All his life, he slept like a stone. But now there is an annoying trip to the toilet every night, sometimes once, twice, and thrice or more. Begin to suspect the prostate. Prostate health is important because as a man ages, his risk for prostate disease increases. In the general population, prostate diseases are most common after age 50 and one can expect it from age 40 and above. Prostate disease can affect a man’s sexual performances and urination. Cancer of the prostate can be fatal. The aforementioned prompted me to seek the opinion of DR PAUL ADEGOKE a consultant surgeon and the medical director of OLA Catholic Hospital Oluyoro, Ibadan.
SR J: Good morning Dr.
DR A: Good morning my beloved SR J.
SR J: How are you today?
DR A: We thank God and our Mother Mary for her intercession and protection.
SR J: Dr, looking around and from what is happening, prostate enlargement is becoming common among elderly men and some of them are not even aware of it. They feel and think that what is happening to them is from their enemies that are they did juju for them. In a way of creating awareness and clarification, I have come to you to enlighten us more on this issue of prostate enlargement.
What is prostate enlargement?
DR A: Before talking about prostate enlargement, one needs to know about the prostate gland. Prostate gland is a walnut-sized gland located between the bladder and the penis. The Prostate is just in front of the rectum. The urethra runs through the centre of the prostate, from the bladder to the penis, letting urine flow out of the body. The prostate secrets fluid that nourishes and protects sperm. During ejaculation, the prostate squeezes this fluid into the urethra and it is expelled with sperm as semen. The vasa differentia (singular: vas deferens) bring sperm from the testes to the seminal vesicles, which contribute fluid to semen ejaculation.
Prostate enlargement means that the prostate has grown bigger and it happens to almost all men as they get older.
SR J: What are the possible causes of prostate enlargement?
DR A: The prostate enlargement can be cause by the following conditions;
- Prostatitis which means that the prostate is inflamed. It could be swollen, tender or sore. It may not have symptoms in the area or one might have a fever or feel tired. One might feel pain in the joints or muscles. At least half of all men have these conditions at some time in their lives. If a man has prostatitis, urination can become difficult or painful and this is caused by infections, kidney stone or cancer.
- Benign Prostatic Hyperplasia (BPH). Benign means “not cancerous”. Prostatic means “of the prostate”. Hyperplasia means “too much growth of tissues”. BPH is enlarged prostate caused by non-cancerous tumors inside certain areas of the prostate. The cause of this non-cancerous tumor is not known but linked to hormonal changes that occur as a man grows old. AS the prostate enlarges it can press against the urethra and the bladder, blocking the flow of urine.
- Prostate Cancer or Cancer of the Prostate (CAP). Prostate cancer is a common clinical condition among adult males worldwide. Its prevalence in the intermediate total Prostate specific Antigen (PSA) values (4-10ng/ml) has not been assessed among Nigerians. The prevalence of prostate cancer varies across various racial groups; this is attributable to differences in patients’ characteristics. It is the second-leading cause of cancer deaths among men in the United States and it is also the cause of death among Nigerian men as well. Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
SR J: What are the symptoms of this enlarged prostate?
DR A: The symptoms of prostatitis, BPH and CAP are almost the same therefore one needs to see the Doctor to evaluate these symptoms and they are as follows:-
- A frequent and urgent need to urinate.
- Getting up more frequently at night to go the bathroom.
- Trouble starting a urine stream.
- A weak stream of urine.
- A small amount of urine each time you go to the Toilet.
- The feeling that you still have to go, even after you have just finished urinating.
- Leaking or dribbling urine.
- Blood or pus in your urine.
- Inability to urinate at all and this will make the man look like a pregnant woman because of the urine retention.
- Pain or burning with urination.
- In addition paralysis of the lower limb can occur in cancer of the prostate.
SR J: what are the risk factors?
DR A: Genetic background may contribute to prostate cancer risk as suggested by associations with race, family and specific gene variants. Having a father, brother, or uncle with prostate cancer raises a man’s risk.
It is believed that eating a lot of high-fat foods and higher meat consumption might also contribute to risk. Alcohol, smoking and environmental oxidation also contribute to risk.
A man’s chances of having prostate cancer also increase with age.
SR J: When is one supposed to get checked in the hospital and what are the examination and tests to be carried out?
DR A: When one feels the symptoms as aforementioned and the different examination and tests to be done for the person is:
- Digital Rectal Examination (DRE): A doctor inserts a lubricated, gloved finger into the rectum and feels the prostate. A DRE can sometimes detect an enlarged prostate, lumps or nodules of prostate cancer, or tenderness from prostatitis.
- Prostate- Specific Antigen PSA: The prostate makes a protein called PSA, which can be measured by blood test. It is actually the tumor marker specific for cancer of the prostate. If PSA is high, prostate cancer is more likely, but an enlarged prostate can also cause a high PSA.
- Prostate Ultrasound (Trans rectal ultrasound): An ultrasound probe is inserted into the rectum, bringing it close to the prostate. Ultrasound is often done with a biopsy to test for prostate cancer.
- Prostate Biopsy: A needle is inserted into the prostate to take tissue out to check for prostate cancer. This is usually done through the rectum.
- Bone Scans and X-rays: These may reveal whether the cancer has involved the bones. To perform a bone scan, doctor injects low doses of radioactive substance into the patient’s vein, which accumulates in bones that have been damaged by cancer.
- Computed Tomography CT or Magnetic Resonance Imaging (MRI) scan: They can further pinpoint the location of the cancer that has spread beyond the prostate.
SR J: Hmmmmmmmm, all these tests for so small a gland with the size of a walnut. IT means small but mighty. Please Dr, what are the possible treatments for this enlarged prostate gland.
DR A: Enlarged prostate gland can be treated with medical and surgical interventions.
- Alpha- blockers: Alpha-blockers relax the muscles around the urethra in men with symptoms from enlarged prostate. Urine then flows more freely.
- 5-alpha-reductase inhibitors: These medications reduce the level of a certain form of testosterone (DHT). The prostate shrinks when less DHT is present, improving urine flow.
- Antibiotics can be used if the enlargement is due to infections.
Usually medications resolve symptoms of an enlarged prostate but some men require surgery to improve the symptoms and prevent complications like cancer.
- Trans Urethral Resection of the prostate (TURP) is the most common type of surgery. Tissue is removed from the prostate using a resectoscope ( a thin , lighted tube with a cutting tool at the end) inserted through the urethra. Prostate tissue blocking the urethra is cut off and removed through the resectoscope.
- Trans Urethral Incision of the prostate (TUIP) may be used when the prostate is slightly enlarged. Using a thin tube inserted through the urethra, the surgeon makes a few small cuts in the prostate near the opening of the bladder. This can help improve the flow of urine.
- Open Surgery is used when the prostate is very enlarged and cannot be removed using a less invasive technique. The doctor removes the prostate tissue directly through an incision, not through the urethra.
THE STANDARD TREATMENTS FOR CLINICALLY LOCALIZED PROSTATE CANCER INCLUDE THE FOLLOWING:
- Active surveillance
- Watchful waiting
- Radical prostatectomy
- Radiation therapy
- Hormone therapy.
SR J: Dr, what are the preventive measures? For I believe that an ounce of prevention is worth a pound of cure.
DR A: Right diet is number one when we talk of ways to prevent prostate enlargement and promote prostate health.
Food that is rich in lycopene e.g. Fresh tomatoes, selenium, omega 3 fatty acids, vitamin D, soy foods(is flavones) phytosterols (beta-sitostero) zinc, vitamin E and other antioxidants, green tea, Exercise and achieve optimal weight, stress reduction.
Maintenance of a healthy colon (taking a lot of fibers to cleanse the colon).
Yearly Prostate examination when you reach 40years, monitoring of special blood tests like prostate specific antigen.
SR J: My brothers, fathers and grandfathers, this has shown you that there is a need for you to start taking care of this walnut -sized gland. A stitch in time saves nine.
Thank you DR for this beautiful information and God bless you abundantly. Amen.
DR A: you are welcome my beloved SR J.