PROSTATE HYPERTROPHY (Prostate enlargement, benign & cancerous)



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About one-third of all men over age 50 experience noncancerous (benign) enlargement of their prostate gland, the result of a gradual process than has the potential to cause severe obstruction of urinary flow with the passage of time. The prostate gland surrounds the neck of the male bladder and the urethra, the tube that carries urine from the bladder during voiding. Why it enlarges with age in not completely understood.

Prostate problems are no longer thought of as an 'old man's disease. In reality 20% of the victims are under the age of 65 and a startling number are only in their forties. Early detection is crucial in providing proper treatment for controlling the problem. No one really enjoys pain, but in the case of prostate, the pain often proves to be a blessing in disguise; it provides an early warning to see a physician and to resolve the problem that much more quickly. An enlarged prostate presses against the urethra and sometimes the bladder as well, thus preventing the bladder from emptying completely. Typically, an older man notices that he needs to urinate more often, the flow is slow to start, and the stream is weak, with some dribbling at the end of voiding. There may also be pain & burning during urination, especially if the prostate is pressing against the urethral canal. If stagnant urine collects in the bladder, it increases the risk of urithritis and bladder stones. More severe blockage may cause urine to back to the kidneys, damaging (hydronephros) these vital organs.

Often people and their families suffer for not knowing the important truth that prostate problems are in fact preventable. Developing a balanced lifestyle is vital. A lifestyle of adequate exercise, low-fat diet, minimal consumption of alcohol, cutting out smoking, and learning to manage stress well - all controllable factors - can substantially improves chances of a full and healthy life. Today, disorders of the prostate gland are fast becoming the most disturbing , costly, and rather bewildering health problem of our times. By the age of 60, over 50% of men will suffer from BPH (benign prostatic hypertrophy, meaning over-enlargement of the prostate gland); by the age of 85, that number rises to 85%. Quite a few of these BPH conditions turn out to be a prostate cancer in fact !

There is nothing shameful about about the disease of BPH except the neglect of so many males who do not get tested for it. The more you understand about prostate cancer, the better your odds are of overcoming it. It is also important to remember that prostate problems are treatable. Death is not inevitable, as the majority of males fear. In fact, many doctors will tell you that it you have to be afflicted by a form of cancer, prostate cancer is the one to choose; it is slow-growing, and many males live out their lives without even knowing that they have it. More men will die with the disease than of the disease.

Two tests are useful in diagnosing BPH. One is a digital rectal examination, during which a doctor palpates the prostate with a gloved finger inserted into the rectum, feeling it for enlargement and unusual hardness or lumps, that may suggest the presence of cancer. The other is a blood test that measures levels of prostate specific antigen (PSA), a substance normally produced by prostate tissue. In 30-50% of men with prostate enlargement, the PSA is elevated, yet the test is considered worthwhile because it can possibly screen for prostate cancer. Blood for the test should be drawn before the digital rectal examination, because palpating the prostate may produce a misleading temporary rise in PSA levels.nOther diagnostic studies may include placing a catheter in the bladder to measure the residual urine after voiding; an ultrasound examination; and cystoscopy, the insertion of a viewing tube into the bladder. A biopsy may be order to rule out cancer.

Initial therapy may involve medication to treat the urinary infections and kidney problems (if any) that frequently accompany an enlarged prostate. A bladder catheter may be necessary if the urinary flow is obstructed. Until recently, the only treatment  for the condition itself was surgery, usually transurethral resection of the prostate, or TURP. For this procedure, the surgeon uses a cytoscope (flexible tube) to reach the prostate through the urethra and then inserts a scalpel-like device (or in some cases, a laser) through the tube ti snip away overgrown prostate tissue. Most men who undergo this procedure remain in the hospital for about three days. The operation usually provides long-term relief from the symptoms of prostate enlargement, but there is about 10% risk of impotence, and some 60-70% of patients develop a retrograde ejaculation, in which, instead of ejaculating from the penis, they ejaculate semen into the bladder. This however does not affect the ability to have an orgasm, but it does impair fertility.

Terazosin (Hytrin), a drug that increases urinary flow, may be prescribed to alleviate urinary retention. For some men, a drug called finasteride (Proscar) may shrink the overgrown prostate. A new procedure called TUNA (transurethral needle ablation) uses heat to reduce benign prostate overgrowth. Herein, a catheter is inserted through the urethra, and special heated needles are then used to to shrink the prostate. TUNA, an outpatient procedure done under local anaesthesia, takes about 40 minutes and most men can return to their regular routines in a day or two.

One cannot prevent the development of BPH. One should however avoid certain drugs that worsen the problem, including cold & allergy pills, which can possibly cause urinary retention. Also, some prescription drugs, including medications used to treat ulcers, irritable bowel syndrome, and depression, may have a similar effect (of worsening BPH symptoms). Urinate when you first feel the urge, rather than delaying. Avoid sexual stimulation and arousal without ejaculation.

Prostate inflammation and prostate cancer produce symptoms similar to those of BPH; both should be rules out in the diagnostic process.