The prostate gland is a walnut-shaped structure that makes prostatic fluid, the major nutrient fluid to support sperm in semen. The gland lies deep at the base of the bladder, and can be felt (palpated) by a finger upon digital rectal examination. The tube that carries urine from the bladder, (the urethra), passes through the prostate. Over time the prostate enlarges.

When the prostate swells, it not only enlarges outwardly, but it enlarges inwardly, pinching the urine tube. This restricts urine flow, causes inadequate emptying, stimulates the desire to urinate day or night, and sometimes causes irritation and burning sensations. Although all men will develop Benign Prostatic Hypertrophy (BPH), a noncancerous overgrowth of the prostate gland, as they age, there is a wide variation in their symptoms. Some are much worse off than others. Post mortem studies reveal that more than 90% of 80 year old men have BPH, and more than 70% have prostate cancer.

Most Benign Prostatic Hypertrophy presents with a combination of irritable and obstructive symptoms.

The classic irritable symptoms include:-

• Nocturia, passing urine at night
• Increased frequency of urination
• Urgency to pass urine
• Burning sensation upon micturition

The obstructive symptoms include:-

• Reduced urine flow and dribbling
• Inadequate emptying
• Increased need to strain upon micturition

Since the work of Dr Huggins in 1942, the cause of Benign Prostatic Hypertrophy (and prostate cancer), has been attributed to raised testosterone levels – however of late, there is increasing acceptance ‘that there is no clinical evidence that the risk of either benign prostatic hypertrophy or prostate cancer increases with testosterone therapy’ . Furthermore, ‘there is no compelling evidence at present to suggest that men with higher testosterone levels are at a greater risk of prostate disease or that treating men with exogenous testosterone increases that risk.’( Mayo Clinic Proceedings.)

A leading Harvard professor of Urology now states, ‘It should be recognised that prostate cancer and benign prostatic hypertrophy become more prevalent exactly at the time of a mans life when testosterone levels have declined.’(New England Journal of Medicine 2004)

Careful diagnostic evaluation, clinical examination and a ‘recommended’ annual PSA for men over 50 years, can usually diagnose BPH and any progression to prostate cancer. Prostate Specific Antigen, PSA, is made in the ‘skin’ cells of the prostate. It is prostate specific, but not specific for prostate cancer. Increased PSA can also occur in inflammation of the prostate, non cancerous enlargement(BPH), prostate cancer and following biopsy. Fractionation of the total and free components can help to differentiate between cancer and non-cancerous enlargement.

Initial treatment of BPH consists of medications to relax the smooth muscle in the neck of the bladder, or to reduce known aggravating molecules. Saw palmetto treatment is cheap, effective and has a low side effect profile.

Surgical intervention is reserved for severe, progressing disease states, and usually consists of either a ‘rebore’, a bladder neck incision or removal of the gland. Prostate cancer, already the most common cancer of men, has been projected to increase by 31% over the next decade. Similarly, BPH will also progress. Right now in the new millennium, 20% of men are expected have early prostate cancer changes by the time they are 50 years old.

Your doctor can help with diagnosis, but prevention is better than cure.