Published in Panorama
Enlargement of the Prostate is a natural process associated with ageing
Prostate Gland Diseases are becoming increasingly common in middle-aged men, particularly in those above the age of 50 years, says Urologist, Dr.K.K.Ramachandran, Zulekha Hospital, Sharjah. It is believed to be the second most common site of cancer in men. While diseases of the prostate do not affect young people, infection of the gland is common amongst men between the ages of 30 – 50. 50% men by the age of 60 are likely to suffer from prostate problems and the percentage increases with age. It is believed that by the age of 85, men have almost 90-95% chance of having to cope with an enlarged prostate.
“The function of the walnut shaped gland, weighing around 20 gms is not very clear,” says Dr.Ramachandran. “Except that it secretes some fluid which flows along with the seminal fluid, we do not know much else about the working of the gland. What we do know is that as a man grows towards middle age his prostate grows and continues to do so for life. This enlargement is believed to be due to hormonal changes. However, the gland may get affected with two kinds of problems, basically. The gland gets enlarged or it can become infected. The three most common prostate problems are prostatitis and prostate enlargement, which may either be benign (benign prostatic hyperplasia (BPH) or malignant, which condition is termed as prostate cancer. The gland gets bigger after a certain age because its function and size depends on the male hormones like testosterone which is present in the blood. This happens after the age of 50 and is a natural process with advancing age, being harmless. However, it is possible that the enlargement is due to cancer. This is a dangerous condition requiring early detection and treatment.”
An infection of the gland, says Dr.Ramachandran, “may be acute or chronic. The symptoms of chronic infection which are of a long standing nature, are rather vague and non specific and include pain in the lower abdomen, below the testes, rectum and back passages. In the acute condition which progresses from a few days to a week, the patient has severe pain, difficulty in passing urine and may have fever. There could be pus formation in the gland like an abscess which needs urgent treatment. But treatment for the acute type is very satisfactory unlike treatment for the chronic condition. This is because the gland has a very thick capsule and once the bacteria enter it, no matter what antibiotic you may give, it is difficult for it to get into the prostate. So it becomes a chronic or lurking problem.”
How does the infection happen? The infection usually comes from the urine because of the gland’s proximity to the bladder from where it is easy for the bacteria to get into the prostate, explains Dr.Ramachandran. “Once the bacteria get into the prostate, they multiply there and give only prostate symptoms. However, it can also happen that there is urinary infection also. Also, the infection can get into the gland through the blood stream. Occasionally, prostatitis is accompanied by chills and a high fever. When prostatitis is the result of a bacterial infection, it usually can be cleared up with antibiotics.”
What are the symptoms of an enlarged prostate caused due to advancing age? As the prostate enlarges, it compresses the bladder which begins to contract even when it contains small amounts of urine, causing more frequent urination. As the bladder weakens, it loses the ability to empty itself, and there is retention of urine. This narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with enlarged prostate. Urine flow becomes slow, there is frequent urination and a feeling of the bladder not getting completely empty. The person may get up at night to pass urine. These are the symptoms in the initial stage,” explains Dr.Ramachandran, “and if ignored, they worsen. Some people may experience low abdominal spasm during urination. When the condition worsens, the person wakes up very frequently at night to pass urine and there may be urine accumulation in the bladder, causing pressure. This may cause some damage to the kidneys if not attended as a medical emergency.”
Such a benign enlargement of the prostate, even if only a normal and natural process, may entail uncomfortable symptoms in some people, necessitating early diagnosis and treatment, says Dr.Ramachandran. “The condition in the initial stage can be treated with medicines alone and most people will respond when the symptoms are not very severe. However, if a person does not respond to the treatment with drugs, or he cannot afford the treatment for a long time, then surgery to remove the gland is the best option for these people.”
How does one know whether the enlargement of the gland is a benign one or a cancerous one? What are the differentiating symptoms? “The symptoms are again vague,” explains Dr.Ramachandran. “A diminished flow of urine may be indicative of growth. There may be an obstruction in the urinary passage and the person may experience feelings of tiredness and malaise.”
Does diet or family history have any relation to causing prostate cancer? Dr.Ramachandran opines that Prostate cancer is much more common in Western community compared to East Asian countries. Diet containing a lot of protein and meat, definitely increases the incidence and heredity is a high risk factor for prostate cancer.
How does one diagnose the prostate problem? Besides clinical examination and history taking, a physical exam called a digital rectal examination and urinalysis may be done to check for infection or bleeding. In addition, a blood test may be done to evaluate the kidney function. In some instances physicians may also investigate for prostate-specific antigen (PSA) to rule out the possibility of cancer. Specific tests are done to find out whether the condition is benign or malignant. In addition, other tests may be done to see if the bladder or kidneys have been affected by BHP.
If malignancy is detected, the patients require aggressive treatment, says Dr.Ramachandran. “These include radio-therapy, chemotherapy and surgical removal of the gland. The prognosis depends on the stage of the malignancy; when the growth is still limited to the gland and has not spread outside, it can be treated effectively to produce 100% cure.”
While there is very little that can be done to prevent the gland disorders and problems associated with it, the best course of action is to be aware of the problem when it first develops and to take remedial measures before it becomes too difficult to treat, opines Dr.Ramachandran. Depending on the severity of the problem, several types of surgery can relieve the symptoms of an enlarged prostate, according to the doctor.