prostate health overview

This article written by Dr. John Hubbard first appeared in Kentuckiana Healthy Woman: July/August 2007

Just How Many Problems Can an Enlarged Prostate Cause?

Most men have some knowledge of prostate cancer because prostate cancer is the most common cancer in men. However, few know how it functions and how it affects their daily activities. Just like the men in the Flomax ad - most men would rather be someplace besides the bathroom.

The prostate gland sits at the neck of the bladder and starts to slowly enlarge once a man reaches reproductive years. Its job is to make the fluid that serves as a vehicle to carry the sperm to impregnate their partner. When a man ejaculates it is 90 percent prostate fluid and 10 percent sperm. The glandular tissue that grows to reproduce the fluid continues to grow throughout most of a man’s life. If the growth is to the inside, it blocks the outlet tube from the bladder and men have trouble urinating.

It’s best to think of the bladder as the reservoir and the prostate channel  as the outlet pipe. If there is a problem with a blocked pipe, men develop lower urinary tract symptoms called LUTS. It’s  easy to understand LUTS symptoms if you think of a blocked pipe in a reservoir that can’t drain completely.

LUTS symptoms include:

  1.     Weak stream
  2.     Difficulty starting urination
  3.     Feeling bladder is full after urinating
  4.     Frequent need to urinate
  5.     Getting up too frequently at night to urinate

When the prostate enlarges, the condition is known as benign prostate hyperplasia (BPH). As described above, when the prostate growth is inward, you get blockage. If the growth is outward and not around the urethral tube, men can get very large prostates but have no symptoms. This is O.K. because we only treat men with symptoms.

Prostate cancer is a totally different animal. Cancer usually occurs in the outer, or peripheral, part of the prostate, so there are rarely symptoms unless the cancer is far advanced. Prostate cancer is detected by an examination and a blood test called PSA.

Another close association with BPH is erectile dysfunction (ED). Large studies have shown men with BPH have a much higher rate of ED. To achieve an erection you need a good blood flow to the penis and intact penile nerves. A man can “worry himself” out of an erection. It begins with a fear of failure, leading to adrenaline release; then nerves are triggered, making penile muscles collapse; blood flows out of the penis and the erection disappears. Many think BPH leads to poor erection because of this “worry” factor.

Men typically don’t see a doctor until their 40s or 50s unless they have a specific problem. So when something is wrong   “down there” (i.e. frequency, urgency and poor stream) men worry, and it shows up as a poor erection. Many men start to experience BPH and LUTS in their 40s and 50s and others not until their 70s and 80s. It depends on the rate of prostate growth and which lobes are enlarged.

Many treatment options are available for BPH. The most common treatment is medication. There are several  from which to choose and, depending on the size of the prostate gland, improvement can occur in two days to six weeks.

Minimally invasive prostate shrinkage has become popular because it can be done in the office setting under conscious sedation with an 80 percent success rate. It’s  important to get an accurate preoperative testing to determine the size of the prostate and which lobes are enlarged to make sure  the right type of treatment is performed. Minimally invasive surgery offers the option of not having to stay on BPH meds the rest of your life.

Now to confuse you even more, when a man has symptoms the prostate is not always the culprit. A bladder “reservoir” that wants to trigger too much can mimic prostate enlargement. The main cause is consuming too much caffeine and artificial sweeteners, which irritate the bladder, causing frequent urination and not giving the kidneys time to refill the bladder; so it presents as a poor urinary stream.

So men, yes, you can have prostate trouble  in your 40s an 50s. To find out what is really going on see your doctor. There are things that happen to your body that you just can’t figure out for yourself.

  1.     Why am I going to the bathroom more frequently?
  2.     Are my symptoms a natural part of aging or is something more serious going on?
  3.     Is ED related to BPH or do I have an artery blockage that could be affecting parts of my body?
  4.     Why am I getting up more frequently at night? This makes me more tired during the day.

John Hubbard, M.D. has been practicing urology for over 25 years. Since opening the Hubbard Clinic in 2000, he has converted his practice to focus on male prostate health, especially the treatment of BPH. In the last five years, he has performed over 450 minimally invasive procedures for BPH in his office. Dr. Hubbard can be reached at 502-893-3510. Or visit