Almost all males suffer enlargement of the prostate gland with advancing years. It is as certain as graying hair, but unfortunately, far more troublesome. Increasing urinary symptoms are the first telltale sign. Medical attention is essential, for if left unchecked, serious repercussions may be inevitable. But a certain number will advance or develop cancer, and herein lays one of the greatest problems for the older man. Early spread to distant sites, often without symptoms, is common.
The enlarged prostate gland is present only in males. It is a firm gland located at the base of the bladder, and is intimately related to it. The urethra, the tube leading from the bladder to the exterior, traverses it.
Although it does not give rise to very much trouble during early life, with advancing years it is notorious for giving trouble. In the male’s reproductive years, the gland helps produce fluid that is part of the seminal ejaculate. This is stored in the seminal vesicles, the large sperm storehouses located behind the bladder.
However, as age increases, “benign prostatic hypertrophy,” as it is termed by the doctors, takes place. This simply means the prostate increases in size. “Benign enlargement of the prostate occurs in nearly all men as they grow older,” Dr John Blandy said recently in the British Medical Journal. “But only one in 10 is likely to need a surgeon.” Although the majority are benign – meaning they are noncancerous – a certain number do advance to malignancy, and this is one of the most serious cancers in males.
The chief problem with advancing enlargement is that an increasing resistance to normal urinary outflow from the bladder takes place. This is caused by two factors: first there is an increase in the thickness of the bladder muscle at the neck (through which urine must pass when voiding), and second the prostate itself gradually adds to the obstruction. As greater pressure has to be exerted to void the urine, adverse effects within the bladder occur. It can lead to the formation of saccules – spaces in the bladder wall that may retain urine – and cause infections within the bladder. In due course, left uncorrected, this may give rise to the formation of stones in the bladder, and these are a well-known cause of later cancer.
As the pressure within the bladder further increases if there has been no action taken, the valve between the bladder and the ureters (the tubes conveying urine from the kidney to the bladder) may give way. This allows urine to reflux or track back up the ureters. This may reach the kidneys, increasing pressure here, and gradually destroying the kidney substance. The ability of the kidney to carry out its normal functions reduces, filtration becomes defective, and a condition called uraemia (in which the body’s metabolites and waste products are not excreted) may take place, and ultimately the patient may die.
This description sounds grim. Fortunately, most patients seek treatment well before this irreversible situation occurs. But these are the steps. They indicate the necessity of obtaining medical advice as soon as telltale symptoms become established.
There is a premium on early diagnosis, and the sooner this is made the better. The less likely are adverse complications, and the longer the patient will live. The picture is as clear-cut as this. As yet it is not known what makes the prostate suddenly flare up and hypertrophy. Therefore, reporting symptoms early is the only way in which a prompt diagnosis may be made.
Enlarged Prostate Gland Symptoms
The symptoms indicating prostate enlargement include hesitancy and straining at urination. Often this happens when initiating the act. There may be loss of force of the flow, often terminal dribbling after the act has been completed, and very often frequency and nocturia. This means there is a desire to urinate often, and the need for performing this at night (often many times) is greatly increased. This may be aggravated considerably if infection is present as well as hypertrophy.
Sometimes a mass may be felt in the lower part of the abdomen, and patients have come along with this as the initial symptom. Indeed, the obstruction to urinary outflow has undoubtedly been present for some time, allowing the urine to build up to extreme proportions, with an overflow occurring irregularly.
The doctor will carry out an examination, and this will often include a rectal examination whereby the prostate can be felt. It is usually softish, but if it is stony hard, this indicates it may be a cancer. However, it is notoriously hard to be certain, for the size of the prostatic growth is not necessarily related to the degree of outflow obstruction.
It is incredible how men, frequently senior executives of major business concerns, company directors, and those of similar high office, will put up with urinary symptoms, believing them to be part of the “growing old” syndrome. Many do not equate them with the possibility that serious things are taking place in their prostate-bladder system that could be life-imperiling if ignored indefinitely.
As the symptoms frequently cause no pain, many are happy to put up with the minor inconveniences and press merrily on their way, becoming involved with their work, and ignoring everything else. Experience over the years in most urology clinics shows that many men do not seek expert advice until their condition is well advanced.
“The rule must be that any man with suspicious symptoms ought to be properly examined,” Blandy says.
Enlarged Prostate Gland Treatment
“To correct the trouble the obstructing muscle and adenoma (enlarged portion of the prostate) have to be removed from the neck of the bladder,” Blandy continues. There are two methods widely used: When an enlarged prostate obstructs the urethra, and so reduces the flow of urine, the muscular wall of the bladder gradually thickens and strengthens as it works harder to force urine through the urethra, an open operation, or a simpler one called transurethral resection, or TUR for short.
In the first, the prostate is shelled out by an open surgical incision in the lower part of the abdomen. In the latter, the prostatic adenoma (growth) and overgrown muscle tissue are removed bit by bit. Both methods have points for and against, although it seems that the TUR is less risky, less painful and requires much less time in hospital.
If complications are present, such as infection, there is a much higher risk with the open operation, of prostatectomy. Some claim that the mortality risk may double. Certain severe complications (such as uraemia and chronic retention) “are extremely lethal.” Whatever type is done, the sooner the operation is performed, the better. The risk to a man aged 70 is far less than the same operation carried out in a man aged 80. Some researchers (Lytton) have stated that “the mortality for surgery is 0.3 per cent for men under 70 years, but this increases to 10.4 per cent in those over 80.” In any case, what man aged 80 wants to have an operation?
Urologists make it very clear that the best and safest place for this form of surgery is in a specialized urology unit at a major hospital. Here surgeons expert in this field operate, and full specialized facilities are available. “Centers treating many hundreds of prostatectomies each year report better figures than small general surgical units treating all kinds of surgical conditions,” it is reported.
After the operation of prostatectomy, the patient is usually satisfied. He may leave hospital within seven to 10 days, and get back to his normal occupation within a further three weeks. He may carry out his usual activities, garden, swim, play golf – and even carry on sexually. However, it is pointed out that “he may be infertile owing to interference with the mechanism of ejaculation.” However, in a male of over 60 years, this probably would not be of much concern.
What tends to worry males more is that erection often suffers also, and many develop a psychological complex about this. Others find that the direction of their urine stream may be odd as well. It is still possible for prostatic cancer to develop, for the outer shell called the surgical capsule, has been left behind. For the same reason, another noncancerous adenoma might arise, but this usually takes time, and may not really worry an older person.
Some doctors have found that simple medication occasionally reduces the prostate outflow obstruction. Dibenyline (an old drug with a new use), one 10 mg capsule at bedtime, is said to bring effective symptomatic relief to many within a few days. It is probably worth a try to start with.