More Information About Prostate Disease
The most common prostate disease is the enlargement of the prostate ( also known as benign prostatic hyperplasia or BPH). This is becoming more prevalent as an increasing portion of the male population ages. No one knows the exact cause of BPH and the symptoms are variable, depending on the size of the prostate and the individual's coping ability. Symptoms include inability to start urinating or slow to start, a weak stream, dribbling after urinating, and night-time urination (nocturia). These symptoms are caused by the enlarged prostate obstructing the bladder outlet and urine tube (urethra). Your family physician will do a digital rectal examination (DRE) of the gland to determine its size. Also, a prostate-specific antigen test (PSA- a blood test) can be done to determine your risk of prostate cancer. With all of this information, your family physician can assess prostatic enlargement. A referral to a urologist may be needed for further assessment such as a prostate biopsy.
Once you have a diagnosis of BPH, what is the treatment? Treatment for BPH varies according to the severity of the symptoms. Watchful waiting is appropriate for those who do not find their symptoms are affecting their everyday life. The symptoms are tolerable at this time and they decide to watch for any changes. The family physician will monitor your symptoms as well as any tests (PSA) for progression of the disease. Not everyone gets worse, in fact, some may get better with time.
Sometimes, the symptoms for BPH have progressed so that the patient wants treatment. There are oral medications that can be taken to alleviate or reduce the symptoms of BPH. Alpha blockers affect muscle in the bladder neck and the prostate by relaxing these muscles. The irritability of the bladder is reduced and so is the feeling of urgency and having to void often (frequency). With this type of medication, a person may also have an improved stream when urinating.
These medications are to be taken once a day, every day, lifelong. If this treatment is stopped, the symptoms will return.
Side effects include headaches, dizziness, and fatigue. Although, for most, these will be mild in severity, they may be severe enough to interfere with your daily life. If this is the case, this treatment should be stopped.
Another type of oral mediation are 5 alpha-reductase inhibitors. These medications block the enzyme so that testosterone is not converted to DHT. DHT is the active form of testosterone and contributes to prostate growth. If DHT is blocked, the prostate shrinks. Symptoms of BPH then decrease or stop completely. Side effects include erectile dysfunction (<3%), decreased libido, and decreased volume of ejaculate.
Another type of treatment is surgery. The most common type of surgery is transurethral resection of the prostate (TURP). A general anaesthetic or an epidural anaesthetic is used and requires at least an overnight stay in the hospital. Once the patient is prepared, the urologist inserts a scope into the urethra and into the bladder. Pieces of the enlarged prostate are cut away and evacuated. They are sent to the lab to be checked for cancer. A catheter with irrigation is inserted to keep the bladder and urethra clear. This is removed prior to discharge, usually the next day. Complications for this surgery are failure to void, bleeding after surgery - possibly requiring a transfusion, blood clots that need removal, and infection. After surgery, (approximately 2 months), the patient will notice the ability to urinate with a good stream and by one year all symptoms should have improved. Loss of ejaculate or inability to ejaculate occurs in just over half of all patients.
Symptoms may return in approximately 20% of patients, requiring them to have another TURP within eight years.
What happens when the PSA blood test is elevated?
This is indicative of prostate disease but not necessarily cancer.
What do you do?
Your doctor can best advise you about treatment options. If you are over 70 years of age, watchful waiting may be appropriate. Prostate cancer progresses at a very slow rate so that there is time to monitor it before aggressive treatment is needed.
Prostate cancer is very prevalent in North America and has been linked to a high fat diet. It is recommended that a low-fat diet along with exercise to maintain an ideal body weight is followed to minimize the risk of prostate cancer. Men, at age 50 and over who have no family history of prostate cancer, should have a PSA and a DRE annually. Those who have a family history of prostate cancer should have a PSA and a DRE starting at the age of 45. Prostate cancer can be treated effectively if diagnosed early! Early diagnosis provides the best chance of treating prostate cancer successfully.