Prostate Health PLAYBOOK The American Urological Association Foundation’s

Any football fan knows the best offense is a good defense.
The American Urological Association Foundation’s
Prostate Health PLAYBOOK
Now that you know the score, please help us get the word
out in your community! The AUA Foundation is committed
to helping the one in six men who will develop prostate
cancer in their lifetime. One in six — that means that one of
your friends may already be facing a future with prostate
cancer. Please help today by making a donation in support
of this vital educational outreach program.
For more information, contact the AUA Foundation
1000 Corporate Blvd.
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Urology Health Line: 1-800-828-7866
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© 2009 AUA Foundation. All rights reserved. The American Urological Association Foundation is a 501(c)(3) nonprofit organization. Donations made to the foundation are tax deductible to the fullest extent of the law.
The American Urological Association Foundation’s
About the American Urological
Association Foundation
The AUA Foundation is the world’s leading nonprofit
urological health foundation and the Official Foundation
of the American Urological Association. Our mission is
to promote health, provide hope and promise a future
free of urologic disease, including cancer.
As the official foundation of the AUA, the professional
organization of approximately 16,000 urologists,
the AUA Foundation is the trusted public source for
the most accurate and current information relating to
urological health.
Knowledge is power.
By reading and learning
from this Playbook, you
are taking the first step
toward your Game Plan for
continued urologic health
and well-being. Monitor
your prostate health with
regular exams and a simple blood test. Knowing your
“stats” or baseline levels of prostate-specific antigen
(PSA) and having annual prostate exams will help
you keep track of changes and seek medical care for
problems that could put you on the sidelines – or take
you out of the game for good.
Pregame Preparation:
What you should know
about your prostate
Prostate health — much like success in football — depends primarily upon key
members of the team. In prostate health, the urologist is your Head Coach —
the leader of your healthcare team, which also includes you, your family and
your friends — who designs and executes a game plan that best suits your needs.
Any football fan or player knows the best offense is a good defense. Learning
about your prostate can help you know your opponent and give you the best
plays to keep you off the sidelines and in the game — the game of life, that is.
Only men have a prostate.* Part of the male reproductive system, the prostate is
located just below the bladder and in front of the rectum. It surrounds the urethra,
the tube that carries urine from the bladder and semen through the penis and out
of the body. The prostate’s main job is to help create semen — the fluid that helps
protect and energize the sperm — by producing ejaculatory fluid. Think of semen
as the offensive line. As the sperm run into the end zone, where the female egg is
waiting, the semen protects the sperm so they can fertilize the egg and form a new
life — touchdown! The seminal vesicles, located next to the prostate, also add fluid
to semen. The most common prostate health problems are non-cancerous enlarged
prostate (benign prostatic hyperplasia, or BPH), inflammatory disease (prostatitis)
and prostate cancer.
Because of its location inside the pelvis, there are no simple self-exams for men
to check their own prostate. Doctors use two tests to monitor prostate health: the
digital rectal examination (DRE) and a blood test called prostate-specific antigen
(PSA). The American Urological Association (AUA) recommends that early detection
and risk assessment of prostate cancer should be offered to men 40 years of age
or older. Your baseline PSA value in your 40s can then be used to compare with
future PSA tests to help identify life-threatening prostate cancer.
*All words that appear in italics are explained in the glossary.
What is the PSA test?
This blood test measures the level of prostate-specific antigen (PSA) in the
blood. Very little PSA is found in the blood of a man with a completely healthy
prostate. Keeping your opponent’s score low is the name of the game and a low
PSA is better for prostate health. A rapid rise in PSA (known as velocity) may
be a sign that something is wrong. One possible cause of a high PSA level is
enlargement of the prostate. Inflammation of the prostate, called prostatitis, is
another possible cause. Prostate cancer is the most serious cause of an increased
PSA level. You should know your PSA score and discuss changes with your doctor
so you can stay on top of your game.
The male urinary tract. The prostate
surrounds the urethra, through which
urine leaves the bladder.
Image provided courtesy of National Institute of Diabetes and Digestive
and Kidney Diseases, National Institutes of Health
What is the DRE?
During the DRE, the doctor inserts a lubricated gloved finger into the rectum. He or
she feels for abnormal size, shape or consistency in the prostate. The DRE can help
the doctor decide if a man has an enlarged prostate or other prostate problems.
However, the DRE by itself is not the only way to detect prostate cancer. A man
should also have a PSA test.
Digital rectal exam (DRE).
Image provided courtesy of National Institute of Diabetes and
Digestive and Kidney Diseases, National Institutes of Health
AUA International Prostate Symptom Score Index
Total score: 0–7 mildly symptomatic; 8–19 moderately symptomatic; 20-35 severely symptomatic.
Not at all
Less than
1 time in 5
Less than
half the time
About half
the time
More than
half the time
Almost always
Incomplete emptying — Over the past month, how often have you had a
sensation of not emptying your bladder completely?
Frequency — Over the past month, how often have you had to urinate
again less than two hours after you finished urinating?
Intermittency — Over the past month, how often have you found you
stopped and started again several times when you urinated?
Urgency — Over the last month, how difficult have you found it
to postpone urination?
Weak stream — Over the past month, how often have you had a weak
urinary stream?
Straining — Over the past month, how often have you had to push or
strain to begin urination?
1 time
2 times
3 times
4 times
5 times or more
about equally
and dissatisfied
Nocturia — Over the past month, how many times on average did you
typically get up to urinate, from when you went to bed until you got up
in the morning?
Your score
Your score
Total IPSS score
Quality of life due to urinary symptoms
If you were to spend the rest of your life with your urinary condition
the way it is now, how would you feel about that?
Enlarged Prostate
The prostate may become larger and start to cause problems as a man ages. Enlarged prostate is also known as
benign prostatic hyperplasia (BPH). The prostate of a 50-year-old man weighs about 20 to 30 grams and is about
the size of a walnut or golf ball; however, it may grow to 50 to 100 grams (almost the size of a baseball) or more.
As the prostate enlarges, it can squeeze the urethra, which can cause some men to experience lower urinary tract
symptoms (LUTS), including symptoms from the International Prostate Symptom Score Index on the previous page.
Who is at risk for enlarged prostate?
Men who have close relatives with an enlarged prostate are more likely to have
an enlarged prostate. Being overweight may also increase a man’s risk; however,
aging is the biggest risk factor for an enlarged prostate.
How is an enlarged prostate diagnosed?
The American Urological Association (AUA) designed a series of questions to
determine how often symptoms occur. The International Prostate Symptom
Score Index, on the previous page, helps doctors measure the problems caused
by an enlarged prostate, ranging from mild to severe.
When a doctor checks a man for an enlarged prostate, he or she takes a thorough
medical history. The doctor performs a physical exam, including a DRE. He or she
may also ask questions from the AUA International Prostate Symptom Score Index.
The doctor will often do a urine test called a urinalysis and may offer to conduct
other medical tests, including the PSA blood test, for a man who may have an
enlarged prostate.
When should a man see a urologist about
an enlarged prostate?
A man should see a doctor if he has any of the symptoms mentioned previously.
In addition, he should see a doctor immediately if he has blood in his urine, pain or
burning with urination or is unable to urinate. An enlarged prostate is not cancer
and cannot lead to cancer, although both conditions can exist together. There are
usually no symptoms during the early stages of prostate cancer; therefore, yearly
physical examinations and PSA tests are highly recommended.
What is the game plan to treat enlarged
prostate problems?
Side view drawing of the male urinary tract, showing the prostate.
Image provided courtesy of National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health
As men age, enlarged prostates can get worse. Knowing your opponent can help your
game plan. An enlarged prostate can lead to bladder damage, infection, and even
kidney damage. A doctor will examine a man with an enlarged prostate to determine
the best treatment options for him. One way to tackle an enlarged prostate may
include medications. If medication does not work, some minimally invasive options
and surgical procedures can help with the lower urinary tract symptoms. If the
symptoms do not improve after treatment, men should consult their doctor to
determine if a different issue might be causing their symptoms.
Researchers estimate that
10–12% of men experience
prostatitis-like symptoms.
Occurring mostly in young and middle-aged men, prostatitis is a common and painful disease of the prostate gland
and its surrounding structures. Although prostatitis is not the end of the game, it can put any player on the sidelines.
Doctors may have difficulty diagnosing prostatitis because the symptoms are not the same for every man.
Many of the symptoms — such as painful or burning urination and incomplete emptying of the bladder — could be
signs of another disease. Researchers estimate that 10–12% of men experience prostatitis-like symptoms.
How is prostatitis diagnosed?
Although the term prostatitis means inflammation of the prostate, doctors use
the term to describe four different disorders. It can be chronic, and keep coming
back. It can also be acute, and come on suddenly. Some cases of prostatitis are
caused by bacteria. For some men, the cause of their prostatitis is not known.
What is the game plan to treat prostatitis?
The treatment is different for the different types of prostatitis disorders.
It is important to make sure other conditions — such as urethritis, cystitis,
an enlarged prostate, or cancer — are not causing the symptoms. To help
make an accurate diagnosis, several types of examinations are useful.
These include a DRE and PSA.
During a prostate infection the PSA can be falsely high. The doctor may also
analyze samples of urine and prostatic fluid for signs of inflammation and
infection. These samples may help the urologist determine whether the problem
is inflammation or infection and whether the problem is in the urethra, bladder, or
prostate. The urologist may use cystoscopy — passing a small telescope through
the urethra to see inside the urethra, prostate, and bladder. The urologist may also
order urine flow studies, which help measure the strength of your urine flow and
any blockage caused by the prostate, urethra, or pelvic muscles.
There is no scientifically proven medication to cure prostatitis. The treatment
recommended often depends on the type of prostatitis a man has. For many men
with prostatitis, the urologist may give antibiotics. Depending on his symptoms, a
man may receive other treatments as well. Although prostatitis may place you on
the sidelines, it is not life threatening and can be effectively treated once diagnosed.
Prostate Cancer
This year more than 192,000 American men will learn they have prostate cancer1 — more than twice the number of fans
who could fit in FedEx Field, home of the NFL Washington Redskins, on a playoff weekend! Sometimes this cancer can
be small, slow growing, and of limited risk to the patient. Other prostate cancers may threaten a man’s well-being or
life. More than 27,000 men die each year from prostate cancer in the United States.
What are the causes and risks
of prostate cancer?
Although prostate cancer is rare before age 40, the risk increases with age.
One in six men faces a diagnosis of prostate cancer in his lifetime.2 Researchers
are still studying what causes prostate cancer, but men with a close family
member (father, brother, or uncle) and those with a high intake of fat in their
diets are at a greater risk of getting prostate cancer. Most doctors agree that,
if you do things that are heart healthy, you will also help keep your prostate
healthy. Eating right, exercising, watching your weight and not smoking can
improve men’s health and help them stay in the game.
What are the symptoms of prostate cancer?
In the early stage, prostate cancer often causes no symptoms. When symptoms
do occur, they may include any of the following: dull pain in the lower pelvic area;
frequent urination; problems with urination, such as the inability to urinate, pain,
burning, or weakened urine flow; blood in the urine or semen; painful ejaculation;
general pain in the lower back, hips, or upper thighs; loss of appetite and/or weight;
and persistent bone pain. Some of the symptoms can be similar to those of BPH,
so it is very important to have a PSA and DRE when you have such symptoms.
How is prostate cancer diagnosed?
The DRE and PSA are the main methods for screening for prostate cancer
(see page 2). Based on 2009 recommendations from the American Urological
Association, men should be offered a baseline DRE and PSA starting at age 40.
Each man should talk to his doctor about his risk factors and the best screening
National Cancer Institute
schedule for him. Just as knowing the score and time in football games leads to a
particular game plan, knowing your PSA “score” will help you identify changes in
your baseline PSA that may indicate prostate problems — including cancer.
If the DRE and or PSA suggest further testing, a prostate biopsy is the next step
for diagnosing prostate cancer. The biopsy removes small pieces of prostate
tissue. A pathologist, a physician who examines human tissue to see whether
it is normal or diseased, examines the prostate tissue to confirm if cancer is
present. If cancer is detected, the pathologist will also grade the tumor. The grade
indicates the tumor’s degree of aggressiveness — that is, how quickly it is likely to
grow and spread. On the playing field, it helps to know the kind of attack that your
opponent is likely to bring so you can set your game plan and strategy accordingly.
What is the game plan to treat prostate cancer?
There are many treatment game plans for men with prostate cancer. The most
common treatments include surgery and radiation. Like going for it on fourth
down, you and your healthcare team must examine the risks associated with each
treatment and determine the most effective play for you to win. The best option
for each man depends on various factors, including age, overall health, stage and
grade of the cancer, and personal preferences. Just as a head coach must prepare a
separate game plan for every opposing team, prostate cancer patients are treated
differently depending upon the characteristics of both themselves and their
disease. Once diagnosed, men should discuss their treatment options with their
healthcare team.
More than 27,000 men die
each year from prostate
cancer in the United States.
POST-Game Wrap Up
Prostate health is important for all men. Winning the battle against prostate diseases involves a team approach.
With a solid head coach (urologist) leading the way and a team made up of healthcare workers and your family
and friends, you will be on the path to victory. When a prostate problem arises, be sure to huddle up with your
entire team, move into formation, and keep your head up as you advance toward your ultimate treatment option,
leading to a cure … touchdown and the extra point!
The American Urological Association Foundation
The AUA Foundation provides this information based on current medical and
scientific knowledge. This information is not a tool for self-diagnosis or a substitute
for professional medical advice and should not be used or relied upon for such
purposes. Please see your urologist or other healthcare provider regarding any health
concerns, and always consult a healthcare professional before you start or stop any
treatments, including medications.
Please go to our Web site — — or call the National Urology
Health Line at 1-800-828-7866 for more information about prostate or other
urological health concerns.
The Prostate Health Playbook Glossary
Biopsy: A tiny piece of prostate tissue is removed (with a needle or during surgery)
for examination under a microscope to determine if cancer or other abnormal cells
are present.
Bladder: The balloon-shaped pouch of thin, flexible muscle in which urine is
temporarily stored before being discharged through the urethra.
Cystitis: Urinary tract infection involving the bladder that causes inflammation of the
bladder and results in pain and a burning feeling in the pelvis or urethra.
Cystoscopy: An examination using a narrow, flexible tube-like instrument
passed through the urethra to examine the bladder and urinary tract for structural
abnormalities or obstructions, such as tumors or stones.
Digital Rectal Examination (DRE): The insertion of a gloved, lubricated finger into
PSA: Also referred to as prostate-specific antigen. This protein is made only by the
prostate gland. High levels of PSA in the blood may be a sign of prostate cancer.
Rectum: The lower part of the large intestine, ending in the anal opening.
Semen: Also known as seminal fluid or ejaculate fluid.
Seminal vesicles: Produce fluid that provides sperm with a source of energy that
helps sperm move. The fluid of the seminal vesicles makes up most of the volume of
a man’s semen.
Sperm: Also referred to as spermatozoa. Male reproductive cells that are produced by
the testicles and that are capable of fertilizing the female partner’s eggs.
Tissue: Group of cells in an organism that are similar in form and function.
the rectum to feel the prostate and check for any abnormalities.
Tumor: An abnormal mass of tissue or growth of cells.
Ejaculation: Release of semen from the penis during sexual climax (orgasm).
Urethra: In males, this narrow tube carries urine from the bladder to the outside of
Pathologist: Scientist who is skilled in identifying the cause and progress of diseases
by examining tissue and fluid from the body.
Pelvic: Relating to, involving, or located in or near the pelvis.
Penis: The male organ used for urination and sex.
Prostate: In men, a walnut-shaped gland that surrounds the urethra at the neck of
the bladder. The prostate supplies fluid that goes into semen.
Prostatitis: Inflammation or infection of the prostate. Chronic prostatitis refers to
the repeated inflammation of the prostate. The most common form of prostatitis is
not associated with any known infecting organism.
PSA Test: Also called the prostate-specific antigen test, this blood test is used to
help detect prostate cancer.
the body; it also serves as the channel through which semen is ejaculated. Extends
from the bladder to the tip of the penis.
Urethritis: Inflammation of the urethra.
Urinalysis: An examination of the urine to determine the general health of the body.
Urinary Tract: The system that takes wastes from the blood and carries them out
of the body in the form of urine. Passageway from the kidneys to the ureters, bladder,
and urethra.
Urinate: To excrete urine.
Urine: Liquid waste product filtered from the blood by the kidneys, stored in the
bladder, and expelled from the body through the urethra by the act of urinating