Most men past age 50 will probably experience an enlarged prostate in their lifetimes. But since it’s not a popular subject of conversation, few men are prepared for it when symptoms begin to surface.
The prostate is a gland critical to the male reproductive system. The prostate surrounds the urethra, the tube through which urine passes during urination. It also produces the fluid that carries sperm out of the body in ejaculation. In younger men, the prostate is normally about the size of a walnut. By age 40, the prostate begins to enlarge, and by age 60 it may have enlarged to the size of a lemon. The process is gradual and may not be diagnosed before it grows large enough to squeeze the urethra, slowing the flow of urine.
Once the prostate has grown large enough to interfere with normal urination, sufferers may begin to hear their doctors use the term benign prostatic hyperplasia or BPH to define the condition. More than 50 percent of men in their sixties experience symptoms of BPH due to an enlarged prostate, a figure that increases to 90 percent in men once they’ve reached their seventies and eighties.
BPH can be uncomfortable, but it does not increase a man’s risk of contracting prostate cancer.
Researchers are still learning what causes an enlarged prostate, and the only risk factors that physicians have been able to associate with the condition are having a functioning set of testicles and aging. Those men who have had their testicles removed in their youth do not develop BPH.
An enlarged prostate may also be the result of other factors, including:
- Genetics. Researchers are examining the likelihood that some prostate cells carry genetic instructions that may trigger their growth in later life.
- Decreased testosterone levels. As a man ages, the amount of testosterone in his blood decreases, causing the naturally occurring estrogen levels in his body to increase, which may encourage growth of the prostate.
- Increased levels of DHT. The prostate develops a substance known as dihydrotestosterone, or DHT, which is a rudimentary cousin of testosterone. While blood testosterone levels drop in men as they age, DHT production does not slow down, which means elevated levels of DHT build up in the prostate, which may lead to the growth of prostate cells.
While anenlarged prostate can be caused by an infection of the prostate gland or prostate cancer, these are not normal events in the aging process and occur much less frequently than BPH.
Symptoms of an enlarged prostate or BPH always involve difficulty urinating. It may be that the sufferer can only maintain a weak stream that stops frequently before the bladder has emptied, or they may need to urinate more frequently, or both. Urinary problems may worsen at night, and although it can be uncomfortable there should be no pain involved in BPH. If there is pain, it may be a sign of infection.
Since BPH is a naturally occurring function of aging, there is no way to prevent it.
Your physician can diagnose enlarged prostate or BPH through a rectal exam, since the prostate gland is most easily felt through the rectum. The doctor will check the size of the prostate and also check for any abnormalities.
A urine test can alert your physician to an enlarged prostate caused by infection, while a blood test measures prostate specific antigen (PSA) which is elevated when prostate cancer is present. However, the United States Preventive Services Task Force has recently recommended against PSA tests for determining prostate cancer. Still, many medical experts continue to believe a PSA blood test is useful in diagnosing prostate disease when combined with other tests.
An ultrasound exam directs sound waves at the prostate through a probe which allows the physician to view the prostate in real time and gain a visible account of the prostate’s condition. A urine flow exam gauges the urine flow’s strength and speed, which helps determine the presence of enlarged prostate or BPH.
A cystoscopy involves a small tube is inserted through the urethra in order to provide the physician with an inside view of the urethra and bladder to see those areas compressed by an enlarged prostate.
When an enlarged prostate can be attributed to BPH, it is most often treated through medication or surgery.
Medications known as alpha-blockers can relieve the pressure caused by the enlarged prostate and restore urine flow by relaxing the muscles surrounding the prostate. However medications will not reduce the size of the prostate. Proscar (finasteride) is another medication used to reduce the size of the prostate by blocking an enzyme that normally interacts with testosterone to escalate prostate growth. When finasteride is used to block this enzyme/testosterone interaction, it also slows the prostate gland’s growth and can even reduce the size of the prostate, which may work toward reducing blockage.
There are a few surgical options used to treat enlarged prostate related to BPH. In some extreme cases the prostate may be removed, although the more common surgical measure taken is to widen the urethra by trimming excess tissue away from the prostate gland. This latter option is used in 90 percent of PBH-related surgeries, and it usually allows the patient to avoid some complications that can occur in other prostate surgeries, including impotence and incontinence.
Researchers are constantly searching for improved treatment options for enlarged prostate and BPH, and active studies are taking place in medical research centers across the U.S.
Unfortunately, even after the type of prostate surgery that involves trimming excess tissue from around the prostate is undertaken, the prostate can enlarge again. The same results can happen if a man discontinues taking his medication. Left untreated, an enlarged prostate can lead to painful kidney or bladder stones, urinary tract infections, or urinary retention and even bladder damage.
For these reasons it is always important to see your doctor if you have any symptoms of an enlarged prostate.