The lowly prostate – in a young adult it’s a walnut-sized gland that forms part of the male reproductive system. It sits below the bladder and wraps around the urethra, the tube through which urine exits the body. Generally it grows with age… and there’s the problem. Most middle-aged and elderly men come to know the prostate as a source of troublesome urinary symptoms. They may have experiences such as standing at a public urinal slowly emptying while three teens come and go taking care of their business with firehose-like efficiency.
This common condition of non-cancerous enlargement of the prostate is called benign prostate hyperplasia or hypertrophy (BPH). It is considered essentially a normal part of the aging process in men and is hormonally dependent on testosterone. An estimated 50% of men demonstrate BPH by age 60 and the number increases to 90% by age 85 years. About half of these men with enlarged prostates have moderate-to-severe symptoms including urinary frequency, urgency, nocturia (awakening at night to urinate), weak urine stream, or a sensation of incomplete emptying. The other half escape with minor versions of these symptoms.
Eventually the chronic partial obstruction of the bladder outflow can lead to complications such as urinary retention. Here, a person may routinely fail to fully empty the bladder or may completely obstruct at some point and have to go to the ER for catheterization to get relief. Additionally, renal insufficiency (loss of kidney function), recurrent urinary tract infections, blood in the urine and bladder stones may occur.
So the question becomes, if this is so common, when does one need to do something about it? The answer to this is somewhat subjective – basically, when the symptoms are bothersome enough for it to be worth it to you to take a daily medicine to treat it. There are a variety of types of BPH meds from ones that relax the grip of the prostate on the urethra to those that slowly shrink the prostate over 3-6 months to others that partially relax an overly twitchy bladder. If meds are unsuccessful then a urologist may suggest any of a variety of procedures, with the trans-urethral resection of the prostate (TURP) being the best known. It is not-so-affectionately known as the roto-rooter procedure by some.
It is important to realize that BPH doesn’t make you any more prone to cancer than the next person your age. The two conditions (BPH and prostate cancer) are separate. However they can produce some of the same symptoms, and they can both cause an elevation of the prostate blood test, PSA, which is often used for cancer screening. Thirdly, the prostate can also become infected, often causing more of a sudden onset of urinary symptoms such as frequency and burning with urination. This condition is called prostatitis.
All-in-all BPH is an inconvenient reminder of aging for the typical male. But if the level of symptoms is really putting a crimp in your day (and night) and your walnut seems to have become a small orange, it may be time to talk things over with your doctor.
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. He is contracted with some commercial insurance carriers and sees Direct Primary Care patients who do not have insurance, who belong to a cost sharing ministry, or who are on Medicare. He is accepting new patients. You may contact him at 982-0835