The Prostate is a gland found only in men.
It is located just under the bladder. The Urethra which carries urine from the bladder passes through the Prostate Gland and continues into the penis. The tubes carrying sperm from the testis also passes through the Prostate Gland before joining to the penis.
As men get older, the Prostate Gland will start to enlarge.
About 50% of men will get Prostate Enlargement by age 60 and 90% will get Prostate Enlargement by age 85 years old.
How do I know if my Prostate Gland is enlarged or not?
The most common symptoms people get from an enlarged Prostate Gland are urinary symptoms.
1. Getting up 2 or more times a night to pass urine.
2. Feeling a great urge to go to the toilet then when you are there, the urine takes a long time to start flowing.
3. When you are urinating, the urine flows very slowly. Or you have to strain hard to make it flow.
4. At the end, the urine keeps dripping from the penis.
Together, these symptoms make up what we call LUTS (lower urinary tract symptoms).
Other common symptoms you may suffer from if your Prostate Gland is enalarged are:
2. Acute Urinary Retention which means you just cannot pass urine no matter how hard you try. This is very uncomfortable and we will need to put a tube into your penis to ge the urine out.
A good tool to see if you suffer from an Enlarged Prostate Gland or not is to answer these few questions called the IPSS (international prostate symptoms score).
If your score is between 8 and 19, you probably are starting to get some symptoms.
If you score more than 20, please see your doctor for treatment.
So aside from answering some questions is there a more objective way for us to see if the Prostate Gland is enlarged or not?
Sure there is. There are several in fact:
1. The easiest and cheapest although not the most comfortable is to have your doctor feel the Prostate Gland. This involved the doctor putting a gloved finger into your anus and feeling for the gland. An enlarged gland is more than 3 finger-breadths across.
2. A less invasive way to go about it is to get an ultrasound. Since most ultrasounds can be done from the tummy, this is a much more comfortable albeit slightly more expensive option. Of course in some cases, the ultrasound cannot be done properly via the tummy and the probe has to be inserted into the rectum. Fortunately this is not common.
3. An indirect way of seeing if there is anything wrong with the Prostate is what we call a Uro-Dynamic study. Basically you urinate into a toilet hooked up with all sorts of sensors to tell you how fast the urine is flowing.
Aside from these tests, doctors will frequently want to do some other related tests for you like:
2. Testing for Urine Infections. This involves just giving a urine sample. This is because Urine Infections can cause the same symptoms.
3. Testing to see if the rest of the urinary tract like the kidneys are doing OK or not. This usually involves a blood test and an ultrasound of the kidneys and tubes.
OK so now I know my Prostate is Enlarged. What can I do about it?
The good thing about BPH is that it is not dangerous. It will NOT lead to Prostate Cancer. You can honestly just leave it alone.
Of course, this is not good if you are getting up 3 times a night to pass urine or suffering problems with your erection because of it.
There are now many treatment options available.
1. Medicines – There are 3 very well established types of medicine to treat Prostate enlargement.
a. Alpha-Blockers – These medicines relax the muscles of the bladder and allows the urine to flow more smoothly. It can however cause the blood pressure to drop leading to giddiness. It can also cause erectile dysfunction, problem with ejaculation and decreased libido.
b. 5-alpha-Reductase Inhibitors – These medicines block the conversion of Testosterone to DHT. Since DHT is primarily responsible for the growing Prostate, long term use of this medicine will cause the Prostate to shrink. However, these medicines can also cause erectile dysfunction, problem with ejaculation and decreased libido. In smaller doses, these medicines are also used to treat male-pattern balding.
*Important note: These medicines can affect the PSA which is used to screen for Prostate Cancer. Be sure to tell your doctor if you are on these medicines.
c. PDE5 Inhibitors – These medicines block the PDE5 enzyme and increases nitric oxide in the blood vessels causing the blood vessels to open up and blood to flow more smoothly. These medicines are actually famous for the treatment of Erectile Dysfunction. However, recent studies have shown that the same biochemical problems that cause LUTS also cause Erectile Dysfunction. These medicines also have the advantage that they do NOT cause erectile dysfunction, problem with ejaculation and decreased libido. In fact, they make the erection even better!
2. Surgery – This is a very old and well established treatment. A small instrument is passed up the penis and the Prostate is scrapped away from the inside. There are now various variations to the classic surgery which results in less bleeding.
3. Energy treatments – Lasers, Microwaves and Ultrasounds have all been used to reduce the size of the prostate.
So I think I have BPH. What do I do now?
Talk to your doctor. You will need some simple tests to verify the diagnosis.
The vast majority of patients do not need surgery and can be easily managed with medicines.
Read our earlier blog entry on Andropause.