Written by Dr Jerome Crouche
Have you ever found that the pressure when you urinate just isn’t the same anymore? or that there’s that annoying dribble at the end that just never seems to stop? If that’s the case it may be time to call the plumber to have those pipes checked out.
Too often do men come in unaware of the annoying little prostate (or large, should I say) that seems to be a problem for some. The prostate is a small gland, about the size of an apricot, that sits just below the bladder and encapsulates the urethra (The pipe that allows the urine to flow from the bladder to the penis). The prostate produces a small amount of fluid that makes up about 30% of the total ejaculate. It is a mixture of enzymes and acids that protects the sperm until it reaches its destination. One of those enzymes is a substance called PSA (Prostatic specific antigen) which helps to thin out the semen, helping it travel further to fertilize an egg. The other important contents of the prostatic fluid are mostly alkaline which helps to protect the sperm when it encounters the acidity of the vaginal secretions.
When we talk about prostate disease, we often think of three potential causes:
(1) Prostate Cancer
(2) Enlarged Prostate also known as Benign Prostatic hyperplasia (BPH)
(3) Prostatitis which is either an inflammation or infection of the prostate.
Today, we’ll be talking about an enlarged prostate.
As we age the prostate continues to enlarge and sometimes continues even when we stop growing. The prostate has two growth spurts - one around puberty when the increasing levels of testosterone fuel the gland to get bigger, and the second around 30 where it then continues to grow for a reason unknown.
Sometimes it gets so large that men start to develop what we call lower urinary tract symptoms (LUTs), but this is not always the case. These symptoms are not specific to an enlarged prostate but are a good starting point to figuring out if the prostate is in fact the problem. We split LUTs into three categories:
Obstructive symptoms: Poor stream, intermittent flow, incomplete emptying of bladder (with frequency), dribbling after urination and hesitancy
Storage symptoms: Frequently urinating, urinating during the night and urgency to urinate
Complex symptoms: Urinating with blood, recurrent urinary tract infections, urinary retention (Unable to urinate) and incontinence
As part of the prostate work up, there are four elements to consider:
(1) Prostate examination which is palpated through a rectal examination
(2) Urine test to exclude an infection
(3) PSA blood test if there is concern about prostate cancer or prostatitis
(4) Prostate/Bladder Ultrasound or Uroflow studies which looks at the size and shape of the prostate as well as the bladders emptying capacity.
Once we have excluded other potential diagnoses with the prostate, most men are diagnosed with an enlarged prostate (BPH). About 90% of men by the age of 80 have an enlarged prostate with a small percentage of men undergoing surgery to fix the issue. The remainder take medication to relieve the symptoms or wait until the symptoms become bothersome. The options for treatment are watchful waiting, medical therapy with medication or referral to a urologist to discuss surgical options.
If you note that you have any of the above symptoms it may be worth having a chat to your GP about further investigating if the prostate could be a problem. As men we often put things off without realizing we do need a bit of a tune up every now and then.
Fix the pressure before the pipes start to crack!
Arianayagam, M 2011, ‘Lower urinary tract symptoms’ Australian Family Physician, Volume 40, Number 10, Page 758-767
Cunningham G, Kadmon D 2018 ‘Benign Prostatic Hyperplasia (Beyond the basics)’ Uptodate
Kumar P, Clark M. 2002 ‘Clinical Medicine’ Pg 545 - 549