blood Count: A complete blood count (CBC) with differential and blood cultures are indicated in cases of acutely toxic patients or suspected septicemia.
Urinalysis: Obtain quantitative values for the white blood count and bacterial count, presence of oval fat bodies, and lipid-laden macrophages.
Urine Culture: A urine culture can be used to identify the causative organism, if any.
Chemistry: Obtain electrolyte panel, including BUN and creatinine values, in patients presenting with urinary retention or obstruction.
Prostate-Specific Antigen Determination (PSA): PSA determination may help in supporting the diagnosis of acute bacterial prostatitis if the diagnosis is unclear. It is also indicated if a neoplasm is suspected as an underlying cause.
ACUTE BACTERIAL PROSTATITIS DIAGNOSIS
After taking a history, the health care practitioner will likely have a directed physical examination concentrating on the scrotum, looking for inflammation of the testicle(s) or epididymis, and the flank and mid-back, where the kidney is located. If a rectal examination is performed, the prostate may be swollen and boggy, consistent with acute inflammation.
Laboratory testing may include urinalysis, looking for white blood cells and bacteria, signifying infection. The urine may also be cultured to identify the bacteria that are responsible for the infection, but results will take up to seven days to return. The results will help confirm that the antibiotic chosen is correct and may help choose an alternate antibiotic should the illness progress.
CHRONIC BACTERIAL PROSTATITIS DIAGNOSIS
The diagnosis is made by finding an abnormal urinalysis. Sometimes, a urinalysis is collected after prostate examination. This may allow some prostatic fluid to be expressed into the urine and cultured.
A blood test called PSA (prostate surface antigen) may be elevated in this type of prostatitis. While PSA is used as a prostate cancer screening tool, it can also be elevated whenever the prostate is inflamed.
CHRONIC PROSTATITIS WITHOUT INFECTION DIAGNOSIS
To make the diagnosis of chronic prostatitis without infection, symptoms should be present for at least three months. The cause of chronic prostatitis without infection (chronic pelvic pain syndrome) is not known.
This is a frustrating condition for the patient and the health care practitioner since there is controversy as to the aggressiveness of testing, and exactly what tests should be done. Often, this is a diagnosis of exclusion, meaning that blood tests, urine tests, x-rays and ultrasounds tend to be normal, yet the patient continues to suffer.
ASYMPTOMATIC INFLAMMATORY PROSTATITIS DIAGNOSIS
There are no symptoms with this type of prostatitis, however, when routine lab tests are performed, white blood cells (a sign of inflammation) are found in the urine, but there are no associated bacteria or infection.
ENLARGED PROSTATE DIAGNOSIS
A physical exam is required to see if other medical problems may be causing your symptoms. The health care provider will conduct a digital rectal exam to examine the prostate gland. He or she can feel the prostate by inserting a gloved, lubricated finger into the rectum. This procedure allows your health care provider to estimate the size and condition of the prostate. Most importantly, it allows the health care provider to feel for lumps or hard areas that could indicate the presence of prostate cancer.
Your health care provider may check your urine (urinalysis) for blood or signs of infection. Your blood may be tested for kidney problems or sent for a prostate-specific antigen (PSA) level - a screening test for prostate cancer.
Some men are referred to a specialist (urologist) for further tests. Urologists specialize in diseases of the male and female urinary tracts and of the male genital tract. Before you are treated for benign prostate enlargement, it is important to rule out other possible causes of an enlarged prostate, such as cancer.
DIGITAL RECTAL EXAMINATION
During a digital rectal exam (DRE), your health care provider manually examines your prostate gland by gently inserting a lubricated, gloved finger into your rectum. Because the prostate gland is in front of the rectum, your health care provider can feel the back surface of the gland this way. If it seems enlarged and tender to the touch, you may have prostatitis. The prostate is checked for hard or lumpy areas and any other abnormalities of the gland.
To confirm the prostate infection, the health care provider may obtain two urine samples - before and after prostate massage (see voiding studies and urine collection below).
URINE & SEMEN TESTS
Your health care provider may want collect and evaluate samples of your urine and semen (prostate fluid) for bacteria and white blood cells. These are key cells in your immune system's response and evaluation will help to establish a diagnosis of prostatitis. The health care provider can diagnose bacterial forms of prostatitis by examining a urine sample with a microscope. The sample may also be sent to a laboratory to perform a culture. In a urine culture, the bacteria are allowed to grow so they can be identified and tested for their resistance to different types of antimicrobials.
VOIDING STUDIES & URINE COLLECTION - FRACTIONAL URINE EXAMINATION
Voiding studies involve the collection and analysis of urine to determine which part of the urinary system is infected. The use of fractional urine specimens may be useful in the diagnosis of prostatitis. Although not practical in most emergency departments, this technique is used by urologists if the diagnosis of prostatitis remains unclear.
- The initial 10 ml of voided urine represents urine from the urethra and is termed "voided urine 1 (V1)". Elevated bacterial counts in V1 suggest urethritis.
- The next 200 ml of voided urine is discarded, and a midstream urine sample (V2) is collected, which represents bladder urine. Bacterial counts elevated in the midstream sample suggest cystitis without prostatitis.
- Next, the practitioner performs a prostatic massage. To perform a prostate massage, the health care provider will insert a gloved and lubricated finger into the rectum, as in a DRE, and stroke the prostate to release fluids from the gland and the expressed prostatic secretions (EPS) are collected from the urethral meatus. The post-massage urine sample will contain prostate fluid.
- Finally, the 10 ml of voided urine following prostatic massage (V3) are collected. The bacterial findings of the EPS and V3 samples represent the microbiologic characteristics of the prostate gland. If that second urine sample contains bacteria or infection-fighting cells that were not present in the pre-massage urine sample, this suggests the prostate contains infection.
Chronic bacterial prostatitis can be diagnosed if the culture of the EPS and V3 samples produce the same bacteria as the first-voided specimen and the colony count of the 2 cultures is at least 10 times as great as the first-void specimen.
PSA BLOOD TESTS
Some health care providers may want to carry out a prostate specific antigen test to measure the amount of this chemical in a person's blood. Both prostatitis and prostate cancer can increase a patient's PSA level.
A blood test to detect elevated levels of a protein called prostate-specific antigen (PSA) is an excellent screening test for prostate cancer. PSA is currently the most valuable "tumor marker" available to diagnose and evaluate the effectiveness of therapy for prostate cancer. A PSA test result between 0 and 4 is considered to be within the normal range. A level between 4 and 10 may raise a health care provider's suspicion, and scores above 50 may indicate a tumor that has spread to elsewhere in the body. High PSA levels can be caused by factors other than cancer, including benign enlargement (BPH) or inflammation of the prostate (prostatitis), an activity as innocuous as bicycle riding, or even the rectal exam itself.
If a man's PSA level is found to be high, the test should always be repeated, because it does yield false-positive or false-negative results an estimated 10 to 20 percent of the time. Having the test repeated every year may help a health care provider to better interpret the results. In healthy men, PSA levels tend to remain relatively stable, rising only gradually from year to year, while cancer causes the levels to rise more dramatically.
ULTRASOUND
Ultrasound scanning of the prostate (and possibly the bladder and lower abdomen-pelvis area) may be done to follow up on an abnormal digital rectal exam or PSA test or to determine other causes.
TRANSRECTAL ULTRASOUND
The health care practitioner inserts a probe into the man's rectum to check for abnormal areas. The probe sends out sound waves that people cannot hear (ultrasound). The waves bounce off the prostate. A computer uses the echoes to create a picture called a sonogram.
Transrectal ultrasonography prostatitis interpretation include:
- Characteristic features are capsular thickening and prostatic calculi.
- Hypoechoic halo in the periurethral region, heterogeneous echo pattern, and enlargement and thickening of the septa of the seminal vesicles may be seen.
Interpretation is highly subjective and therefore not very reliable; diagnosis requires clinical correlation and digital rectal examination. In acute prostatitis, a marked increase in color in the prostatic urethral site, around the ejaculatory ducts, and close to the seminal vesicles is visualized on color Doppler ultrasonography.
OTHER TESTS & EXAMINATIONS
Other diagnostic tests, including computerized tomography (CT) scans, bone scans, and magnetic resonance imaging (MRI) may be necessary, but are costly.
DIAGNOSTIC PROCEDURES
Suprapubic Catheterization: This may be warranted in severe obstruction and should be placed in consultation with a urologist.
Needle Biopsy or Aspiration: In cases of prostatic abscess, the fluctuant site may be drained under local anesthesia through the perineal route, followed by insertion of a pigtail catheter.
Urodynamic Testing: This may be indicated. Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests help your health care provider see how well your bladder and sphincter muscles work and can help explain symptoms such as
- Incontinence.
- Frequent urination.
- Sudden, strong urges to urinate.
- Problems starting a urine stream.
- Painful urination.
- Problems emptying your bladder completely.
- Recurrent urinary tract infections.
Cystoscopy: Cystoscopy may be performed to rule out bladder cancer and interstitial cystitis. The health care practitioner uses a thin, lighted tube to look into the urethra and bladder to check for abnormalities. Cystoscopy is useful in follow-up of refractory cases to rule out neoplasm of the bladder or interstitial cystitis.
TRANSRECTAL BIOPSY
Ultimately, if a test result points consistently to the presence of cancer, a tissue diagnosis must be done to confirm it. This can be done only by microscopic examination of a needle biopsy, preferably directed under ultrasound control.
A biopsy is the removal of tissue to look for cancer cells. It is the only sure way to diagnose prostate cancer. The health practitioner takes small tissue samples from many area of the prostate. Ultrasound may be used to guide the needle. A pathologist checks for cancer cells in the tissue.
If Cancer Is Not Found: If the physical exam and test results do not suggest cancer, your health care provider may suggest medicine to reduce symptoms caused by an enlarged prostate. Surgery also can relieve these symptoms. The surgery most often used in such cases is transurethral resection of the prostate (TURP or TUR). In TURP, an instrument is inserted through the urethra to remove prostate tissue that is pressing against the upper part of the urethra and restricting the flow of urine. You should talk to your health care provider about the best treatment option.
If Cancer Is Found: If cancer is present, the pathologist studies tissue samples from the prostate under a microscope to report the grade of the tumor. The grade tells how much the tumor tissue differs from normal prostate tissue. It suggests how fast the tumor is likely to grow. Tumors with higher grades tend to grow faster than those with lower grades. They are also more likely to spread. One system of grading prostate cancer uses G1 through G4. Another way of grading is with the Gleason score. The pathologist gives each area of cancer a grade of 1 through 5. The pathologist adds the two most common grades together to make a Gleason score. Or the pathologist may add the most common grade and the highest (most abnormal) grade to get the score. Gleason scores can range from 2 to 10.
Repeated biopsies may be needed in some cases. This invasive procedure may itself cause complications. Bleeding, urinary retention, impotence, and sepsis ("blood poisoning") have been reported.
CONVENTIONAL MEDICAL TREATMENT
PRE-HOSPITAL CARE
No specific pre-hospital treatments of prostatitis exist; treatment should be tailored to symptoms and be supportive.
EMERGENCY DEPARTMENT CARE
Individuals with acute bacterial prostatitis who appear acutely ill, have evidence of sepsis, or both require admission for parenteral antibiotics and supportive care.
- Antibiotic therapy should initially include parental bactericidal agents such as broad-spectrum penicillin derivatives, third-generation cephalosporins with or without aminoglycosides, or fluoroquinolones. Patients without a toxic appearance can be treated as outpatients with a 14- to 28-day course of oral antibiotics. Urologic follow-up is necessary to ensure eradication and to provide continuity of care to prevent relapse.
- Urinary retention may complicate acute infection and warrant hospitalization. Suprapubic catheters are considered safer than urethral catheterization in severe obstruction and may be placed in consultation with a urologist.
- Provide supportive measures such as antipyretics, analgesics, hydration, and stool softeners as needed.
- Avoid serial examinations of the prostate to avoid seeding of the blood and subsequent bacteremia in acute bacterial prostatitis.
- Chronic bacterial prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis are probably best treated by or in consultation with a urologist.
- A 4-week trial of antibiotic therapy is indicated in chronic bacterial prostatitis and chronic pelvic pain syndrome with inflammation, but no consensus exists regarding its use in chronic pelvic pain syndrome without inflammation and asymptomatic prostatitis.
- Supportive measures such as analgesics (particularly non-steroidal anti-inflammatory drugs [NSAIDs]), alpha-blocking agents, hydration, stool softeners, and sitz baths are often used.
In cases where infected prostatic calculi serve as a nidus, transurethral resection or total prostatectomy may result in a cure. See surgery below.
CONSULTING A HEALTH CARE PROVIDER
Antibiotic therapy is essential in the treatment of acute bacterial prostatitis. If the patient is having systemic symptoms, then admission is warranted for intravenous antibiotics, hydration, and analgesia. If the patient has signs of urinary retention or obstruction, then placement of a Foley catheter is indicated.
Therapy for chronic bacterial prostatitis varies in regards to type and duration of antibiotics used as well as adjunctive medications. Treatment typically consists of 4-8 weeks of prostate-penetrating antibiotics, such a fluoroquinolone or trimethoprim-sulfamethoxazole.
Chronic prostatitis, chronic pelvic pain syndrome, and asymptomatic inflammatory prostatitis may be treated with alpha-blocking agents or diazepam with sitz baths. Some studies have shown that a longer course of antibiotics has been shown to result in a decrease in PSA values in patients with category IV prostatitis.
DRUG THERAPY FOR PROSTATITIS
Treatments vary among urologists and are tailored to the type of prostatitis you have. Correct diagnosis is crucial and treatments vary. It is important to make sure your symptoms are not caused by urethritis (inflammation of the urethra) or some other condition that may lead to permanent bladder or kidney damage.
Prostatitis is a treatable disease. Even if the problem cannot be cured, you can usually get relief from your symptoms by following the recommended treatment. Be sure to follow the full course any prescription you are given, even if you no longer have any symptoms. With infectious prostatitis, for example, the symptoms may disappear before the infection has completely cleared.
Acute Bacterial Prostatitis Treatment
The bacterial forms of prostatitis are treated with antimicrobials. These medicines are not effective treatments for non-infectious prostatitis. Treatment for acute bacterial prostatitis is a prescription for antibiotics by mouth, usually ciprofloxacin (Cipro) or tetracycline (Achromycin). If the patient is acutely ill or has a compromised immune system (for example, is taking chemotherapy or other immune suppression drugs or has HIV/AIDS), hospitalization for intravenous antibiotics and care may be required.
Acute prostatitis may require a short hospital stay so that fluids and antimicrobials can be given through an intravenous, or IV, tube. After the initial therapy, the patient will need to take antimicrobials for a minimum of 14 days and possibly 2 to 4 weeks. Almost all acute infections can be cured with this treatment. Home care includes drinking plenty of fluids (increased fluid intake), bed rest, medications for pain control, and possibly a stool softener.
Chronic Bacterial Prostatitis Treatment
Chronic bacterial prostatitis requires a longer course of therapy. Chronic bacterial prostatitis treatment is with long-term antibiotics, up to 4 to 12 weeks, with ciprofloxacin (Cipro, Cipro XR), sulfa drugs [for example, sulfamethoxazole and trimethoprim, (Bactrim)], or erythromycin. About 75 percent of all cases of chronic infectious prostatitis clear up with this treatment. Even with appropriate therapy, this type of prostatitis can recur. It is uncertain as to why, but it may be due to a poorly emptying bladder. A small amount of stagnant urine allows the potential for recurrent infection to occur. This situation can be caused by benign prostatic hypertrophy (BPH), bladder stones, or prostate stones.
The health care provider may prescribe a low dose of antimicrobials for 6 months to prevent recurrent infection or for those that do not clear up with the initial long-term antibiotic treatment. If a patient has trouble emptying his bladder, the practitioner may recommend medicine or surgery to correct blockage.
Chronic Prostatitis Without Infection Treatment
Chronic prostatitis without infection treatment addresses chronic pain control and may include physical therapy and relaxation techniques as well as tricyclic antidepressant medications. Other treatments for chronic non-infectious prostatitis include the use of the alpha blocker drugs such as Hytrin and Cardura. These drugs relax the muscles of the prostate and bladder to improve urine flow and decrease symptoms. Other drugs that lower hormone levels, such as Proscar, may help to shrink the prostate gland in some men.
Antimicrobials will not help non-bacterial prostatitis. Each patient will have to work with his health care provider to find an effective treatment. Changing diet or taking warm baths may help. No single solution works for everyone with this condition. Many cases of a-bacterial (non-bacterial) prostatitis (also considered chronic pelvic pain syndrome) respond to a mix of treatments that include exercise, myofascial trigger point release, progressive relaxation, and counseling.
Other medication possibilities include alpha-adrenergic blockers. Tamsulosin (Flomax) and terazosin (Hytrin) are drugs that block the non-heart adrenaline receptors and are used in treating BPH and bladder outlet obstruction. Allowing better bladder emptying may help minimize symptoms. Supportive therapies for chronic prostatitis, including stool softeners and prostate massage.
Asymptomatic Inflammatory Prostatitis Treatment
Treatment is not required for asymptomatic inflammatory prostatitis.
MEDICATIONS: ANTIBIOTICS
Antibiotics are usually the first choice of treatment for category 1 and 2 prostatitis. Your health care provider will likely begin right away with an antibiotic that fights a broad spectrum of bacteria. He or she will also proceed with testing to determine the exact bacteria causing your infection. Once the exact bacterium is identified, your health care provider can prescribe a specific antibiotic that is more likely to kill the particular bacteria present.
How long you take antibiotics depends on how well you respond to the drug. If you have category 1 prostatitis, you may need medication for a few weeks. Category 2 prostatitis is more resistant to antibiotics and takes longer to treat. You may need to continue taking medication for as long as six to 12 weeks. In some cases the infection may never be eliminated, and you could have a relapse as soon as the drug is withdrawn. If this happens, you may need to take a low-dose antibiotic indefinitely.
Some health care providers may prescribe an antibiotic for category 3 prostatitis to see if symptoms improve. For unknown reasons, some men with this condition seem to benefit from a continuous low dose of an antibiotic. Empiric antibiotics should be tailored toward treating gram-negative pathogens. STDs, where N. gonorrhea and C. trachomatis are the primary suspected pathogens, must also be considered, especially in patients younger than 35 years.
In April 2007, the Centers for Disease Control and Prevention (CDC) updated treatment guidelines for gonococcal infection and associated conditions. Fluoroquinolone antibiotics are no longer recommended to treat gonorrhea in the United States. The recommendation was based on analysis of new data from the CDC's Gonococcal Isolate Surveillance Project (GISP). The data from GISP showed the proportion of gonorrhea cases in heterosexual men that were fluoroquinolone-resistant (QRNG) reached 6.7 percent, an 11-fold increase from 0.6 percent in 2001. The data were published in the April 13, 2007, issue of the Morbidity and Mortality Weekly Report. This limits treatment of gonorrhea to drugs in the cephalosporin class (eg, ceftriaxone 125 mg IM once as a single dose). Fluoroquinolones may be an alternative treatment option for disseminated gonococcal infection if antimicrobial susceptibility can be documented. For more information see, the CDC's Antibiotic-Resistant Gonorrhea Web site; CDC Updated Gonococcal treatment recommendations (April 2007); or Medscape Medical News on CDC Issues - New Treatment Recommendations for Gonorrhea.
For the treatment of chronic bacterial prostatitis, where Enterobacteriaceae, enterococci, and P. aeruginosa are common pathogens, consider trimethoprim/sulfamethoxazole (Bactrim) or fluoroquinolones for 28 days or more as empiric agents.
For non-bacterial prostatitis caused by Chlamydia and Ureaplasma species, which are difficult to culture, an empiric trial of doxycycline or erythromycin should be instituted.
Although antibiotics are often used to treat prostatitis, the long term use of such drugs can lead to bacterial resistance, which in turn necessitates more potent drugs, more expense, and more medical complications.
Drug Name Ofloxacin (Floxin) Description Quinolone that is a pyridine carboxylic acid derivative with broad-spectrum bactericidal effect. Adult Dose 400 mg PO once, then 300 mg PO bid for 14-28 d. Pediatric Dose Less than 18 years: Not recommended.
More than 18 years: Administer as in adults.Contraindications Documented hypersensitivity; prolonged QT interval. Interactions Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT) Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus. Precautions In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy.
Drug Name Ciprofloxacin (Cipro, Cipro XR) Description Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared. Adult Dose 500 mg PO bid for 14-28 d Pediatric Dose Less than 18 years: Not recommended.
More than 18 years: Administer as in adults.Contraindications Documented hypersensitivity. Interactions Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT); ciprofloxacin reduces therapeutic effects of phenytoin. Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus. Precautions A white crystalline precipitate located in superficial portion of corneal defect may occur (onset starts in 1-7 d); precipitate is usually cleared within 2 wks and does not adversely affect clinical course or outcome; do not use in ocular infections that may become systemic; superinfections may occur with prolonged or repeated antibiotic therapy.
Drug Name Levofloxacin (Levaquin) Description Indicated to treat chronic bacterial prostatitis due to E coli, E faecalis, or S epidermidis. This is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. Good monotherapy with extended coverage against Pseudomonas species, as well as excellent activity against pneumococcus. Agent acts by inhibition of DNA gyrase activity. Adult Dose 500 mg PO qd for 14-28 d Pediatric Dose Less than 18 years: Not recommended.
More than 18 years: Administer as in adults.Contraindications Documented hypersensitivity; prolonged QT interval. Interactions Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase levofloxacin serum concentrations. Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus. Precautions In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy.
Drug Name Trimethoprim/sulfamethoxazole DS (Bactrim) Description Trimethoprim inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Antibacterial activity of TMP-SMZ includes common urinary tract pathogens, except Pseudomonas aeruginosa. Adult Dose 1 DS tab (160 mg TMP) PO bid for 10-28 d Pediatric Dose Less than 2 years: Not recommended.
More than 2 years: 8-10 mg/kg/d trimethoprim divided bid.Contraindications Documented hypersensitivity; megaloblastic anemia due to folate deficiency. Interactions May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); co-administration with dapsone may increase blood levels of both drugs; co-administration of diuretics increases incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with co-administration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with co-administration; may increase levels of zidovudine. Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus. Precautions Discontinue at first appearance of skin rash or sign of adverse reaction; obtain CBCs frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, give 5-15 mg/d leucovorin); caution in folate deficiency (eg, those with chronic alcoholism, elderly persons, those receiving anticonvulsant therapy, or those with malabsorption syndrome); hemolysis may occur in patients with G-6-PD deficiency; patients with AIDS may not tolerate or respond to TMP-SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); give fluids to prevent crystalluria and stone formation.
Drug Name Ceftriaxone (Rocephin) Description Third-generation cephalosporin with broad-spectrum, gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Bactericidal activity results from inhibiting cell wall synthesis by binding to one or more penicillin-binding proteins. Exerts antimicrobial effect by interfering with synthesis of peptidoglycan, a major structural component of bacterial cell wall. Bacteria eventually lyse due to the ongoing activity of cell wall autolytic enzymes while cell wall assembly is arrested.
Highly stable in presence of beta-lactamases, both penicillinase and cephalosporinase, of gram-negative and gram-positive bacteria. Approximately 33-67% of dose excreted unchanged in urine, and remainder secreted in bile and ultimately in feces as microbiologically inactive compounds. Reversibly binds to human plasma proteins, and binding has been reported to decrease from 95% bound at plasma concentrations less than 25 mcg/ml to 85% bound at 300 mcg/ml.Adult Dose 250 mg IM once (in conjunction with doxycycline 100 mg PO for 10 d) Pediatric Dose Neonates More than 7 d: 25-50 mg/kg/d IV/IM; not to exceed 125 mg/d.
Infants and children: 50-75 mg/kg/d IV/IM divided q12h; not to exceed 2 g/d.Contraindications Documented hypersensitivity. Interactions Probenecid may increase ceftriaxone levels; co-administration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity. Pregnancy B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals. Precautions Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy; caution in breastfeeding women.
Drug Name Doxycycline (Bio-Tab, Doryx, Vibramycin) Description Inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. May block dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Used to treat nonbacterial prostatitis caused by Chlamydia species. Chlamydia and Ureaplasma are difficult to culture; therefore, an empiric trial of doxycycline should be instituted.Adult Dose 100 mg PO bid for 10 d (used in conjunction with ceftriaxone 250 mg IM once). Pediatric Dose Less than 8 years: Not recommended.
More than 8 years: 100 mg PO bid for 10 d.Contraindications Documented hypersensitivity; severe hepatic dysfunction. Interactions Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants. Pregnancy D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus. Precautions Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines.
MEDICATIONS: ALPHA-BLOCKERS Alpha-Adrenergic Antagonists
If you are having difficulty urinating, your health care provider may prescribe an alpha blocker. This is an oral medication that helps relax the bladder neck and the muscle fibers where your prostate joins your bladder. This may help you urinate more easily and empty your bladder more completely.
These agents are used in the treatment of benign prostatic hypertrophy. Alpha-blockers such as prazosin (Minipress), terazosin (Hytrin), and doxazosin (Cardura) can be used to reduce the size of an enlarged prostate.
Studies suggest that combining alpha-blockers with antibiotics may reduce the risk of prostatitis recurrence in chronic prostatitis. Alpha-blockers improve bladder outlet obstruction and thus improves voiding dysfunction that may be associated with the pathogenesis of prostatitis. Alpha-blockers may also have role in chronic pelvic pain syndrome to improve symptoms.
Drug Name Terazosin (Hytrin) Description Quinazoline compound that counteracts alpha1-induced adrenergic contractions of bladder neck, facilitating urinary flow in presence of prostate inflammation. Adult Dose 1 mg PO qhs; increase slowly to effect; not to exceed 10 mg/d. Pediatric Dose Not established. Contraindications Documented hypersensitivity. Interactions Effects decrease with co-administration of NSAIDs; effects increase with co-administration of diuretics and antihypertensive medications. Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus. Precautions Caution in renal impairment; may cause marked hypotension following first dose and co-administration with beta-blockers.
Drug Name Tamsulosin (Flomax) Description An alpha-adrenergic blocker, specifically targeting the A1 receptors. Has the advantage of causing relatively less orthostatic hypotension, and it requires no gradual up-titration from the initial introductory dosage. On the other hand, a higher incidence of ejaculatory dysfunction exists with this medication (8.4-18.1%). Adult Dose 0.4-0.8 mg PO qd. Pediatric Dose Not established. Contraindications Documented hypersensitivity. Interactions Cimetidine may significantly increase plasma concentrations; tamsulosin may increase toxicity of warfarin. Pregnancy C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus. Precautions Not for use as antihypertensive drug; may cause orthostasis; avoid situations that may result in injuries if syncope occurs; rule out presence of carcinoma or cancer before initiating treatment.
ENLARGED PROSTATE TREATMENT
Once the diagnosis of prostate enlargement is made, your health care provider may not recommend immediate treatment if symptoms are mild. Likely, one or more exams will be conducted per year to be sure that you are not developing any complications from prostate enlargement. Should your symptoms become more severe, both medical and surgical treatments are available.
Watchful waiting is the conservative and often wise program of care is used because, for many men, symptoms can lessen without treatment. On the other hand, medications should be started early for moderate symptoms. Also, if there are complications or if symptoms are severe, your health care provider may recommend surgery. For most men, the decision to treat the symptoms of an enlarged prostate is based on the patient's desire to improve his quality of life.
MEDICATION CONSIDERATIONS FOR ENLARGED PROSTATE
The drug finasteride (Proscar) may be used to treat moderate prostate enlargement. It blocks an enzyme that converts the male hormone testosterone into dihydrotestosterone, which promotes the growth of prostate tissue. This drug has been shown to increase urine flow in 30 percent of test cases and to reduce the size of prostate by 20 percent in more than half of the test cases. But it also causes impotence and reduced libido in many cases. In addition, because it reduces the amount of prostate tissue, it can skew the results of a PSA blood test used to detect prostate cancer.
The drug dutasteride (Avodart) can cause the prostate to shrink. As a result the urinary symptoms may improve. These first two drugs (fubasteride and dutasteride) are most helpful in men who have at least moderate enlargement of the prostate.
Alpha-blockers, such as terazosin (Hytrin), prazosin (Minipress), or doxazosin (Cardura), relax the muscles in the prostate and thus may relieve symptoms. Newer alpha blockers, such as tamsulosin (Flomax) and alfuzosin (Uroxatral), are more commonly prescribed because they may have fewer side effects.
The injectable drug leuprolide (Lupron) may shrink an enlarged prostate. Side effects that can occur with the use of leuprolide include impotence, decreased libido, and even hot flashes. You should take this drug only if you are not concerned with potency. It is available by a health care provider's prescription only.
More resent studies have indicated that the best results may be seen in men who take a combination of an alpha-blocker and a drug to shrink the prostate.
MEDICATIONS: PAIN RELIEVERS
Sometimes an over-the-counter (OTC) pain reliever, such as aspirin or ibuprofen (Motrin, Advil, others), can make you more comfortable. Keep in mind, however, that taking too much of any of these medications can cause serious side effects including abdominal pain, intestinal bleeding or ulcers.
MEDICATIONS: MUSCLE RELAXANTS
Spasms of the pelvic muscles can accompany prostatitis. A combination of a muscle relaxant medication and other medications used to treat prostatitis may be helpful.
FOLLOW-UP & FURTHER PATIENT CARE
Carefully treat associated septicemia in acutely ill patients.
Carefully monitor for bladder outlet obstruction and renal failure.
After primary management and stabilization, care of the patient is appropriately transferred to a urologist, as aggressive treatment of acute prostatitis can lessen the chance of developing chronic prostatitis.
After initial improvement with parental antibiotics, acute bacterial prostatitis may be managed with outpatient care with a 2- to 4-week course of oral antibiotics and urologic follow-up.
Management strategies for category II prostatitis, chronic bacterial prostatitis, include intraprostatic antibiotic injection, transurethral resection of the prostate (TURP), and long-term antimicrobial suppression.
Additional therapeutic modalities studied for category III prostatitis include anti-inflammatories, phytotherapy, biofeedback, thermal therapy, and pelvic floor exercises.
Although no clear connection between elevated PSA level in prostatitis and cancer have been established, patients found to have elevated PSA levels should be followed up by their primary care providers, urologists, or both.
In patients undergoing infertility assessment, this inflammation may be treated with a course of either a non-steroidal anti-inflammatory medication (ibuprofen, Motrin, Advil) or antibiotics.
TREATMENT - LEGAL PITFALLS
- Failure to consider diagnosis in sexually active adolescents.
- Performing prostatic massage in patients with acute bacterial prostatitis.
- Failure to recognize acute urinary retention.
SPECIAL CONCERNS
- Acute bacterial prostatitis is a recognized complication after sclerotherapy for rectal prolapse.
- Nursing home patients with indwelling urethral catheters may be at increased risk.
- Patients with an elevated PSA value must be referred to their primary care health care provider or a urologist for PSA recheck and follow-up.
OTHER RECOMMENDED THERAPIES
PHYSICAL THERAPY
Special exercises and relaxation techniques can improve symptoms of prostatitis in some men, perhaps because tight or irritated muscles can contribute to the condition. Common techniques include:
- Exercise. Stretching and relaxing the lower pelvic muscles - sometimes with the addition of heat to make the muscles more limber - may help relieve your symptoms. A physical therapist can show you which exercises will benefit you the most and how to perform them. You can then do the exercises yourself at home. Consider taking yoga classes to help with stretching.
- Biofeedback. This technique teaches you how to control certain body responses, including relaxing your muscles. During a biofeedback session, a trained therapist applies electrodes and other sensors to various parts of your body. The electrodes are attached to a monitor that displays your heart rate, blood pressure and degree of muscle tension. You will see changes on the monitor and learn to control these changes on your own.
- Sitz Baths. Named from the German word "sitzen," which means "to sit," this type of bath simply involves soaking the lower half of your body in a tub of warm water. Warm baths can relieve pain and relax the lower abdominal muscles. Few treatments are easier or as relaxing. Anti-inflammatory medicines may be recommended along with warm sitz baths (sitting in two to three inches of warm water). This is the most conservative treatment for chronic prostatitis.
- Prostate Massage. Some men have found that having their prostate massaged helps relieve congestion by unplugging the small ducts blocked by inflammation. The massage is performed using a gloved finger, similar to what is done during a digital rectal exam. This procedure is used less commonly today than it once was.
- Finasteride (Proscar), a drug that lowers hormone levels in the prostate, and microwave thermotherapy (heat therapy) have been used successfully in a few men with prostatitis, but there is little long-term experience with these treatments.
SUGGESTED LIFESTYLE & HOME REMEDIES
Because traditional treatments are not always effective for prostatitis, many men experiment with various lifestyle changes to control their symptoms. Although no scientific evidence proves these practices are beneficial, you may want to try one or more of the following suggestions:
- Drink plenty of water.
- Some people may benefit from limiting or avoiding alcohol, caffeine, acidic drinks and spicy foods.
- Urinate at regular intervals. Keep your bladder empty. Do not delay to urinate once you experience the urge and empty the bladder completely.
- Have regular sexual activity. Regular ejaculation activates the prostate gland, keeping it from getting stagnant and inflamed.
Activities that aggravate the condition, such as bicycling may need to be eliminated as well. If you are a cyclist, use a "split" bicycle seat, which reduces the pressure on your prostate.
Men with chronic prostatitis can learn to live with the disease by limiting the things that make their symptoms worse and emphasizing the things that make them feel better.
ALTERNATIVE MEDICINE
Although how they work is poorly understood by conventional medical practitioners, some natural remedies, including saw palmetto preparations, zinc supplements and quercetin, have helped some men manage the symptoms of prostatitis. For more information about alternative medicine, nutrition, and dietary supplements, see the Holistic & Nutrition Recommendations section below.
PROSTATE SURGERY
Surgical removal of the infected part of the prostate is an option in a few severe cases when other treatments do not work. A health care provider may advise this treatment for severe cases of chronic prostatitis or for men whose swollen prostate is blocking the flow of urine. The chances of responding to a major surgical procedure for any type of prostatitis are quite low. For this reason most health care providers are very hesitant to perform surgery for these conditions and generally discourage surgery even as a last resort.
You may want to ask your health care provider these questions before choosing surgery:
- What kinds of surgery can I consider?
- Is nerve-sparing surgery an option for me?
- Which operation do you recommend for me? Why?
- How will I feel after the operation?
- If I have pain, how can we control it?
- Will I have any lasting side effects?
- Is there someone I can talk with who has had the same surgery I will be having?
PROSTATE ENLARGEMENT SURGERY
The common operation for prostate enlargement is transurethral resection of the prostate (TURP). In this procedure, the health care provider scrapes away the innermost core of the prostate through a small instrument inserted through the urethra. The surgery reduces pressure on the urethra and generally gives relief from symptoms.
A more limited operation called transurethral incision of the prostate (TUIP) may be an option for some men. In this operation, instead of removing prostate tissue, the health care provider passes an instrument through the urethra to make one or two small cuts in the prostate. These cuts reduce the prostate's pressure on the urethra, making urination easier.
Several newer treatments which may be performed in the office with local anesthetic alone or supplemented by sedation have been introduced and may be effective for men with an enlarged prostate. These include transurethral microwave thermotherapy (TUMT), transurethral needle ablation of the prostate (TUNA), and interstitial laser coagulation (ILC). The general principle of these three treatments is similar. In each case, the prostate tissue is heated to a level that will lead to death of portions of the prostate tissue, thus shrinking away and removing some of the obstruction.
Another popular new treatment is photovaporization of the prostate (PVP), in which a laser is used to directly remove prostate tissue in a similar fashion to what is accomplished with a TURP (see above). The advantage of this technique compared with TUMT, TUNA, or ILC is that it offers immediate removal of tissue with rapid improvement in symptoms. Conversely, these other three treatments lead to delayed tissue loss and are not associated with immediate improvement of urinary symptoms in most cases.
Other new surgical alternatives are being developed. Ask your health care provider about the potential risks and benefits of medication and surgery. An operation for an enlarged prostate does not eliminate the risk of developing prostate cancer.
PROSTATE CANCER SURGERY
Surgery is a common treatment for early stage prostate cancer and if you are in good health. Your surgeon may remove the whole prostate or only part of it. Surgery to remove the prostate is called prostatectomy. In some cases, your surgeon can use a method known as nerve-sparing surgery. This type of surgery may save the nerves that control your bladder and erections. But if you have a large tumor or a tumor that is very close to the nerves, you may not be able to have this surgery. Each type of surgery has benefits and risks.
COMMON TYPES OF PROSTATE SURGERY
Your health care provider can further describe these types:
- Radical Retropubic Prostatectomy: The surgeon removes the entire prostate and nearby lymph nodes through an incision (cut) in the abdomen. He or she can also check nearby lymph nodes for cancer. This approach gives the surgeon a better chance to spare the nerves important for your bladder and erections.
- Radical Perineal Prostatectomy: The surgeon removes the entire prostate through a cut between the scrotum and the anus. Nearby lymph nodes may be removed through a separate cut in the abdomen. This type of surgery is not used as often and your surgeon is not able to check the lymph nodes for cancer. It is also more difficult to spare the nerves that control erections. This approach is used when the cancer is confined to the prostate.
- Laparoscopic Prostatectomy: The surgeon removes the entire prostate and nearby lymph nodes through small incisions, rather than a single long cut in the abdomen. A thin, lighted tube (a laparoscope) is used to help remove the prostate. Laparoscopic surgery is the newest type of surgery to remove the prostate. It is done with smaller incisions using a slender laparoscope with a camera on the end, which may be robotically controlled. The scope is inserted through the navel, and the surgeon can see a highly enlarged image of the prostate on a computer screen. Compared with other types of prostatectomy, this technique may lead to shorter hospital stays, faster recovery, and less blood loss and pain. However, it is fairly new and not widely used. Some surgeons have limited experience with this type of surgery. Since it is newer, researchers have not had the chance to follow its effectiveness for as long as they have for standard surgery.
- Transurethral Resection of the Prostate (TURP): Enlarged prostate may be treated surgically with a procedure called transurethral resection of the prostate, or TURP. This procedure is twice as likely to provide long-term relief than drugs or other treatments are. The surgeon removes part of the prostate with a long, thin device that is inserted through the urethra. The cancer is cut from the prostate. TURP may not remove all of the cancer. But it can remove tissue that blocks the flow of urine. Side effects of the procedure include retrograde ejaculation (in which the semen is pumped back up into the bladder) and, in some cases, impotence or incontinence. About 15 percent of men who have had the procedure need another operation within 8 years.
- Transurethral Vaporization of the Prostate (TVP): TVP is an advance on TURP. TVP uses an electrical current to bombard tissue and vaporize it, causing less bleeding.
- Transurethral Incision of the Prostate (TUIP): TUIP is usually done on an outpatient basis. It consists of making a few small incisions in the urethra to relieve pressure. A lower incidence of retrograde ejaculation is reported with this procedure.
- Cryosurgery: This type of surgery for prostate cancer is under study at some medical centers. Cryosurgery freezes and thaws tissue to kill prostate cancer with the surgeon being guided by ultrasound. Also called cryotherapy, it is often used when the prostate has more advanced, yet still confined disease, and when surgery is not an option. The prostate is not removed with this approach. Cryosurgery can result in injury to the rectum, incontinence, swelling of the scrotum, pain or numbness in the penis, or blocked urine flow. In 1 in 200 cases, a hole (called a fistula) appears between the rectum and prostate. Results depend highly on the surgeon's skill and experience. Success rates may not be as high as with prostatectomy or with any form of external beam radiation therapy. Long-term results for this type of treatment are not yet known.
- Pelvic Lymphadenectomy: This is routinely done during prostatectomy. The surgeon removes lymph nodes in the pelvis to see if cancer has spread to them. If there are cancer cells in the lymph nodes, the disease may have spread to other parts of the body. In this case, the practitioner may suggest other types of treatment.
AFTER SURGERY
The time it takes to heal after surgery is different for each man and depends on the type of surgery he has had. You may be uncomfortable for the first few days. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your health care provider. After surgery, your practitioner can adjust the plan if you need more pain relief.
After surgery, the urethra needs time to heal. You will have a catheter. A catheter is a tube put through the urethra into the bladder to drain urine. You will have the catheter for 5 days to 3 weeks. Your health care provider will show you how to care for it.
Surgery may cause short-term problems, such as incontinence. After surgery, some men may lose control of the flow of urine (incontinence). Most men regain bladder control after a few weeks.
Some men may become impotent (unable to obtain or maintain an erection). Nerve-sparing surgery is an attempt to avoid the problem of impotence. If a man can have nerve-sparing surgery and the operation is a success, impotence may not last. In some cases, men become permanently impotent. You can talk with your health care provider about medicine and other ways to help manage the sexual effects of cancer treatment.
If your prostate is removed, you will no longer produce semen. You will have dry orgasms (no semen will be ejaculated during sexual climax). If you wish to father children, you may consider sperm banking or a sperm retrieval procedure. This stored sperm can be used later to inseminate your partner to have a child.
RELATED INFORMATION RESOURCES
American Urological Association Foundation
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 1-866-RING-AUA (746-4282) or 410-689-3700
Email: patienteducation@auafoundation.org
Internet: www.auafoundation.org & www.UrologyHealth.org
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
(800) 891-5390
Internet: kidney.niddk.nih.gov
The Prostatitis Foundation
1063 30th Street, Box 8
Smithshire, IL 61478
Phone: 1-888-891-4200
Fax: 309-325-7184
Internet: www.prostatitis.org
National Cancer Institute: Prostate Cancer Home Page
National Cancer Institute
Cancer Information Service (CIS)
Toll-free: 1-800-4-CANCER (1-800-422-6237)
TTY: 1-800-332-8615
NCI Online: www.cancer.gov
Chat Online: www.cancer.gov/cis
Clinical Trials: www.cancer.gov/clinicaltrials/search
OTHER FEDERAL RESOURCES
Medicare - For more information about Medicare benefits, contact:
Toll-free: 1-800-MEDICARE (1-800-633-4227)
Online: www.medicare.gov
National Kidney and Urologic Diseases Information Clearinghouse
Toll-free: 1-800-891-5390
Online: www.kidney.niddk.nih.gov
PROGNOSIS
The prognosis of the first occurrence of acute bacterial prostatitis is good with aggressive antibiotic therapy and good patient compliance. Acute bacterial prostatitis is curable with a short course of antibiotics.
Chronic bacterial prostatitis is often recurrent even with appropriate therapy. In cases of recurrent chronic bacterial prostatitis that may present with acute exacerbations, causative underlying factors must be determined to affect outcome.
Chronic pelvic pain syndrome will be challenging for the patient and the health care practitioner. Symptoms tend to linger and be difficult to control.
Asymptomatic inflammatory prostatitis is not clinically significant and does not require treatment.
LONG-TERM EFFECTS OF CHRONIC PROSTATITIS
Chronic prostatitis affects men differently, with varying degrees of discomfort or pain.
Prostatitis is not a contagious disease. You can live your life normally and continue sexual relations without passing it on.
Having prostatitis does not increase your risk of developing prostate cancer or any other prostate or kidney disease. But even if your prostatitis is cured, you should continue to have regular examinations to detect prostate cancer.
ENLARGED PROSTATE FOLLOW-UP & PROGNOSIS
Once your health care provider has given you a medical plan, you should stick with it and follow up as recommended. Sometimes men need follow-up with a urologist.
Your condition may improve, remain the same, or become worse. Serious urinary problems from prostate enlargement affect one in 10 older men. If the bladder is permanently damaged from prostate enlargement, treatment may not be as effective.
Prostate enlargement is not cancer, nor does it seem to increase your chances of developing prostate cancer. You can, however, have both prostate enlargement and prostate cancer at the same time.
HOLISTIC & NUTRITIONAL INFORMATION
NUTRITIONAL RECOMMENDATIONS
Drink more cranberry juice. This can protect against urinary tract infections (UTIs), which have been linked to some forms of prostatitis. Use the unsweetened, pure juice. Sugared juices can contribute to UTIs.
Cranberry Juice Concentrate, Natural Premium Quality, Kosher, Dynamic Health, 16 fl. oz.
This Cranberry juice concentrate is in a space saving size and is ideal for smoothies and makes a delicious healthy topping. Cranberry juice is well known for it's role in helping defeat urinary tract infections, and reducing urine odor. All natural, no preservatives, no sugar added, fat-free, cholesterol-free, and beneficial as a dietary supplement. Serving size: 8 teaspoons = 16 fluid ounces with reconstituted.
Cranberry Extract, Standardized, Vegetarian Supplement, 400 mg, 120 VCaps
When you take Nature's Way cranberry extract, you can enjoy the benefits of cranberry without the added calories or sugar of a fruit juice. A urinary tract natural remedy, clinically proven to promote urinary tract health. This supplement is 90MX potency of cranberry solids (2X more potent than other brands). The Concentrate is a 48:1 Extract - More potent than diluted cranberry juice cocktails with no calories or added sugars. Nature's Way is the Best Value for an Effective encapsulated cranberry extract concentrate fortified with Ester-C. Primarily useful for female adults and those with chronic or recurrent urinary tract infection. Cranberry is used to prevent and urinary tract infection, odor of urine and to relieve cramps and spasms and hysteria. Cranberry fruit helps maintain a healthy urinary tract by inhibiting the adhesion of E. coli bacteria to the lining of the bladder. Recommended Daily Dosage: Take one tablet three times daily with 8 ounce glass of water or other liquid.
See Herbs, below, and try one or more of the recommended combinations. Acute inflammation or enlargement of the prostate gland often responds to certain herbal teas. If no improvement takes place or if the symptoms worsen, consult a urologist.
Take steps to reduce your blood cholesterol level. Studies have shown a connection between high cholesterol and prostate disorders. Cholesterol has been shown to accumulate in enlarged or cancerous human prostates.
Eat 1 to 4 ounces of raw pumpkin seeds every day. Pumpkin seeds are helpful for most all prostate troubles because they are rich in Zinc. As an alternative, pumpkin seed oil can be taken in capsule form.
Chinese Pumpkin Seeds, Raw, NOW Foods, 1 lb.
NOW Pumpkin Seeds are a healthy snack that can be enjoyed all year long. This wonderful source of nutrients is naturally rich in essential fatty acids, magnesium, iron, zinc, protein, and fiber.
Black Seed Oil & Styrian Pumpkin Seed Oil Blend, Amazing Herbs, 8 fl. oz.
This is a premium blend of Black Seed Oil and Styrian Pumpkin Seed Oil.
Pumpkin Seed Oil, 100% Natural, NOW Foods, 1000 mg, 100 Softgels
Pumpkin Seed Oil is a nutritional oil rich in essential fatty acids. This pumpkin seed oil is 100% natural and is screened for potency and purity.
Eliminate from your lifestyle such items such as tobacco, alcoholic beverages (especially beer and wine), caffeine (especially coffee and tea), chlorinated and fluoridated water, and spicy and junk foods. Limit your exposure to pesticides and other environmental contaminants.
If you have prostatitis, increase your fluid intake. Drink 2 to 3 quarts of spring or distilled water daily to stimulate urine flow. This helps to prevent cystitis (bladder infection) and kidney infection as well as dehydration.
Prostate Enzyme Formula, Prostate Health, and Prost-Actin are complexes designed to promote prostate health.
Prostol Prostate Supplement Formula, Nature's way, 120 Softgels
Prostol Dual Action Prostate Supplement combines the synergistics benefits of Sabal (Saw Palmetto) and Urtica (Nettle) in a preparation proven to inhibit 5-alpha-reductase and aromatase activity. Prostol have shown the following benefits: Increase urine flow. Decreases residual urine in the bladder. Reduces frequency of urination. Reduces post-urination dribbling. Prostol is the only prostate formula proven to be a "dual enzyme inhibitor", and to be more effective than Saw Palmetto alone. Recommended Use: Take one softgel twice daily with water. Best results are obtained with continuous use.
ProstaClean, Prostate Herbs, Balanceuticals, TCM Prostate Formula, 100% Natural, 60 Caps
Chinese medicine uses this well-known formula for its diuretic and immune supporting properties to clear the prostate and eliminate heat and toxins, and to rejuvenate. Direction for Use: As a dietary supplement, take 3-5 capsules 3 times daily.
ProstaStrong, Irwin Naturals Prostate Health, 90 Gelcaps
Bioperine enhanced Prosta-Strong is both a preventative and supportive prostate formula. Significant clinical research on benign prostate hyperplasia (BPH) and prostate-cancer has been conducted on each of the potent ingredients in Prosta-Strong. This formula has been designed to support normal prostate size, urine flow, and cellular support against free radicals in the prostate. The liquid content of these easy-to-swallow caps allows them to be quickly absorbed by the body. Dry capsules and tablets contain binders and fillers, which can cause stomach upset. Natural Liquid Gels are body friendly. For maximum results, take up to 4 capsules a day with meals. May be taken all at once or divided throughout the day.
Prost-RX, Prostate Supplement, Hi-Tech, 90 Caps
Prost-RX, Prostate Supplement, is a revolutionary formula designed to support a healthy prostate. The most advanced formula ever developed for men.
Zinc deficiency is linked to enlargement of the prostate. Soil used for farming is often deficient in zinc, and unless you eat husks of cereals or brewer's yeast, it is difficult to get enough zinc in the diet. Alcohol causes deficiency of zinc and other serious nutritional deficiencies. However, too much zinc (over 100 mg daily) can depress immune function. See Nutritional Supplements below for zinc product links and dosage recommendations.
Diet and nutrition are important not only for treatment, but for prevention of cancer. An anti-cancer diet is composed primarily of brown rice, fresh raw fruits and vegetables, fresh juices, legumes, raw nuts and seeds, and whole grains, and excludes alcohol, coffee, refined carbohydrates and strong tea. Regular intake of zinc 50 mg daily) and essential fatty acids (in supplement form or from cold-pressed sesame, safflower, or olive oil in later life also may help to prevent the development of problems.
For nutritional, dietary, & supplement recommendations see this link:
OTHER CONSIDERATIONS & RECOMMENDATIONS FOR PROSTATITIS
Use hydrotherapy to increase circulation in the prostate region. One method involves sitting in a hot tub that contains the hottest water tolerable for 15 to 30 minutes once or twice a day. Another form of hydrotherapy involves spraying the lower abdomen and pelvic area with warm and cold water, alternating between 3 minutes of hot water and 1 minute of cold. Still another technique involves sitting in hot water while immersing the feet in cold water for 3 minutes, and then sitting in cold water while immersing the feet in hot water for 1 minute.
Get regular exercise. Do not ride a normal bicycle, however. This may put pressure on the prostate. Special bicycle seats are available that have a center opening so that pressure is not put on the prostate. Walking is good exercise.
If your prostate is enlarged, be cautious about using OTC cold or allergy remedies. Many of these products contain ingredients that can inflame the condition and cause urinary retention.
All men aged 40 or over should have a yearly rectal examination, during which the prostate gland is checked.
Engaging in sexual intercourse while the prostate is infected and irritated may further irritate the prostate and delay recovery.
Some people believe that prostatitis is caused by an inability to process uric acid, a condition that can lead to gout.
Vasectomy for sterilization has been linked to prostate disorders and even cancer, according to some resources. However, other resources state that there is no link. More research needs to be done to resolve this concern.
PROSTATE CANCER NUTRITION RECOMMENDATIONS
Maintain a healthy whole-foods diet. Eat plenty of whole grains, raw nuts and seeds, and unpolished brown rice. Millet cereal is a good source of protein. Eat wheat, oats and bran. Also eating plenty of cruciferous vegetables, such as broccoli, Brussels sprouts, cabbage, and cauliflower, and yellow and deep-orange vegetables, such as carrots, pumpkin, squash, and yams. This type of diet is important for the prevention of cancer as well as for healing.
Consume freshly made vegetable and fruit juices daily. Carrot and cabbage juices are good choices. Fresh cabbage and carrot juice have also been used in alternative clinics worldwide in prostate cancer therapy.
Eat plenty of grapefruit, watermelon, and tomatoes and tomato products such as tomato juice and tomato based sauces. These contain lycopene, which has been shown to protect against prostate cancer.
Include in your diet foods that are high in zinc, such as mushrooms, pumpkin seeds, seafood, spinach, sunflower seeds, and whole grains. Zinc nourishes the prostate gland and is vital for proper immune function.
Eat salmon, mackerel, sardines, or herring. Regular consumption of these sources of omega-3 fatty acids may lower the risk of prostate cancer. One study found that eating fish more than 3 times a week was associated with a reduced risk of prostate cancer compared to infrequent fish consumption.
Drink at least 10 8-ounce glasses of quality water a day. This hydrates the body, keeps the prostate working efficiently, and helps to eliminate toxins from the body.
Restrict your intake of dairy products. Moderate consumption of soured products such as low-fat yogurt and kefir is acceptable.
Use cold-pressed organic oils such as sesame, safflower, or olive oil to obtain essential fatty acids.
Do not eat meat. There is a definite correlation between high red meat consumption (five servings a week or more) and the development of prostate cancer.
Eliminate from the diet alcoholic beverages, coffee, and all teas, except for caffeine-free herbal teas. A study conducted at the Fred Hutchinson Cancer Research Center in Seattle suggested that drinking one glass of red wine per day may reduce the risk of prostate cancer by 50 percent. However, it is still believed that alcohol consumption is not necessarily good for the body, and until more conclusive evidence becomes available, abstinence is considered the best practice. If there is a compound in red wine that might help, it certainly is not the alcohol.
A high-fat, low-fiber diet is linked not just to heart disease, but also to prostate cancer. Chemical reactions occur when fat is cooked, leading to the production of free radicals, which play a major role in certain cancers. Researchers theorize that a diet high in fat raises the levels of testosterone and other hormones in the body, which stimulates the prostate - and may cancerous cells in it - to grow. A high intake of milk and coffee also increase the risk of developing prostate cancer.
Strictly avoid the following foods, junk foods, processed refined foods, salt, saturated fats, polyunsaturated vegetable oils, sugar, and white flour. Instead of salt, use a kelp or potassium substitute. If necessary, a small amount of blackstrap molasses or pure maple syrup can be used as a natural sweetener in place of sugar. Use whole wheat or rye instead of white flour.
Unless otherwise recommended in the Nutritional Supplement table below, take vitamins and other supplements daily with meals, with the exception of Vitamin E, which should be taken before meals. Consult with your health care provider about contraindications of any medications and nutritional supplements.
Consider following a macrobiotic diet.
WebMD: Macrobiotic Diet
Macrobiotic Guide: Essential Guide to Macrobiotics Online
For more macrobiotic resources, use the Amazon.com search box further down on this page and put macrobiotic in the search box.
Research has shown that soybeans and soy products, such as tofu, tempeh, soy flour, and soy milk, have cancer fighting powers due to the presence of a protein called genistein. Genistein apparently retards growth by preventing the growth of new blood vessels to feed the tumor. It appears to be particularly effective against prostate cancer, but also work against breast cancer in women and colon cancer in both sexes.
Berries help protect DNA from damage and mutation that may result in cancer.
Excess dietary calcium may increase the risk of prostate cancer. This may be because calcium can reduce the levels of vitamin D, which has been shown to be prostate-protective.
The hormone dehydroepiandrosterone (DHEA) is believed to help prevent cancer by blocking an enzyme that promotes cancer cell growth. There is also 7-keto-DHEA, which is a form of DHEA that appears not to be converted into testosterone or estrogens in the body. It may be a better option for those at risk for prostate cancer.
S-ally-mercaptocysteine (SAMC), a compound derived from aged garlic, appears to diminish the growth of human prostate cancer cells. Researchers from Memorial Sloan-Kettering Cancer Center in New York City found that SAMC causes cancer cells to break down testosterone 2 to 4 times more quickly than normal - and through a route that does not produce dihydrotestosterone (DHT), a form of the hormone strongly associated with the multiplication of prostate cells. SAMC can be found only in garlic extract that has been aged.
Some types of cancer are treated with chemotherapy and can apparently be cured with this treatment. Cancer chemotherapy is the administration of highly toxic medications meant to kill cancer cells. Side effects of chemotherapy can include hair loss, extreme nausea, vomiting, fatigue, weakness, sterility, and damage to the kidneys and heart. Certain nutrients may help the body avoid some of the damage done by this treatment, among them vitamin B-6 (pyridoxine), coenzyme Q-10, glutathione, and vitamin C.
Nutritional supplements and better dietary habits offer great support to cancer patients who are receiving chemotherapy and/or radiation therapy, or who are in remission. Taking shark liver oil prior to radiation therapy has been shown to protect healthy tissue against injury from the procedure. Shark liver oil contains alkylglycerols (AKGs), vitamin A and E, omega-3 fatty acids, trace minerals, and squalene. A study published in the European Journal of Cancer in 1997 reported that glutathione can reduce adverse side effects associated with chemotherapy.
Shark cartilage has been shown to be helpful for certain types of cancer, including cancer of the breast, cervix, pancreas, and prostate, as well as Kaposi's sarcoma, a type of skin cancer. It suppresses angiogenesis (the development of new blood vessels), depriving cancerous tumors of nourishment and, often, causing them to shrink and die.
Studies have shown grape seed extract to not only enhance the development of normal cells, but also inhibit abnormal cell growth.
Any recommended nutrients or supplement given above will have product links below in the Nutritional Supplements section and the Supplements & Products section.
LIFESTYLE RECOMMENDATIONS
Try to avoid all carcinogens. Eat only organic foods, if possible. Avoid tobacco smoke, polluted air, polluted water, noxious chemicals, and food additives. Use only distilled or quality water or reverse-osmosis filtered water. Municiple and well water can contain chlorine, fluoride, and agricultural chemical residue.
Get regular physical activity. Active men maintain better health and have lower risk of developing prostate cancer.
Enjoy regular sexual activity. Regular ejaculation activates the prostate gland, keeping it from getting stagnant and inflamed.
Do not take any drugs except for those prescribed by your health care provider. Always seek counsel and alternative opinions before deciding which treatments, if any, you will pursue.
Avoid stress as much as possible. Learn relaxation and stress management techniques to help you deal with those stresses you cannot avoid.
Take coffee enemas alternated with enemas made by adding 1 ounce of fresh wheatgrass juice to 1 cup of water. Do this daily to help the body eliminate toxins. Wheatgrass enemas contain many nutrients and enzymes, and are used in many alternative clinics for cancer treatment. Also use cleansing enemas with lemon and water or garlic (Kyolic liquid) and water two or three times weekly.
For more information about alternative therapies for cancer treatment see this link:
HERBS
HERBS FOR PROSTATITIS
Teas made from the diuretic herbs Buchu and Corn Silk are helpful. Juniper Berries, Slippery Elm Bark, and Uva Ursi are also natural diuretics and urinary tract tonics.
Bilberry and Birch are urinary tract antiseptics.
Chinese Ginseng is beneficial for prostate health and sexual vitality.
Goldenseal root is diuretic and antiseptic. Caution: Do not take Goldenseal internally on a daily basis for more than 1 week at a time, and use it with caution if you are allergic to ragweed.
A decoction of equal quantities of Gravel Root, Hydrangea Root, and Sea Holly helps to ease inflammation and reduce the discomfort of urination. Take 3 to 4 teaspoonfuls 3 times daily. Marshmallow leaves may be added to this mixture for their demulcent properties if burning persists.
Olive Leaf extract contains anti-inflammatory agents.
Nettle and Turmeric are anti-inflammatory agents. Combined extracts of Nettle Root and Saw Palmetto have proved effective for BPH.
Horsetail is astringent and can be used if small amounts of blood are passed, as well as for frequent urination at night. Combine it with Hydrangea for even greater effect.
Pygeum (Pygeum africanum) has been proven effective in the treatment and prevention of BPH and prostatitis in many worldwide studies. It has become a primary therapy for these conditions in Europe.
Saw Palmetto has been used to treat prostate enlargement and inflammation, painful ejaculation, difficult urination, and enuresis (the inability to control urination). It reduces prostatic enlargement by reducing the amount of hormonal stimulation of the prostate gland.
Siberian Ginseng (Eleuthero Root) is a tonic for the male reproductive organs. Caution: Do not use Siberian Ginseng if you have hypoglycemia, high blood pressure, or a heart disorder.
Other herbs beneficial for the prostate include Cayenne (Capsicum) and False Unicorn Root.
HERBS FOR PROSTATE CANCER
Black Radish, Dandelion, Milk Thistle, and Red Clover are good for cleansing the liver and the blood.
Buchu, Carnivora, Echinacea, Goldenseal, Pau D'Arco, and Suma have all shown anti-cancer properties. Take them in tea form, using two at a time and alternating among them. Caution: Do not take Goldenseal internally on a daily basis for more than one week at a time, and use it with caution if you are allergic to ragweed.
Damiana and Licorice Root have the ability to balance hormones and glandular function. Caution: Do not use Licorice for more than 7 days at a time. Avoid it completely if you have high blood pressure.
Gravel Root, Hydrangea, Oat Straw, Parsley Root, Uva Ursi, and Yarrow are diuretics that also dissolve sediment.
A plant substance in Green Tea has been found by researchers at the Mayo Clinic to be a potent killer of prostate cancer cells. Many studies have linked Green Tea consumption to a reduced risk for prostate cancer.
Modified Citrus Pectin has been shown to substantially inhibit the growth of cancer cells and is especially effective in combating prostate cancer.
Pygeum and Saw Palmetto are helpful. European studies suggest Pygeum may prevent prostate cancer.
Resveratrol is a phytochemical derived from grapes that helps to maintain a healthy prostate. See product link under Nutritional Supplements.
Turmeric is a spice that contains Curcumin, an antioxidant that may be effective in controlling prostate cancer cells.
NUTRITIONAL SUPPLEMENTS
Links have been provided for recommended supplements so you will be able to obtain them without having to do a lot of searching. The doses given below are for adults. If you have any questions, consult with your health care provider or nutritionist and follow their recommendations specific for your situation and health status.
PROSTATE SUPPLEMENTS & PRODUCTS
Information, supplements and products for prostate problems, which can range from mild to life-threatening & prostate health. Supplements and products for benign prostatic hyperplasia, a non-cancerous enlargement of the prostate.
Acai Green Tea, Superfruit Tea, Republic of Tea, 50 Tea Bags
Açai (ah-sigh-ee) berry is one of the most nutritious fruits in the world. For centuries, inhabitants of the Amazon rainforest have gathered these berries from the azaicero palm tree for their powerful health benefits. This deep purple fruit has the rich flavors of concord grape and ripe blueberries.Acidophilus And Your Health, By Frank Murray
A "Good Health Guide" essential for digestion, acidophilus helps cure diarrhea and candida infections, lower cholesterol, prevent and heal cancer and restores healthy intestinal flora after antibiotic treatment.Alfalfa Tincture, 100% Organic, 2 fl. oz.
Alfalfa (Medicago sativa) is Useful to generate energy and endurance; a tonic for the whole body, due to its highly nutritive value.Alpha Lipoic Acid, Nature's Ultimate Antioxidant, By Allan Sosin, M.D., & Beth Ley, Ph.D
This book shows how to fight back against aging and degenerative diseases with nature's powerful antioxidant.Barlean's Flax Oil, 100% Highest Lignan Content, Organic, Pesticide & Herbicide Free, 16 fl. oz.
Barlean's Flax Oil contains 25% more lignan bearing flax particulate than competing brands. Barlean's Flax Oil is one of the Nation's Top-10 Best Selling Health Products.Blueberry Green Tea, Republic of Tea, 50 Tea Bags
Premium China green tea with blueberries for great taste and also for men's prostate health.BodyZyme, Systemic Enzyme, 90 Capsules
BodyZyme is a potent systemic enzyme. Enzymes are protein based substances found in every cell of every plant and animal.Buchu Herb, Urinary / Kidney Herb, African Red Tea Imports, 2 fl. oz.
Buchu herb has traditionally been claimed to treat a wide variety of disorders, some of which include stomach complaints and urinary tract infections.Colostrum, 480 mg, 120 Caps
Colostrum known for its powerful healing factors offers optimal health. Colostrum research proves a wide spectrum of immunoglobulins, antibodies, and accessory immune factors.Cat's Claw Tea Spice System Builder, Regular, 100% Organic, Loose Leaf, 8 oz.
Reduces inflammation in arthritis, protects the body from harmful substances, supports the body while undergoing cancer treatments, helps to boost the immune system.Cat's Claw Tincture, 100% Organic, 2 fl. oz.
Cat's Claw is a rain forest herb that grows in the Peruvian Amazon; it has been used by native healers for many years.CoQ10, NOW Foods, 400 mg, 60 Softgels
As an active contributor to all aspects of cellular function, coq10 has become universally regarded as one of the most vital nutrients ever made available to the public.CoQ10 With Vitamin E, NOW Foods, 200 mg, 90 Lozenges
Our new orange flavored chewable CoQ10 200 mg is formulated with 100 IU of Vitamin E in a base of non-genetically engineered Soy Lecithin.Dandelion Tea, Organic, NOW Foods, 30 Tea Bags
Dandelion tea is warm and soothing, and acts as a blood cleanser and gentle diuretic and is 100% Organic.DMG Supplement, N,N Dimethyl Glycine, NOW Foods, 125 mg, 100 Caps
NOW Foods' DMG Supplement is a methylated amino acid found in all cells. DMG is an antioxidant and methyl donor that has a number of beneficial effects. It has shown to have potential in increasing immune response to the flu and salmonella.Eleuthero Vascutone Herb Tea, 20 Tea Bags
Siberian Ginseng Root helps support the immune system, improve memory, endurance, vitality, and to balance hormone levels in male and female.Flax Oil As A True Aid Against Arthritis, Heart Infarction, Cancer & Other Diseases, By Dr. Johanna Budwig
This book contains the lectures by seven-time Nobel prize nominee and the world-renowned Scientist & Biochemist that have brought about a scientific revolution connecting the relationship between Cancer & Fat Metabolism.Flax: The Superfood, Over 80 Different Recipes Using Flax Oil & Ground Flax Seed, By B. Bloomfield, J. Brown & S. Gursche
This Book explains how Flax may play a vital role in the prevention of breast cancer, prostate cancer, uterine cancer and colon cancer.Flor Essence Tea, Truman's Best, Loose Leaf, 8 oz.
The Essiac Report states that this is the improved version of Rene Cassie's, famous cancer, C.F.S. (Chronic Fatigue Syndrome), Psoriasis, Diabetes, HIV Infection/Aids cure. Used for all virus infectionsGarlic Tincture, 100% Organic, 2 fl. oz.
The Europeans use garlic as an all-around treatment for preventing atherosclerosis, the cause of heart disease and strokes.Goldenseal Herb, Nature's Way, 400 mg, 180 Caps
Goldenseal herb (hydrastis canadensis), a perennial wild native American herb, is also called Yellow Root. Native Americans used Goldenseal both internally and externally and also derived a dye from the root. Golden Seal is a very important traditional herb.Gravel Root Tincture, 2 fl. oz.
Today Gravel root is used for kidney stones, cystitis, and pelvic inflammatory disease. Because it encourages the excretion of excess uric acid, it is also used to treat rheumatism and gout.Green Tea, 100% Darjeeling Green Tea, NOW Foods, 30 Tea Bags
100% Organic Green Tea contains antioxidants that may reduce the risk of cancer, fight the flu, lower blood sugar, prevent cavities, and lower blood cholesterol.Hoxy Formula Tincture, 100% Organic, 2 fl. oz.
The Hoxy Formula can be used to help dissolve tumors.Hydrangea Herb Extract Tincture, Herbal Remedies USA, 2 fl. oz.
Hydrangea herb can be useful is in the treatment of inflamed or enlarged prostate glands. It may also be used for urinary stones or gravel associated with infections such as cystitis. Hydrangea herb was originally used by the Cherokee Indians as a remedy for kidney stones.Hydrangea Root, Nature's Way, 415 mg, 100 Caps
Hydrangea root has traditionally been used to strengthen the urinary tract and help regulate its function. This plant contains alkaloids which help soothe the body, especially in the bladder and kidney areas. Hydrangea root also works like a natural inflammation reliever and cleanses the joint areas.Immune-RX, Immune System Supplement, Hi-Tech Pharmaceuticals, 60 Tabs
Immune-RX, Immune System Supplement, was formulated to strengthen your immune system because Immune-Rx offers the most powerful protection against the elements.Immune System Formula Tincture, 100% Organic, 2 fl. oz.
The Immune System Formula can be used for AIDS, Auto-immune Diseases, and Cancer.Irwin Naturals ProstaStrong, Prostate Health, 90 Gelcaps
Significant clinical research on benign prostate hyperplasia (BPH) and prostate-cancer has been conducted on each of the potent ingredients in Irwin Naturals Prosta-Strong.Kidney / Bladder Formula Tincture, 100% Organic, 2 fl. oz.
Use the Kidney Bladder Formula for Auto-immune Diseases, Bladder, Cancer, Cold Sores and deposits.Kombucha Tea, 100% Organic, Original Flavor, 64 fl. oz
Kombucha's benefits to the physical body vary widely. It is said to enhance the immune system. By detoxifing the body, kombucha makes it unlikely for disease causing bacteria and viruses to find a suitable growth environment. This results in a healthier physical body!L-Arginine, Pharmaceutical Grade, Free Form, NOW Foods, 500 mg, 100 Caps
L-Arginine is a conditionally essential basic amino acid involved primarily in urea metabolism and excretion as well as DNA synthesis.Lycopene, Double Strength, NOW Foods, 20 mg, 50 SoftGels
Clinical studies have indicated that Lycopene works through a number of mechanisms to support cardiovascular health and immune function. In addition, epidermiological studies have determined that Lycopene may be particularly important for the support of prostate health, as well as for the health of the digestive tract.Lycopene Super Antioxidant, Lycopene Supplement, Nature's Way, 5 mg, 60 SoftGels
Nature's way Lycopene Supplement provides food nutrients from organic tomatoes.Lymphatic Glands Formula Tincture, 100% Organic, 2 fl. oz.
Helps the lymphatic Glands cleanse the body of its wastes. May be used as a preventative and for acute conditions.Maitake Mushroom Powder, 100% Organic, 4 oz.
The unique chemicals in raw, cooked, and dried Maitake mushrooms may help boost immunity, fend off infections and fight cancer. The Food and Drug Administration has approved testing of a compound called Maitake D-fraction, in treating advanced breast and prostate cancers. The same compound is showing promise against lung, liver and brain cancers as well.Maitake Mushroom Whole, Certified Organic, 4 oz. Dry Weight
The Maitake Mushroom is not only the medicinal mushroom that leads as an anti-cancer agent specializing in breast and prostate cancers, but is also renown for it's ability to regulate blood sugar, cholesterol, blood pressure, inflammation, and blood clots.Mangosteen Juice, Kosher & Vegetarian, Dynamic Health, 32 fl. oz.
Dynamic Health Mangosteen Juice is rich in the Xanthone Antioxidant, and Mangosteen Juice contains naturally occurring minerals, enzymes, vitamins, antioxidants, phytonutrients and bioflavonoids and stimulates your body to boost energy.Natural Fiber Supplement, Trumans, 12 oz.
Truman's Natural Fiber Supplement formula helps to give bulk to the stool and to check diarrhea; thus, creating balance in the bowel movements.Nettle Leaf (Urtica Dioica) Powder, 4 oz. Bulk
Nettle Leaf (Urtica dioica), from ancient Greece to the present, nettle has been documented for its use in treating coughs, tuberculosis, and arthritis, asthma and in stimulating hair growth.Nettle Tincture, 2 fl. oz.
Nettle leaf has become a popular treatment of allergies (hay fever) and it can improve goiter, inflammatory conditions, and arthritis.Odorless Garlic Supplement, NOW Foods, 50 mg, 250 SoftGels
Odorless Garlic supplement is extracted from Allum sativum and is a specially made Japanese product. Our Odorless Garlic yields high amounts of Scordiin, a unique sulfur compound which may be responsible for many of garlic's renowned benefits.Olive Leaf Extract, Standardized, Nature's Way, 500 mg, 60 Caps
Nature's Way Standardized Olive Leaf extract is a technically advanced herbal product. Standardization assures specific measurable levels of important compounds that provide beneficial activity in the body.Opuntia (Prickly Pear), Nature's Way, 250 mg, 100 Caps
Nature's Way Opuntia prickly pear flowers were traditionally used as medicine for male urinary discomforts. It was also used externally as an ointment.Pau D'Arco Liquid Extract, Incan LaPacho, 100% Natural Herbal, 4 fl. oz.
The Incan Lapacho Co. Pau d'Arco extract is made from the inner barks of Plantation Grown Purple Lapacho trees found on or near the ancient Inca Trail.Pau D'Arco Tea, Incan LaPacho, 48 Tea Bags
Pau d'Arco tea has shown that it may support the bodies own ability to ward off many diseases.Periwinkle (Vinpocetine) Tincture, 100% Organic, 2 fl. oz.
Rosy Periwinkle produces 70 known alkaloids, some of which are used by the pharmaceutical industry for the treatment of childhood leukemia, Hodgkin's disease, testicular cancer and cancerous tumors.Platinum Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Platinum is a pure liquid Platinum Supplement. Platinum is used in the treatment of cancer and as a base in some of the chemotherapeutic treatments. Platinum may be effective in killing disease- causing bacteria, fungus, viruses, and help boost the immune system.Pomeratrol, NOW Foods, 60 VCaps
NOW® Pomeratrol's combination of antioxidant power and cellular protection thus provides strong support against abnormal cell growth, as well as against the effects of aging.ProgestaCare Natural Progesterone Cream, Men's Formula, 100% Natural, 3 oz.
Medical researchers are just now discovering the many health benefits that natural progesterone cream can offer men.Prostactive, Saw Palmetto Supplement With Nettle Root, Nature's Way, 140 mg, 50 Softgels
Prostactive Plus Saw Palmetto Supplement is a concentrated 12:1 extract made from the berries of the Saw Palmetto tree blended with Nettle Root extract, providing a unique synergistic effectiveness.ProstaClean, Prostate Herbs, Balanceuticals, TCM Prostate Formula, 100% Natural, 60 Caps
Chinese medicine uses this well-known formula for its diuretic and immune supporting properties to clear the prostate and eliminate heat and toxins, and to rejuvenate.Prostate Disorders & Natural Medicine, By Rita Elkins
This book discusses the causes and concerns of prostate problems.Prostate Formula Tincture, Liquid, Prostate Herbal Supplement, 2 fl. oz.
Alternative Health & Herbs Remedies Prostate formula, prostate herbal supplement, is for prostate problems and to balance male hormones.Prostate Health In 90 Days, By Larry Clapp, Ph.D., J.D.
Shows how to stop prostate trouble in its tracks, using nutrition, massage, herbs, homeopathy and other alternative healing approaches.Prostate Nutritional Support Formula, Allergy Research Group / Nutricology, 60 Softgels
Contains diindolylmethane, or DIM, which has been shown to support healthy estrogen metabolism. Combined with a complex of DIM, saw palmetto, stinging nettles, beta-sitosterol, lycopene and pumpkin seed oil, all of which have been shown to support prostate health.Prostate Support Wellness Oil, Nature's Inventory, 2 fl. oz.
If you are suffering from a prostate disorder like prostatitis, BPH, have to frequently use the bathroom or are simply looking to promote a healthy prostate, then Nature's Inventory Prostate Wellness Oil may be a viable alternative to conventional treatments.Prostate Supplement With Saw Palmetto, Nature's Way, 60 Caps
Nature's Way Prostate Supplement represents the powerful synergy of current scientific research and traditional herbal medicine.Prostol Prostate Supplement Formula, Nature's Way, 120 Softgels
Prostol Dual Action Prostate Supplement combines the synergistic benefits of Sabal (saw palmetto) and Urtica (nettle) in a preparation proven to inhibit 5-alpha-reductase and aromatase activity.Pumpkin Seed Oil, 100% Natural, NOW Foods, 1000 mg, 100 Softgels
Pumpkin Seed Oil is a nutritional oil rich in essential fatty acids. Our pumpkin seed oil is 100% natural and is screened for potency and purity.Queen of the Meadow Root (Eupatorium Purpureum) Powder, 4 oz. Bulk
Queen of the Meadow (Eupatorium purpureum), also called Gravel root, Kidney root, Purple boneset and Joe Pye Weed after the Native American herbalist Joe Pye, has an apple scent. Infuse the dried root and flowers for a diuretic tea to relieve kidney and urinary problems. The tea is also used to induce sweating and break a high fever. Also useful for rheumatism, gravel (gallstones), and dropsy (fluid retention).Resveratrol Synergistic Formula, Nature's Way, 37.5 mg, 60 Caps
Japanese Knotweed is a potent source of Resveratrol and has been used for the heart, liver and blood vessels.Samento, Extra Strength (100 Times More Effective Than Cat's Claw), 600 mg, 30 Caps
Samento is beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.Samento Liquid Extract, 1 fl oz.
Beneficial in the treatment of a wide range of immune system related conditions; these include but are not limited to cancer, arthritis, bursitis, rheumatism, allergies, ulcers, systemic candidiasis, all forms of herpes, diabetes, lupus, chronic fatigue syndrome, intestinal disorders and HIV infection.Saw Palmetto Berries, 585 mg, 180 Caps
Saw Palmetto is especially helpful to men suffering from prostate gland problems. Saw Palmetto relieves symptoms of BPH, such as urinary frequency and urgency, excessive nighttime urination, or delayed urination.Saw Palmetto Berries Tincture, 100% Organic, 2 fl. oz.
Using Saw Palmetto may also enhance sexual functioning and sexual desire.Saw Palmetto Extract With Pygeum, Standardized, 410 mg, 30 Softgels
Once daily Saw Palmetto Extract With Pygeum formula is standardized to 85-95% fatty acids and 13% sterols.Saw Palmetto, Standardized Extract, 160 mg, 60 Softgels
A liposterolic extract of the fruit of Saw Palmetto is the most popular herbal supplement for the promotion of prostate health in Europe. Saw Palmetto is the ideal supplement for men interested in supporting normal urinary flow.Sea Buckthorn Seed Oil, 100% Natural, 500 mg, 60 SoftGels
A rare source of vitamin E, Sea Buckthorn Oil also provides other vitamins including Vitamins A, C, D, K, etc, carotenoids, flavonoids, phytosterols, amino acids, serotonin and 28 trace elements: iron, zinc, calcium, magnesium, selenium, iodine, etc.Selenium, 100% Natural, 200 mcg, 100 Caps
Selenium is an essential component of glutathione, the body's most potent natural antioxidant system. It is a popular choice in many antioxidant regimens.Selenium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz.
WaterOz Ionic Selenium is pure liquid Selenium supplement. Selenium promotes normal body growth, enhances fertility, encourages tissue elasticity and is a potent antioxidant that naturally reduces the retention of toxic metals in the body. Selenium is crucial for the proper functioning of the heart muscle and there is evidence that it can help the body fight cancer.Shark Cartilage, NOW Foods, 750 mg, 100 Caps
Shark cartilage is taken to ease the pain and inflammation of arthritis and other bone and joint ailments. Popular as an alternative treatment for cancer, shark cartilage is taken both to slow the growth of existing tumors and in smaller daily doses to prevent new cancers.Shiitake & Maitake Extract, Standardized, 200 mg, 60 Caps
Nature's Way Shiitake and Maitake extract is formulated in a base of Oat powder standardized to a total of 8% beta glucan, the polysaccharide to which most of the health benefits are attributed.Thisilyn, Milk Thistle Extract, Vegetarian, Nature's Way, 175 mg, 100 VCaps
Nature's Way Thisilyn, Milk Thistle Extract, is especially recommended for those who drink, smoke, or are exposed to environmental pollutants.Turmeric Extract, Standardized to 95% Curcuminoids, Nature's Way, 500 mg, 120 Tabs
Nature's Way standardized Turmeric extract is a technically advanced herbal extract standardized to 95% curcuminoids. This is the highest concentration of curcuminoids available.Turmeric Tincture, 100% Organic, 2 fl. oz.
Turmeric is useful as an anti-inflammatory and can be used to reduce Alzheimer's debilitating effects, but there are multiple studies that suggest curcumin can have some potential in actually treating various forms of cancer.Vital Yew (Pacific Yew), 300 mg, 180 Caps
Pacific Yew tree has not only been intensively used and analyzed for its remarkable anti-cancer properties, but has also been historically utilized in its natural form for promoting relief from a variety of health concerns including colds, viral, bacterial and fungal infections, flu, rheumatism, sciatica, kidney problems, lung problems and more.Vitamin A, 100% Natural, Nature's Way, 10,000 IU, 100 Softgels
Nature's Way vitamin A is 100% natural from fish liver oil. It contains no artificial ingredients or preservatives.Vitamin B-100 Complex With Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
A complete Vitamin B complex of 8 essential vitamins. B Vitamins are precursors of coenzymes involved in the conversion of cellular energy, manufacture of hormones and proteins, and repair and maintenance of nerve structures.Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps
Nature's Way Vitamin C with Bioflavonoids provides antioxidant protection for many of the body's important enzyme systems.
FOR A COMPLETE LIST OF PROSTATE CANCER & PROSTATE SUPPLEMENTS & PRODUCTS:
HerbalRemedies: Benign Prostatic Hyperplasia, Supplements, Information & Products
HerbalRemedies: Prostate Cancer Information
HerbalRemedies: Prostate Cancer Supplements, Information & Products
HerbalRemedies: Prostate Problem Supplements, Information & Products
HerbalRemedies: Cancer Supplements, Information & Products
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You develop any of the signs and symptoms of prostatitis or BPH, such as persistent urinary discomfort and pain, blood-tinged urine or semen, or pain while ejaculating - especially if these signs and symptoms come on suddenly. When untreated, prostatitis can lead to more serious problems such as infection throughout your body. It is also important to see your health care provider to rule out other conditions that eventually may cause bladder or kidney damage.
You are being treated for acute bacterial prostatitis, see your health care provider when you have finished your course of antibiotics to make sure the infection has cleared. This is also a good time to discuss what you can do to prevent a recurrence.
You need to have a regular prostate check-up. Most men have a prostate checkup in conjunction with a regular physical exam. If your health care provider does not perform a digital rectal exam when you have a routine physical, ask whether you should have one.
If you experience fever/chills or nausea/vomiting or if the prostate enlargement condition worsens and symptoms such as blood in the urine or lower back pain are present, consult a health care provider immediately. If you cannot reach your health care provider when these symptoms are present, seek evaluation at a hospital's emergency department.
For acute symptoms such as acute urinary retention, you cannot urinate), you should immediately go to the closest emergency medical facility.
If you are over 50 years of age and need to have your prostate checked annually by your health care provider, even if you have no symptoms.
You suspect or have signs that may be associated with prostate cancer.
You want more information regarding prostate cancer therapies, conventional and alternative.
You have unusual or unexplained symptoms. Some therapies, both conventional and alternative, may produce side effects during treatment.
Your symptoms worsen, despite treatment.
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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