By Seth Lamming
From PHN Issue 52, Spring 2023
Dear Prison Health News,
Would you please send any and all information on an enlarged prostate? What is the end result if I have to have it removed?
– Sincerely, Mr. Tracy
Dear Mr. Tracy,
Prostate health is an important topic for anyone who has a penis. The prostate is a gland about the size of a walnut that sits below the bladder and in front the rectum. It wraps around the urethra, the tube that pee and semen come out of. When the prostate is big, it squeezes the urethra and makes it harder to pee. Its main purpose is to make some of the fluid that goes into semen. In this article, we will discuss benign prostatic hyperplasia (BPH) and prostate cancer.
Benign prostatic hyperplasia is a mouthful, so let’s break it down and make sense of it. Benign means not dangerous, or not cancer. Prostatic means having to do with the prostate. Hyperplasia means it’s larger than expected. Prostates never stop growing during a person’s life, so BPH is common. If you live long enough, you’ll likely end up with BPH.
Around 50% of people ages 51-60 have BPH, while 80% of people over 70 have BPH.
Cancer happens when cells grow out of control. So, does BPH cause cancer? The answer is no! Prostate cancer usually happens in a different part of the prostate than BPH. Prostate cancer grows really slowly, and a small number of people have metastatic cancer. Metastatic cancer is when the cancer spreads from one part of the body to another. When cancer has spread, it is more dangerous and more likely to lead to death.
Symptoms
Sometimes people with BPH have no symptoms. Sometimes people with BPH notice changes in the way they pee. Changes include having to pee more suddenly and more often, trouble starting to pee, and waking up at night to pee. BPH can cause people to retain urine, meaning they stop being able to empty their bladders. The pee stream might also change, coming out more slowly, splitting, starting and stopping, or dribbling.
Although BPH can cause these symptoms, other health conditions can cause similar symptoms. There are usually no symptoms of prostate cancer. In advanced cancer, there might be blood in urine or semen.
Tests
A medical provider might do a digital rectal exam, which is exactly what it sounds like. A provider will gently place a finger into the rectum to feel the prostate. Healthy prostates are smooth, firm, symmetric, and they should not hurt on exam. Lumps, hardened areas, uneven size, and prostate pain are not normal, and the medical provider should follow up with more tests. Your provider can usually tell you have BPH based on symptoms and physical exam.
The most important lab test related to prostate cancer is prostatespecific antigen (PSA). A PSA test is a blood test that looks for proteins released by the prostate. Prostate cancer screening looks for high levels of PSA. The normal range of PSA depends on the person’s age. The older you are, the higher your PSA will be. The main benefit of testing PSA is catching cancer before it spreads. A lot of different things can cause PSA levels to be high, such as BPH, older age, infections in the prostate, and riding a bike or other activities that put pressure on the prostate. If you are probably going to live for less than 10 years or you do not want to go through cancer testing and treatment, there is no need to test PSA.
Not all doctors recommend testing PSA. Knowing that PSA levels are not a very reliable way to check for prostate cancer, you can start getting tested at age 55. If you have a father, brother, or other close relatives with prostate cancer, start getting tested in your 40s.
If PSA levels are high and you want to check for cancer, the next step would be to do more tests. Ultrasound or MRI images can help figure out if the high PSA is from cancer. If there is enough reason to think it might be cancer, the next step is to get a biopsy of the prostate to look for cancer. A biopsy is when someone takes tissue from the body and studies it under a microscope for changes in cells.
Treatment
There are many different treatment options for BPH. Sometimes changing bathroom habits can make BPH symptoms better. Here are some things you can do to control symptoms on your own:
- Try not to drink much in the evening, especially before bed
- Drink less caffeine, soda, and alcohol
- Avoid foods that can irritate the bladder, including spicy foods, tomato sauces, and chocolate
- Make sure you are having regular bowel movements by eating plenty of fiber
- Pee on a schedule, like every 2 hours, if you retain urine
- When you’re finished peeing, wait a minute, and then try peeing again
There are two different types of meds that are usually used to treat BPH. People who retain urine and have trouble starting their stream might take a type of medication called alpha-1 adrenergic receptor antagonists. Examples of this medicine include tamsulosin (also known as Flomax). Some people take a type of medicine called 5-alpha reductase inhibitors to make the prostate grow more slowly. Finasteride (also known as Proscar or Propecia) is an example of this type of medication. Sometimes these meds are used together.
Treating prostate cancer is complicated and depends on how much the cancer has spread and how healthy you are. The good news is that prostate cancer usually grows slowly. Treatment options for prostate cancer are chemotherapy, radiation, and surgically removing the prostate. Surgically removing the prostate is also an option for severe BPH. Removing the prostate can lead to incontinence (peeing without meaning to pee), erectile dysfunction, and might affect your ability to have children in the future.
Prison Health News 