Cancer of the prostate is thes econd most common malignancy in men and, after cancer of the lung and colon, the third most common cause of cancer death in men over the age of 55.

Symptoms include difficulty in passing urine, painful urination, increased frequency of passing urine, back or hip pain or blood in the urine. However, many early as well as moderately advanced cases of prostate cancer are asymptomatic at the time of diagnosis. Rectal examination of the prostate is recommended during all routine physical check-ups. The posterior surface of the prostate, where cancer most often begins, is easily palpable by digital rectal examination.

Ancillary blood tests to detect prostate cancer include the prostate specific antigen and the acid phosphatase. The PSA is more sensitive than the acid phosphatase test to detect cancer. However, neither test is sufficiently sensitive, or specific, to be used solely for screening. Their major application is to follow the progress of the disease or response to treatment.

If prostate cancer is suspected, transrectal prostate ultrasound scans are sensitive enough to detect cancer growths. If the scans shows an area of the prostate suspicious for cancer, a biopsy is necessary to confirm the diagnosis. This often can be done with a needle that is guided by ultrasound imaging to the area suspicious of cancer.

Another type of prostate disease is the benign enlargement of the prostate that occurs in almost all aging men. The disorder starts affecting men by the age of 45 and increases in frequency with age such that by the eighth decade more than 90 percent of men have prostate enlargement disease.

The prostate surrounds the urethra and progressive enlargement ultimately results in obstructive symptoms such as difficulty in voiding, hesitancy, post voiding dribbling, sensation of incomplete emptying and complete urinary retention. Retention of urine can result in bladder and sometimes kidney infections.

The prostate can be easily examined by a digital rectal examination that can provide an estimate of the extent of prostate enlargement. However, if there are urinary symptoms, additional radiologic tests such as ultrasound of the prostate and intravenous pyelogram may be needed. An intravenous pyelogram is a test where x-rays are taken of the kidneys and urinary tract after dye is injected into the veins.

As majority of men aged above 60 have some degree of prostate enlargement, the presence of the disorder is not an indication for treatment. Indications for treatment include a decrease in urine flow of sufficient magnitude to cause men to seek relief, inability to empty the bladder or sudden urinary flow obstruction. Treatment is usually surgical. When surgery is indicated, a transurethral prostatectomy is the procedure of choice. This is an operation where part of the prostate is removed through the urethra using an instrument called a resectoscope. Laser-assisted prostatectomy is a new alternative therapy for treating prostate enlargement. During the 10-minute procedure (performed on an outpatient basis in the United States), the laser fiber is passed through the urethra using a cystoscope. The patient is discharged with a catheter in place for approximately 3 to 5 days.

Patients may find that urinary frequency temporarily increases once the catheter is removed. However, during the ensuring several months, the laser-treated tissue passes with urination allowing improvement in voiding. While long-term data is not available, short-term results have been encouraging.

Lastly, medications are often used as a temporary measure to alleviate symptoms associated with prostate enlargement. Drug therapies include Hytrin and Minipress (alpha blocker medication) or Proscar (5-alpha reductase inhibitor), which interferes with tesosterone metabolism and may decrease prostate size. Both drug therapies provide improvement in voiding in 30 to 40 percent of patients and require daily medication.