Other prostate disorders.

The symptoms can be deceiving. A man may have difficulty urinating or may have frequent and urgent needs to urinate. His prostate specific antigen (PSA) levels may be elevated. These signs may point to prostate cancer. But more often than not, the prostate gland is acting up in less dangerous ways, the most common situation being benign prostate hyperplasia (BPH).

A disorder in which the prostate enlarges, BPH is not cancer and does not cause cancer. It is much more common than prostate cancer, affecting more than half of American men in their 60s. Up to 90% of men over age 80 have some BPH symptoms. Health care costs for BPH exceed $2 billion a year, according to National Institutes of Health (NIH) estimates.

The physician can detect the condition through a digital rectal examination. Other tests can determine severity. Because the prostate surrounds the urethra, any enlargement can choke off urine flow. Sometimes the prostate is only mildly enlarged, and symptoms may subside or not be noticeable. But if the urine stream has been reduced to a trickle, if strain is necessary to start the stream, or if there are frequent urges to urinate, especially at night, treatment is probably necessary.

Besides watchful waiting, where patient and physician monitor prostate conditions, four other treatment options for BPH are available:

* Balloon dilation -- The physician threads a balloon-tipped catheter into the urethra to the point of blockage and inflates the balloon, stretching the urethra and allowing increased urine flow.

* Surgery -- The most common technique, and presently the most effective, transurethral resection of the prostate (TURP) involves removal of excess prostate tissue with a special instrument inserted into the urethra. Two other methods may be used: transurethral incision of the prostate and open prostatectomy. A new surgical method using lasers is undergoing clinical trials. Other alternative treatments also are under study, such as the use of microwaves to heat and destroy prostatic tissue and the use of metallic stents to open the urethra.

* Alpha blockers -- These oral medications help to relax prostate muscles, easing pressure on the urethra. The FDA has approved only one alpha blocker for BPH -- terazosin (Hytrin).

* Proscar (finasteride) -- This oral drug reduces male hormone levels in the prostate and can shrink the gland. Side effects include impotence and reduced sex drive. The NIH is recruiting men for a five-year trial set to begin in 1995 that will study the effects of Proscar and the drug doxazosin (Cardura) on BPH.

Another common prostate disorder, prostatitis, is caused by bacterial infections. Unlike BPH, prostatitis occurs mostly in younger men. It is usually treated with antibiotics.