The Growing Problem of an Enlarged Prostate

All his life, Mr. Sen, a 50-year-old businessman, slept like a log. But lately, he’s forced to make annoying trips to the bathroom every night, sometimes more than thrice a night. He decided to consult a doctor when the nightly bathroom trips became more frequent, edging their way into his daytime schedule. He found it difficult to sit through meetings or a flight without getting up more than once to use the bathroom.

Mr. Sen’s doctor diagnosed him with a problem that has several names: enlarged prostate, benign prostate hyperplasia, or just BPH. An enlarged prostate simply means the gland has grown bigger. It occurs when cells of the prostate gland begin multiplying. The additional cells cause the prostate gland to swell, squeezing the urethra and limiting the flow of urine. The condition is not the same as prostate cancer.

In India, BPH is a common geriatric problem with an incidence of 92.97%. By the age of 60 years, half of all men usually have an enlarged prostate, which reaches 90% by the age of 85 years. While BPH does not increase the chances of prostate cancer or encountering sexual problems, it often affects the quality of life by causing embarrassing and unwanted urination problems.

The Signs and Symptoms of an Enlarged Prostate

Some of the common symptoms include the following:

• A weak flow while urinating
• A feeling that the bladder has not emptied properly
• Difficulty in urinating
• Continued dribbling of urine
• Urge to urinate frequently, especially at night
• A sudden urge to urinate – you may sometimes leak before you get to the toilet
• Returning to urinate minutes after finishing

Less common signs and symptoms include:

• Urinary tract infection
• Blood in the urine
• Inability to urinate

You may not experience all these symptoms as many men with an enlarged prostate don’t experience any of these symptoms at all. These can also be caused by anxiety, hypertension, lifestyle factors, some medicines, and other health problems.

What Causes An Enlarged Prostate

It isn’t entirely clear what exactly causes the prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older. Possible risk factors for an enlarged prostate are as follows:

• Ageing. Symptoms of prostate gland enlargement is not very common among men below the age of 40. About one-third of men experience moderate to severe symptoms by the time they turn 60 and about half do so by 80.
• Family history. Having a blood relative, like father or brother, with prostate problems indicates that you are more likely to encounter problems related to an enlarged prostate.
• Diabetes and heart disease. Diabetes, heart diseases, and the use of beta-blockers may increase the risk of BPH.
• Lifestyle. Obesity, generally, increases the risk of BPH.

Tests for Diagnosing an Enlarged Prostate

Diagnosis of BPH is made by a mixture of physical, radiographic examinations, and a few lab tests.

• Physical examination includes DRE (digital rectal examination), which involves a physical examination of prostate by a urologist
• Abdominal and pelvic ultrasound indicates the size of the prostate gland
• Lab tests include PSA (Prostate-specific antigen)

PSA is a protein that is produced only by the prostate. When the prostate is healthy, only a small amount of PSA is found in the blood.

Deciding on Treatment for an Enlarged Prostate

A range of treatments can relieve enlarged prostate symptoms: medications, minimally-invasive office procedures, and surgery. The ideal one depends on the symptoms you are experiencing, how severe they are, and whether you are suffering from any other medical conditions.

The driving force in treatment is whether the above mentioned symptoms are affecting the quality of life and whether a blockage is causing complications, such as blood in your urine, inability to urinate, bladder stones, kidney failure, or other bladder problems.

A few questions to ask yourself:

• How severe are the symptoms ?
• Are these preventing you from doing the things you enjoy ?
• Are the symptoms affecting the quality of life ?
• Are they getting worse with time ?
• Are you ready to get rid of your symptoms ?

The size of your prostate gland, age, and overall health will be evaluated to decide the treatment decisions. What’s best for a man in his 40s may not be optimal for an 80-year-old. An older man may want immediate symptom relief with drugs or surgery while a younger man may look forward to minimally invasive treatment.

Consider the options carefully with your doctor. In many cases, specialists may start with medication, and if there is little or no improvement, they consider minimally invasive therapies to reduce a portion of the prostate. These procedures are effective and side effects are rare.

If symptoms are bothersome or if you encounter complications such as urine retention, it may be best to bypass medication. For most men with very enlarged prostates, surgery can help relieve symptoms but there are both certain risks and benefits with each type of operation. After a careful evaluation of your medical condition, your doctor will recommend which is best for you.

If you’re having one or more of the symptoms mentioned above or any other urinary problem, discuss them with your urologist. Even if you do not find those urinary symptoms to be bothersome, it is important to identify or rule out an underlying cause. Untreated, urinary problems may lead to obstruction of the urinary tract.

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