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All you need to know about an enlarged prostate.

By Eduardo Gonzales, MD

Is it really normal for older men to have an enlarged prostate? Does an enlarged prostate cause cancer or impotence? How can I tell if my prostate is enlarged? What is the treatment for this condition?

As a rule, the prostate, a small gland that is present only in males, starts to enlarge at age 25. This growth is continuous but gradual, but I don't know whether you can call this phenomenon normal because it sometimes gives rise to urinary problems. The medical term for the enlargement of the prostate that is associated with aging is benign prostatic hyperplasia (BPH).

The prostate is about the size and shape of a chestnut (kastanyas in Filipino). It produces fluid that forms part of semen (male ejaculate). It lies below the urinary bladder and the initial segment of the male urethra--the tube that serves as passageway of urine from the urinary bladder to the external environment--passes through it. Thus, enlargement of the gland can compress and choke the urethra and impede the flow of urine from the bladder to the outside giving rise to urinary symptoms.

BPH rarely causes symptoms before age 40, but by age 60, about one-third of men experience moderate to severe symptoms, and by age 80, about half do so. Only 10 percent, however, of symptomatic patients need medical or surgical treatment.

The exact cause of BPH is not known yet, but it probably has something to do with testosterone, the male hormone. Aside from age, the other risk factors, albeit minor, for the disease are family history, diabetes, heart disease, and obesity.


Some of the signs and symptoms of BPH are similar to prostate cancer, but BPH does not lead to nor does it increase a man's chances of developing prostate cancer.

BPH, per se does not give rise to erectile dysfunction (ED), however, certain treatments for the condition can cause ED and other sexual side effects.


You could have BPH if you experience hesitancy or difficulty in starting urination, urgency or a need to urinate right away, a weak or frequently interrupted urine flow, a feeling of incomplete emptying of the bladder, dribbling of urine after urination, frequent urination especially at night, and burning sensation or pain during urination.

BPH is diagnosed by physicians by doing a rectal examination and feeling for the prostate. Sometimes, other tests are prescribed such as ultrasound examination, cystoscopy, biopsy, and urine flow studies.


In mild cases of BPH, the symptoms usually clear up spontaneously. Thus, the management consists simply of "watchful waiting" with medical monitoring once a year. BPH, however, has to be treated if the symptoms become very troublesome or if complications such as sudden inability to urinate (urinary retention), repeated urinary tract infection, kidney or bladder stones, or bladder or kidney damage occur.

Generally, symptomatic BPH is initially treated with drugs. The drugs that are presently being used work either by relaxing the muscle fibers within the prostate and the urinary bladder, thereby easing the obstruction to urine flow, or by shrinking the prostate through drugs that counteract the effects of testosterone on the gland.

Sometimes, surgery may have to be performed to ease if not eliminate the symptoms of BPH. The most common surgical procedure for BPH is transurethral resection of the prostate (TURP) where, under anesthesia, parts of the gland that impinge on the urethra are peeled off by means of an endoscope (a flexible tube with attached surgical instruments) that is inserted into the urethra through the penis. Other surgical procedures include transurethral needle ablation (TUNA) also known as radiofrequency ablation, transurethral microwave therapy (TUMT), laser treatments, and stenting of the urethra.

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Title Annotation:Well-Being
Publication:Manila Bulletin
Date:Apr 10, 2018
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