Weiland: The male curse

By Dr. Kevin Weiland | Wednesday, August 16, 2006

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The prostate gland is a small organ in men (about the size of a walnut) that is located above the rectum and at the bottom of the bladder. It surrounds the urethra (the tube that carries urine from the bladder) like a doughnut and its function is to make a fluid that becomes part of semen (the white fluid that contains sperm).

BPH or benign prostatic hypertrophy is enlargement of the prostate and is very common in older men. More than half of men in their 60s have BPH and as high as 90 percent of men in their 70s and 80s.

This enlargement may eventually block the urethra, making it difficult to urinate. Other symptoms include dribbling after urination and the urge to urinate often, especially at night.

There are several different ways to treat BPH; one is watchful waiting if you are not bothered by the symptoms. You should get regular checkups and wait to see whether or not the condition gets worse.

Drugs such as alpha blockers (Hytrin, Cardura and Flomax) help to relax muscles near the prostate and may relieve your symptoms. These drugs can lower your blood pressure so side effects can include lightheadedness, feeling tired or dizzy.

Finasteride (Proscar) and dutasteride (Avodart) are drugs that inhibit the action of the male hormone testosterone and may shrink the prostate. Side effects of this drug include a declining interest in sex and erectile problems.

Saw palmetto is a plant-derived therapy (phytotherapy) and may be beneficial in treating symptoms of benign prostate disease. The amount of active drug in the preparation is so variable that it has been difficult for most physicians to make recommendations regarding its effectiveness.

Surgery is the treatment most likely to relieve BPH symptoms. However, it also has the most complications. This is usually performed by urologists who specialize in this area. They are often consulted to discuss further treatment options and to rule out a cancer or "silent prostatism" before treatment begins.

Transurethral Resection of the Prostate (TURP) is the most common surgical procedure for BPH. The doctor will insert an instrument into the urethra and remove part of the prostate to lessen the obstruction.

Sometimes a urologist can make several small cuts into the prostate through the urethra if the prostate is not too enlarged. (Transurethral incision of the prostate or TUIP).

Other procedures include placing stents into the urethra that act like scaffolding to hold open the area of the urethra obstructed by the prostate and needle ablation, which utilizes low levels of radiofrequency energy to ablate the prostate through the urethra.

Laser surgery is another option to kill off the prostate tissue surrounding the urethra and it appears to be very effective in relief of BPH symptoms. The long-term effects remain unknown at this time.

The FDA has recently approved the technology known as Transurethral Microwave Thermotherapy. This one-hour procedure has been widely used in Europe and Japan for many years and has proved to be an effective alternative to surgery and long-term medications.

Although enlargement of the prostate is an apparently normal part of aging, problems with urination that often accompany this enlargement are not normal. BPH is not cancerous but the signs of enlargement are often the same signs and symptoms of prostate cancer.

Physicians will often do a blood test that measures concentrations of a protein produced by the prostate called the Prostate Specific Antigen or the PSA. This may be elevated in men if cancer is present or if the prostate is enlarged or infected. The use of this blood test as a general screening tool is still controversial however, there are a number of newer tests being evaluated that may enhance the accuracy of the PSA in order to detect prostate cancer.

The best advice to protect yourself against prostate problems is to have regular medical checkups and a careful exam of your prostate by your physician. You should see your doctor promptly if you have symptoms of an enlarged prostate. The sooner your doctor finds a problem, the better the chances are that the treatment will work.