Prostrate problems

The prostrate, present in the pelvis area of males since birth, starts to grow at puberty and increases in size all through life - from 15cc to 30cc. If it becomes bigger, the man is said to have BPH (benign prostatic hypertrophy). Hormones such as testosterone, dihydrotestosterone (DHT), and estrogen are responsible for the growth of the prostrate. The enlarged prostrate (BPH) causes symptoms in some men but not in others. The reason for this discrepancy is not known.

By Dr Gita Mathai
  • Published 7.09.15
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The prostrate, present in the pelvis area of males since birth, starts to grow at puberty and increases in size all through life - from 15cc to 30cc. If it becomes bigger, the man is said to have BPH (benign prostatic hypertrophy). Hormones such as testosterone, dihydrotestosterone (DHT), and estrogen are responsible for the growth of the prostrate. The enlarged prostrate (BPH) causes symptoms in some men but not in others. The reason for this discrepancy is not known.

In men, the urethra through which urine leaves the body actually passes through the prostrate. This means that as BPH occurs, it causes problems in 60-80 per cent of men. This usually starts from the age of 50. By the time they are 85, 90 per cent men have symptoms.

Initially, there may be difficulty in initiating urination, a delay during which, despite efforts to empty the bladder, the urine stream just refuses to start. There may be a sense of incomplete evacuation, a feeling that some urine is still present in the bladder. Straining to expel this urine results in further blockage with the prostrate acting as a stop valve. The increased effort may result in hypertrophy of the bladder musculature. Urine may get infected. It may be forced backwards into the kidney, which can eventually get damaged. There may be sudden acute retention of urine, with a painful enlarged and full bladder that cannot be emptied.

Similar symptoms can occur with inflammation or infection of the prostrate, or a combination of both. Acute infection can follow a urinary tract infection. Unlike in BPH, there is also fever, pelvic pain and dysuria. Cure requires around two weeks of treatment with antibiotics. If the treatment is incomplete, acute complications like a prostrate abscess can occur. If the infection still persists in a low-grade form for three months or more, it is called "chronic prostatitis". In this situation antibiotics need to be given for one to one and a half months to eradicate the infection. Long-term suppressive therapy may be required in some men.

BPH is frightening because, although it does not increase the risk of prostrate cancer, the symptoms are the same. Evaluation of BPH includes a digital rectal evaluation of the prostrate and an ultrasound examination. Blood tests can be done to estimate the level of PSA (prostrate specific antigen). Earlier this test was done as part of the "master health check up" for men. It was considered a standard test to estimate the risk of developing prostrate cancer. It is now found to be unreliable and non-specific. It only reduces the risk of dying of prostrate cancer by 21 per cent. It resulted in many biopsies in normal men. It should be reserved for men at high risk.

The risk of developing cancer of the prostrate increases after the age of 50. It is also two and a half times greater in men with a father or brother who had prostrate cancer, especially if they were diagnosed before 60 years. Some older men (almost 80 per cent) never realise they have prostrate cancer. It remains as a slow-growing, non-invasive encapsulated tumour causing no symptoms. In younger men (under 50), however, it is an aggressive tumour that spreads rapidly even outside the prostrate.

 

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in