Wait a minute! I thought I had discussed both Benign Prostatic Hypertrophy (BPH) and prostate cancer more than a dozen times each, since 2003, when I started writing “Doctor Sun” column. Yes, if you go to Sunday Sun archives, and Google you will see BPH and prostate cancer from different angles and perspectives, depending on what my readers, respondents or patients wanted to know.
Last week one of my regular readers called from Nnewi in Anambra State, he is 52. He said there was a Russian-Ukrainian war going on between two medical personnel. One said he has enlarged prostate, that is, BPH, the other countered that it is prostate cancer. The man was confused in a matter of life and death. He wanted me to bail him out. He sent me all the results done by the two medical personnel and said I should also discuss BPH and prostate cancer in my weekly column.
I had said ad infinitum that the prostate gland which contributes to the production of semen, encircles the base of the male urethra where it joins the bladder. When it begins to enlarge, it compresses the urethra and causes difficulty in voiding. Urination may be difficult to start, and when the urine stream appears it may be thinner and normal, because urine may remain in the bladder, there is the possibility of local infection that may spread to the kidneys. If the kidneys become enlarged because of this type of obstruction, a condition known as hydronephrosis is said to exist. This disease can cause impaired kidney function and leads to uremia.
Enlargement of the prostate gland occurs in about half the male population over 50, and the incidence increases with increasing age. BPH could be treated with drugs like “terazosin” an alpha-adrenergic blocker, which helps shrink the prostate, dilates the prostate tissue, and also helps in decreased libido. Most of my patients with erectile dysfunction have reported improved sexual function after taking terazosin.
If there is sufficient obstruction, BPH could be treated surgically. For temporary relief, a catheter can be inserted into the bladder through the urethra, allowing the urine to drain through the catheter and out of the body. If surgery is necessary, the entire prostate may be removed or only part of it that surrounds the urethra.
Symptoms of Benign Prostatic Hypertrophy are quite distinctive, increased difficulty in urination, an urge to continue to urinate after voiding has been completed, burning and frequent urination, caused in part by infection from urine retrained in the bladder.
The cause of BPH is thought to be a change during the ageing process in the hormone that affects prostate tissue, but the exact nature of the change and its effect is not clear. It is likely that hormone – containing medicine will eventually be developed, that will prevent or reverse prostate tissue growth.
Acute Prostatitis, which people confuse with BPH, occurs typically in young men. Symptoms include pain during urination, sometimes a discharge of pus from the penis, pain in the lower back or abdomen, indicating a tender and enlarged prostate, and fever. It is caused by a bacterial infection and usually responds promptly to antibiotics.
Cancer of the prostate is common type of malignancy in older men. It accounts for about 10% of male deaths, from cancer in Nigeria. Prostate cancer may be present without any symptoms or interference with normal function and is therefore difficult to diagnose. A very high proportion of men over 80 – probably possibly more than 50 per cent has been found to have had cancer of the prostate at autopsy in USA. When symptoms are present, they are likely to be the same as those of BPH.
Prostate cancer can be diagnosed only by a biopsy examination of the tissue sample taken from the prostate during surgery. This was what I told my beleaguered respondent from Nnewi, that the diagnostic confirmation of prostate cancer can only be made from a biopsy taken from the prostate tissue. Let me re-emphasise now, that prostate cancer is not diagnosed by the level of Prostate Specific Antigen (PSA). I have had most of my patients forlornly looking up to me and crying for help whenever their health care providers diagnosed them with prostate cancer. I have always had to re-evaluate them, knowing that high PSA is not synonymous with prostate cancer.
Let me restate here for umpteenth time, as I have written over the years, high PSA, is not synonymous with prostate cancer. Besides cancer, other conditions that can raise PSA levels include, inflamed or infected prostate (prostatitis). It should also be noted significantly that PSA level is also increased in BPH.
If malignancy is found in tissue biopsy, the gland is surgically removed, when feasible to do so, the testes are sometimes removed too so that the level of male hormones in the body is lowered.
Male hormones increase the growth of malignant tissue, but because female hormones slow it down, they may be administered after a diagnosis of prostate malignancy. If the tumour has spread to bone tissue, radiation treatment of the affected areas may slow down cancerous growth and relieve pain.
Men over 50 should have a rectal examination and a PSA blood test once a year, since tumours of the prostate and BPH can often be diagnosed early in this way.
Growing old is the greatest risk factor for prostate cancer, particularly after age 50. After age 70, studies suggest that anywhere from 31 to 83 per cent of men have some form of prostate cancer, though there may be no symptoms. Family history increases a man’s risk, having a father or brother with prostate cancer more than doubles the risk. Africans, African American men, and Caribbean men of African descent are at high risk and have the highest rate of prostate cancer in the world.
Diet seems to play a role in the development of prostate cancer, which is much more common in countries where meat and high fat dairy are mainstays. The reason for this link is unclear. Dietary fat particularly animal fat from red meat may boost male hormone levels. And this may fuel the growth of cancerous prostate cells. A diet too low in fruits and vegetables may also play a role in development of prostate cancer.
Let me now answer some of the erroneous questions and assumptions put forward by my respondents over the years. Let me state categorically that too much sex, masturbation and vasectomy do no lead to prostate cancer or BPH. Researchers are still studying whether too much alcohol use, sexually transmitted disease (STD), or prostatitis play a role in development of prostate cancer.
Erectile dysfunction (ED) is a common side effect of prostate cancer – please Google my earlier write ups, to read up mode of treatment which includes drugs like terazosin an alpha-adrenergic blocker.
Always be medically guided.
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