June 18, 2018
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Prostate enlargement isn’t always so benign

By Dr. William Sturrock, Special to the BDN

Ah, the prostate. A curious gland of which boys under 15 are not aware, and men over 50 can be all too aware.

The gland’s evolutionary purpose is to provide sustenance to our sperm as they race to their date with destiny. But in the words of one of my patients who is an Episcopal cleric, “The prostate is proof that God has a sense of humor.”

Often it can go from a gland not perceived to a “royal pain in the . . .” Apart from being the source of the most frequently diagnosed cancer in men (excluding the skin, but more on that subject later), it wants to behave like a 1953 Austin-Healey. It purrs for the first 5,000 miles, but then it runs in fits and starts — and stops.

In a recent study looking at how frequently men over age 50 report having prostate problems, researchers at the University of Maryland found that 42 percent have some abnormality of urinary function attributed to an enlarging or inflamed gland. It’s a moving target for those of us still up and running, or briskly walking, past that age of 50. Like the footfalls of Father Time running to catch us, prostate problems increase in frequency as we get older, affecting 80 percent of men over 70.

With this (unfortunate) greater awareness of the prostate, some misunderstanding by patients and their health care providers about this gland has occurred. What is really known about “benign prostatic hypertrophy,” or BPH as most everyone calls it?

There is a strong inherited tendency some men have for developing BPH. One study showed that if a man needs a surgical procedure to prevent this benign growth from becoming obstructive, there is a four to six times greater likelihood that his brother will also need the surgery. Twin studies have shown that genetics contribute as much as 72 percent to the risk of bothersome symptoms.

Another known fact about BPH is the consistent association of this problem with the “diseases of modern living” that include metabolic syndrome, diabetes, obesity and even coronary heart disease. Multiple studies have shown that increased exercise and weight loss can decrease our personal risk of prostate problems up to 25 percent. The common factor between these illnesses and BPH appears to be the abnormal inflammatory substances produced in “belly fat” in overweight men. Unfortunately, in the hurly-burly of an office visit for prostate issues, the important advice to make major lifestyle changes may get lost. That includes avoiding many dietary substances, such as caffeine, which can worsen prostate function.

If we’re talking about changes in exercise and diet habits, what about smoking? Sorry, the research here will not aid the anti-smoking campaign, but don’t take home any false message. There is a direct link between smoking and bladder cancer, so don’t pick up any bad habits on account of your prostate’s indifference. As for alcohol, here you get a reprieve, for it appears that moderate consumption is a good thing.

What are the available treatments for benign prostate problems aside from the important lifestyle changes above? First, if there are signs of possible low-grade infection, antibiotics may be advised. The problem is that unlike a strep throat or a bladder infection in women, often the tests do not give a black and white answer, so many times the antibiotic is given as a “therapeutic trial.”

Next, there are medications to decrease the pressure inside the gland that seems to contribute to prostate inflammation. These are generally well tolerated and work in less than a week, but may have to be taken for life. Other medications gradually shrink the gland, but require months to have optimal benefit and can sometimes have the side effect of sexual dysfunction.

Last, there are surgical options to decrease obstruction to urine flow that are needed in a minority of patients. Of course, with all surgical fixes come risks, and this should be reserved for the most severely affected patients, especially if they have already tried the standard medications.

Recently I spoke with Dr. Ali Khavari at Eastern Maine Medical Center, recognized as the most experienced urologist in the Bangor area in the treatment of BPH. He states that, “There is no direct relation between the size of the gland and the level of obstructive symptoms.” Further, when patients ask him about the use of saw palmetto and other herbal remedies, he answers that “saw palmetto may be safe and possibly helps men in their 50s or early 60s with milder symptoms, but if they have more significant obstruction they will need prescriptions. The newer medications have the benefit of both decreasing the chance that a man might eventually need surgery, as well as making any procedures safer with fewer complications, like bleeding.”

I cannot bring this article to a close without mentioning the elephant in the room (well maybe your prostate is not that big). The question in the back of the minds of most men when they think about their prostate is “What about prostate cancer?” Many of us have a friend, colleague or close relative that has been affected by this difficult disease. This is a complex subject with controversy surrounding both detection and treatment. I pledge to tackle this subject in a future column with the help of several colleagues who are more expert than I.

Until then, I leave you with a modified New-Age farewell: May your prostate always allow you to go with the flow.

This column is the third of three columns by Dr. William Sturrock about men’s health issues. Sturrock is Eastern Maine Medical Center’s men’s health consultant at Urologic Surgery of Maine in Bangor.

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