By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

BENIGN ENLARGEMENT OF PROSTATE IS NOT A RISK FACTOR FOR CANCER

Question: My husband is a healthy 65-year-old. At his annual checkup, he was told he had an enlarged prostate. How concerned should we be about this? Can it lead to prostate cancer? What new symptoms would mean this is getting worse?

Answer: Over 50 percent of all men have benign prostatic hyperplasia by age 60. Sometimes you’ll see the word “hypertrophy” substituted for “hyperplasia,” but it’s still the same disease with the same abbreviation -- BPH. By the time a man reaches 80, there’s an 90 percent change that he’ll have BPH. Men don’t usually start having symptoms of this problem until they have had it for a few years. Interestingly, African American men begin to have symptoms at a younger age than Caucasian men, by about five years.

Now, for a brief anatomy lesson: The prostate gland is just below the bladder and is only found in men. The prostate produces fluid that liquefies semen. This gland is about the size of a walnut and surrounds the urethra -- the tube that carries urine from the bladder to the outside. When the prostate enlarges, it presses on the urethra and causes difficulty urinating.

Some the common symptoms of BPH include:
• difficulty starting to urinate,
• needing to urinate more frequently, especially at night,
• a weak urinary stream,
• a feeling of incomplete emptying of the bladder,
• dribbling after urination, and
• painful urination.

Sometimes, the obstructed urethra can back up urine and cause an infection. This can lead to blood in the urine. In severe cases, the man may find himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines that contain an ingredient that in men with BPH can prevent the bladder from relaxing and allowing urine to empty. Men with acute urinary retention usually seek immediate medical attention; however, it’s important for men with even mild symptoms to seek an evaluation by a physician.

Several things can be done to minimize the symptoms in the early stages of BPH. Some suggestions are:
• Avoid caffeine and alcohol in the evenings;
• Don’t delay unrination -- when you have the urge -- GO; and
• Avoid the over-the-counter medications mentioned earlier. Also, some men are helped by taking Saw Palmetto extract. This herbal remedy can be found in pharmacies and health food stores.

When the symptoms are not relieved by these measures, it may be time to start some prescription medications. Your doctor has several to choose from. If medications fail, the prostate can be surgically “debulked.” The most common procedure for this is called TURP (transurethral resection of the prostate). It is minimally invasive and has a high rate of success.

The great news is BPH does NOT increase a man’s risk for developing prostate cancer. Also, many men never require any medication for treatment for their mild BPH. As always, your husband should consult with his physician prior to starting any herbal remedies, and he should ask the pharmacist about any over-the-counter medication’s potential for worsening his BPH symptoms.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via email to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.