Prostatic enlargement

By Tedler D. Depaynos, MD

“ A number of our elderly coffeemate acquaintances are taking medicines allegedly for their prostatic problems but the mechanism on how their medicines work is unknown to them. “

Prostate is a male gland that is located just outside the bladder. It adds fluid to the semen enabling the sperms to swim easily. Without its secretion, the semen will be gel-like and the sperms will just be plastered. Hence, it contributes to fertilization. It is not true as a lawyer coffeemate argues that if the prostate becomes bigger, it has more secretions.
There are various causes why the prostate enlarges. It could be due to infection (Prostatitis), tumors which may be benign or cancerous or may just enlarge due to old age commonly known as Benign Prostatic Hypertrophy or BPH. For this week’s column, we will just limit ourselves to BPH.
Because of ageing the prostate enlarges. Testosterone which is converted to dihydrotestosterone contributes to its enlargement. It is not true that those ageing individuals with less testosterone hence less “manly” have lesser tendencies to have enlarged prostate or not so large ones. Actually many BPH patients are still with lots of testosterone and are still very “manly”. It is its conversion to dihydrotestosterone that matters. Enzymes responsible to its conversion are apparently increased in ageing. Hence, ageing individuals that have more dihydrotestosterone consequently have bigger prostates no matter how they dye their whitening hair to look like less than middle aged trying to deceive their ‘agemates’. From the older textbooks we read during our student days, fatty diet as well as smoking may contribute to its hypertrophy but some younger urologists now dispute this. They say there are no definite studies yet to confirm this theory. I guess they should know better. They agree, however, that smoking is definitely an etiologic agent that contributes to the formation of renal and bladder cancers.
Signs of prostatic enlargement are due to bladder obstruction. This is manifested by hesitancy in urination, dribbling, nocturnal urination, frequency sometimes every 2 hrs, feeling of incomplete urination and urinating with effort. Do not be amazed then if those with prostatic enlargement appear to be prolonging their stay in the comfort rooms causing long waiting lines with cursing mummers. Sometimes they could be observed as suddenly rushing looking for the comfort room despite an interesting discussion and some wakes up 2 or 3 times a night just to be relieved irritating their bedmates. There is no manifestation that is experienced earlier than the others. Any one of them may come first or even all at the same time.
Once these signs and symptoms are experienced a urologic consult is advised. The initial examination done is usually a digital rectal examination. If this is done by experienced urologists, this may be more reliable than the other tests like prostatic ultrasound (UTZ). Because of hundreds or even a thousand of rectums examined, these experts could easily feel if there is infection like Prostatitis or Tuberculosis, if there is a tumor like Ca or if there is just a simple enlargement or BPH. Normal weight of a normal prostate is 20 gms. and these experts could even guess accurately how many grams is the prostate gland just by their finger examination! Of course, a final diagnosis is required after, a prostatic biopsy.
If no treatment is done and urinary obstruction persists and worsens, other complications may occur. Aside from urinary tract infection and the formation of stones or calculi, bilateral renal failure and appearance of bladder out pouching called diverticuli may occur because of increasing reversed pressure.
A number of our elderly coffeemate acquaintances are taking medicines allegedly for their prostatic problems but the mechanism on how their medicines work is unknown to them. Although some of them claim that their doctors took time explaining it to them, the terms used were alien and even hard to pronounce. Some were just hard in hearing.
To make urination more comfortable, medicines that block the constriction of the bladder neck making urination difficult are prescribed. Alpha adrenergic blocking agents like Terazosin (Hytrin) which is also given for hypertension is an example. Initial dose is 2 mg taken at bedtime. To prevent the conversion of testosterone to dihydrotestosterone that causes the prostatic enlargement, a more complicated drug is prescribed by urologists. Alpha 5@-reductase or Finesteride 5 mg taken once a day for at least 6 months to realize its effects is given. These drugs are not without side effects that may challenge your manliness so that it is better prescribed by experienced M.D.s and follow-up consultations are a must. Because these prescribed medicines may take time to work, some patients will shift to herbal medicines and will even proudly boost that they are working better. Because of our ignorance we have no comment.
Neglected BPH or those non-responsive to conservative medical treatment could now be treated by laser therapy but this may only be available in some special centers. Standard treatment now is Trans Uretral Resection of the Prostate (TURP) which is easily done by trained young urologists. A special instrument is inserted into the urethra and the prostate is practically scraped. Of course it is done under sedation or spinal anesthesia. Only when it is so enlarged and TURP is not feasible that open prostatectomy is considered.**

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