You may have heard many elderly men having difficulty in peeing complaining of “PROSTATE PROBLEM”. Hearing this, some questions come to mind, like – What is Prostate? How is it related to urination? Why does it cause problems in elderly men? Will I be affected too when I get old?…etc.
In this article, I shall try and clear some of these common queries.
What is Prostate?
The prostate is a small organ present in males. The normal size of this organ in men resembles a walnut. It is an important reproductive organ that is involved in the production of semen. It is located just below the outlet of the urinary bladder, surrounding the urine tube through which urine comes out during peeing (this tube is called the urethra). It is situated within the abdomen and cannot be seen outside. To feel for the prostate, the doctor has to do a rectal exam.
Why does it affect old men?
The size of the prostate tends to increase with age in men after the 3rd decade of life. This is referred to as BPH (Benign Prostatic Hyperplasia) in medical terminology. Since it surrounds the urethra, in many men, it tends to compress the urethra as its size increases. This results in urinary problems like difficulty in passing urine, hesitancy, intermittency, and frequency both during day and night time. It is estimated that about 30% of men in their 50s may have prostate-related urinary problems. This percentage increases to over 50% in men over 70 years of age.
Is the problem treatable?
Not everyone with BPH requires treatment. Only those having bothersome symptoms or secondary complications require treatment. Some of the complications secondary to BPH include urinary retention, i.e., inability to pass urine usually associated with severe pain or discomfort in the lower part of the belly; recurrent urinary infections, urinary bladder stones, kidney dysfunction, etc.
What treatments are there?
The treatment for this condition involves medication or surgery. Most mild to moderate cases are treated with medication. Severe cases, complicated cases or those that do not respond to medication require surgery. There are still other modalities of treatments for those who are not controlled with medication and are not fit for surgery.
Does the problem run in families?
This condition has some hereditary component. This means if one’s father had BPH, he is more likely to have BPH when he gets old as compared to his friend whose father did not have BPH.
Can prostate cause problems in young men also?
BPH is the most common prostate-related illness in humans. There are other problems related to the prostate which are fairly common as well. In young and middle-aged men, Prostatitis troubles men rather than BPH. Prostatitis means inflammation of the prostate gland which is most commonly due to bacterial infection of the organ. The symptoms are the same as that of a urinary tract infection – burning in urine, frequency, urgency, lower abdomen, and perineal pain, and fever. As compared to uncomplicated UTI, the treatment of Prostatitis requires much longer use of medication. Prostatitis, if not treated on time and fully can develop complications.
What are the complications of Prostatitis?
There can be pus formation inside the prostate, known as a prostatic abscess. In such a case, a Urologist may need to drain the pus for early and complete recovery of the patient. Another complication is what we call chronic prostatitis, which is persistence and/or recurrence of urinary symptoms mentioned above that are a continuous source of bother to the patient which adversely affects the quality of life. This can also be controlled with long term medication.
Are there any other common prostate problems? What about Prostate cancer?
Prostate cancer is another problem of elderly men that is much common than usually thought and is increasing with increasing life expectancy. It is estimated that 1 in 7 men will develop prostate cancer. It is rarely seen before 50 years of age. The incidence increases with increasing age.
How does prostate cancer affect a person?
Prostate cancer is not to be feared off. This cancer varies widely in aggressiveness. Most commonly, it is of low or moderate grade which is a very slow-growing type. Low-grade cancer may take several years to spread in the body and cause problems. The common problems caused by cancer are local problems like BPH due to an increase in prostate size. Other problems are due to the spread of cancer to other body parts. The most common body part affected is bones when it causes back pain. Also, loss of weight and appetite are seen when cancer spreads.
How to detect prostate cancer?
The answer is a rectal examination by a Urologist and PSA (Prostate-Specific Antigen). These 2 tests are simple tests to screen for prostate cancer. PSA test is a simple blood test that detects a chemical released from the prostate which is increased in any prostate disease. So, all increases in PSA does not reflect cancer. However, any abnormal PSA test result should be discussed with a Urologist to ensure what it represents. If any suspicion arises for prostate cancer, further tests like MRI, PSMA-PET, Prostate biopsy, CT Scan of the abdomen, Bone scan, etc. are needed to confirm the diagnosis, stage the disease and decide for the treatment.
What is the treatment of prostate cancer?
There are different treatment options for prostate cancer, one of which is to do nothing. That’s right, we can just leave it if it is low grade, low stage, and the patient has low life expectancy due to age or co-morbidities. Otherwise, treatment options include surgery, radiation therapy, hormone therapy, chemotherapy, novel hormones, immunotherapy, and new targeted agents. The treatment depends on the stage and grade of cancer.
Important take-home message:
I would like to give is that prostate problems are common and easily treatable if detected early. Do not hesitate to consult a Urologist if you suspect any prostate problem.
Dr. Paras Singhal | Consultant – Urology | Dharamshila Narayana Superspeciality Hospital, Delhi
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