The prostate gland is the part of men's reproductive system that produces fluid that carries sperm during ejaculation. The prostate gland surrounds the urethra, the tube through which urine passes out of the body. A healthy prostate weighs about 15 g but may increase to 30 g in cases of enlarged prostate.Dr Patrick Ezie, an Abuja-based medical practitioner, advised men above 40 years to go for prostate examination to avoid developing prostate enlargement which could lead to prostate cancer.
Men above 40 are prone to 3 prostate-related diseases:
a) prostate enlargement
b) prostatitis (inflammation)
c) prostate cancer.
Prostate enlargement happens to about 25% of men aged between 40-60, and 40% of men above 60, according to statistics in the 80s. The older a man becomes, the higher the risk of prostate cancer.
According to Dr Ezie, urinary complaints which lead to the development of the disease include frequency of urination especially at night, and sudden urge and immediate need to urinate. Other symptoms include inability to control the passage of urine, straining to urinate, hesitation while urinating, urine flow that starts and stops without completion of urination and urination that ends in dribbling. In severe or advanced cases, one will also suffer from extreme weight loss (associated with the spread of the cancer), tenderness in the bones and back pain.
Dr Ezie said that although the primary risk factor for the development of prostate cancer is aging, genetics and familial inheritance, diet and lifestyle also play a role in the development of the disease.
1. Enlarged Prostate
An enlarged prostate is often called benign prostatic hyperplasia (BPH). It is not cancerous and it does not raise your risk for prostate cancer. The actual cause of prostate enlargement is unknown. Factors linked to aging and changes in the cells of the testicles may have a role in the growth of the gland.
The likelihood of developing an enlarged prostate increases with age. BPH is so common that it has been said that all men will have an enlarged prostate if they live long enough.
A small amount of prostate enlargement is present in many men over the age of 40. More than 90% of men over the age of 80 have the condition.
Less than half of all men with BPH have symptoms of the disease. Symptoms may include:
- Dribbling at the end of urination
- Inability to urinate (urinary retention)
- Incomplete emptying of bladder
- Incontinence
- Needing to urinate 2 or more times per night
- Pain while urinating or blood in urine (may indicate infection)
- Slow or delayed start of the urinary stream
- Straining to urinate
- Strong and sudden urge to urinate
- Weak urine stream.
The International Prostate Symptom Score (IPSS) is a scoring system used to screen for and diagnose BPH as well as to monitor symptoms and guide decisions about how to manage the disease. The IPSS is based on answers to 8 questions; 7 regarding disease symptoms and 1 relating to the patient's quality of life. For the questions, the patient is asked to choose the rating that best represents his condition. The scale ranges from 1 to 5; with 5 representing the most symptomatic disease and giving an overall maximum possible score of 35. The answers to the quality of life question is scored on a scale of 1 to 6. The questions are the same as those used in the American Urological Association Symptom Index.
The IPSS symptom questions ask the patient to report on their experience of the following during the past month:
1. How often the bladder feels like it is not completely emptied?
2. How often there is an urge to urinate less than 2 hours after the last time?
3. How often the flow has stopped and started again?
4. How often it is difficult to withhold from urinating?
5. How often the stream of urine is weak?
6. How often urinating is a strain?7. How often one needs to get up at night to urinate?
According to the IPSS scoring system, scores can be categorised as follows:
- Symptoms are mild if the score is 7 or less
- Symptoms are moderate of the score is 8 to 19
- Symptoms are severe if the score is 20 to 35.
Quality of life, as perceived by the patient, is assessed using the 8th question as per recommendations from the International Scientific Committee under the patronage of the World Health Organisation (WHO) and the International Union Against Cancer. For responses to this question, a score of 6 means the patient perceives his quality of life as "terrible", while a score of 0 indicates that a patient is "delighted" with his quality of life.
Tests
Your doctor will ask questions about your medical history and do a digital rectal exam to feel the prostate gland.
Other tests may include:
- Check the urine flow rate
- See how much urine is left in the bladder after urination
- Measure the pressure in the bladder as you urinate
- Urine culture to check for infection
- Cystoscopy (endoscopy of the urinary bladder via the urethra)
- Prostate specific antigen (PSA) blood test. PSA is a protein produced by the prostate gland. High reading may indicate a higher chance of prostate cancer. Normal reading is < 4 ng/ml.
Treatments
A wide variety of treatments are available for enlarged prostate - medications and surgery. The treatment choice depends on several factors, including how much the symptoms bother you, the size of the prostate, other health conditions you may have, age and preference.
If the symptoms are not too bad, you may decide not to have treatment and wait until the symptoms become more bothersome over time. Medication is the most common treatment for moderate prostate enlargement to relieve the symptoms. Surgery is the last resort if medication proves to be ineffective.
The 2 commonly used Medications are:
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