Healthy living
Body matters
Enlarged prostate
Enlarged prostate affects more than half of men aged over 60, Melody Rousseau finds out what can be done about this common problem
What are the symptoms?
Getting up more often at night to visit the bathroom is accepted by many men as a normal part of ageing, but in fact it could be a sign of benign prostatic hyperplasia (BPH), a non-cancerous condition that affects a third of men over 50 and more than half of those over 60.
With BPH, the doughnut-shaped prostate gland that surrounds the neck of the bladder grows abnormally large. In a healthy man, it is about the size of a walnut, but it can become the size of a tangerine, when it will constrict the slender urethral tube that carries urine out of the body and slow or even stop the flow. Although sufferers may make frequent trips to the bathroom, they often experience a very weak and hesitant stream or are left with the feeling that they haven't emptied their bladders.
What tests are there?
At your first meeting with your GP, the initial test is a digital rectal examination, in which the doctor examines the size and consistency of the prostate with a gloved, lubricated finger. The GP will test your urine to rule out an infection and blood tests will determine your Prostate Specific Antigen (PSA) level, because an enlarged prostate, whether because of BPH or cancer, secretes more of this enzyme.
How do I know it's not prostate cancer?
If your doctor is concerned, he will send you for a biopsy, where a tissue sample from the prostate will be examined under a microscope.
What can be done?
Once it's been decided it's not prostate cancer, and if your problem is mild and doesn't affect the quality of your life too much, your GP may advise “active surveillance”. This means no treatments but perhaps implementing lifestyle changes, such as not drinking too much in the evenings, in particular alcohol or tea and coffee, which make you want to urinate more often.
For those exhausted by broken sleep, or whose symptoms worsen, medicine may be the next option. There are two main types, alpha blockers and 5 alpha reductase inhibitors. Alpha blockers work by relaxing the muscle tissue of the prostate and at the neck of the bladder, thus increasing the flow of urine. Roughly 10% of men experience side effects such as tiredness, dizziness and headache, and although alpha blockers can ease symptoms they can't cure BPH and surgery may still be required at some stage.
By contrast, 5 alpha reductase inhibitors can shrink the prostate over time and reverse BPH to some extent. They do this by blocking conversion of testosterone to DHT (dihydrotestosterone), which plays a part in prostate growth. However, they take about three to six months to become effective, and up to 5% of men taking these drugs experience erection problems as a side effect. Your doctor may prescribe both drugs to work in combination, particularly if your prostate is very large and there is a danger of the flow of urine being blocked (acute urinary retention), which can in turn put pressure on the kidneys, causing kidney damage or even failure.
What about surgery?
The most widely performed surgical option is the Trans Urethral Resection of the Prostate (TURP), which involves cutting out the middle of the prostate with an instrument inserted up the penis under anaesthetic. It usually involves a two- to five-day stay in hospital, and entails some discomfort and bleeding. Around 70 to 90% of patients experience the side effect of retrograde ejaculation, in which semen passes into the bladder rather than through the penis. While not painful or dangerous, retrograde ejaculation will reduce a man's ability to father a child. About one in 10 men will become impotent after surgery.
Very large prostates are usually treated by open prostatectomy, in which the surgeon removes the central part of the prostate through a cut in the lower abdomen. Patients stay in hospital for a week to 10 days and then require around six weeks' rest.
What's new?
Gordon Muir, Consultant Urological Surgeon to King's College Hospital, London, has pioneered an alternative to both operations, which goes by the long name of GreenLight laser photoselective prostate vaporisation (PVP). It has been available in the UK since October 2002, and it was approved by the National Institute for Health and Clinical Excellence (NICE) in May 2005 and so far is performed in 16 NHS hospitals. Under local or general anaesthetic, depending on your condition, a thin fibre is inserted into the urethra to deliver a green laser energy that vaporises the enlarged prostate tissue.
Gordon Muir says: "Patients go home on the day of surgery since there is much less bleeding, erection problems are reduced and it takes only a few days to get back to normality." Post-operative patients require either no catheter or a small, soft one which they can usually remove themselves after a day or two. There appear to be very few reported side effects, but these may include a slight burning and/or a little blood in the urine for a couple of weeks, in addition to a slight risk of retrograde ejaculation.
Information on this site is for interest only and is not a substitute for professional medical advice. You should consult your own doctor about any specific health concerns.