The Prostate

     The prostate is a muscular gland about the size of a walnut that is a part of the male reproductive system.  It is located below the bladder and in front of the rectum and surrounds a part of the urethra which is a tube where urine and semen passes out of the body.  The normal size of the prostate is 20 grams.  The prostate secretes prostatic fluid which combines with sperm from the testicles and other fluids from adjacent glands to form semen.  During sexual climax, muscles of the prostate are responsible in propelling the semen out of the penis through the urethra.

     Disorders of the prostate start to affect men at age 40.  There are three conditions affecting the prostate: benign prostatic enlargement, prostatitis and prostate adenocarcinoma.  The prostate is not part of the urinary system but due to its location and relationship to the urethra, it causes lower urinary tract symptoms or LUTS. 

     Symptoms brought about by disorders by the prostate can either be obstructive or irritative or a combination of both.  Urologists use a scoring system call the International Prostate Symptom Score (IPSS) to assess their patients’ urinary problems.  The IPSS will classify symptoms as to mild, moderate or severe and will serve as the  basis for the treatment option best  suited for the patient. 

     For men with prostate problems, aside for a thorough history taking, the mainstay of diagnosis is to do a digital rectal exam (DRE).  This examination will give vital information since the examiner can give a rough estimate of the prostate size, note the consistency of the prostate and suspicious tumors can also be felt.

     Essential laboratory and imaging tests include the following: PSA or prostate specific antigen, creatinine, urinalysis, ultrasound of the the kidneys, ureters and bladder.  An ultrasound of the prostate done through the abdomen is not an accurate tool since there can be discrepancies with the size, a more accurate way of getting the prostate size is by doing a trans-rectal (through the rectum) ultrasound. It is emphasized that no laboratory or imaging test can replace the DRE in diagnosing prostate problems.  

      Prostate problems are classified as benign (non cancerous), inflammatory and malignant (cancerous).

     Benign prostate enlargement or hypertrophy (BPE or BPH) is a common occurrence in men in their mid-50’s.  This happens when the overgrowth of the prostate constricts the urethra causing obstructive symptoms or the enlarged prostate impinges on the bladder causing irritative symptoms.  Obstructive symptoms include interruptions in the urine stream, having to wait before urine comes outs, sensation of not emptying the bladder completely and a weak urinary stream.  Irriitative symptoms are bothersome which include the following: increased frequency of urination at less than 2 hour intervals, strong urge to urinate and having to get up at night more than two times. 

     BPH occurs due to increased production of the cells or to impaired normal programmed cell death or apoptosis leading to accumulation of more cells in the gland.  The condition is associated with hormonal changes that occur as men age. The testes produce the hormone testosterone, which is converted to dihydrotestosterone (DHT) and estradiol (estrogen) in certain tissues. High levels of dihydrotestosterone, a testosterone derivative involved in prostate growth, may accumulate and cause increased cell production in the prostate. 

    There is also substantial evidence that genetics play a role in development of BPH.  The inheritable form of BPH is more common in men below 60 years old who underwent surgery for the prostate.  

    There is, however, no convincing evidence for any individual diet/factor to play a major role in the development of an enlarged prostate.  Therefore, any diet modification will not directly affect nor improve symptoms brought about by an enlarged prostate.

    Complications from an enlarged prostate include: urinary retention, recurrent urinary infection, formation of urinary bladder stones, renal insuffiency, blood in the urine and urinary bladder wall disruption (diverticulum).

   The treatment options for prostate problems depend on the symptom score.  For mild symptoms, observation and an annual DRE is done.  For moderate symptoms,   the initial treatment is medical.  There are two drugs for the prostate: first are the alpha blockers which work on the prostatic part of the urethra as well as the bladder neck.  These relax the prostatic urethra and bladder neck to ease the flow of urine as well as decrease the pressure on the bladder to minimize irritative symptoms.  Second are the 5-alpha reductase inhibitors (ARI) which block the hormones responsible for enlargement of the prostate.  The 5-ARIs however have to be taken constantly and it may take 6 to 12 months before improvement in symptoms will be noticed. 

     For severe symptoms, the main treatment option is surgery.  There are two types of surgery for the prostate: cystoscopic and open.  A cystoscopic transurethral resection of the prosate (TURP) is done by inserting operating telescope through the penis going to the bladder.  The obstructing prostate tissue is then resected to achieve an opening in the urethra.  An open prostate surgery is done for prostates more than 70 grams as well as those with urinary bladder stones and diverticulum.

    Prostate problems arise as men age.  Symptoms may vary from person to person.  It is strongly advised that men should start to see their urologist and have their prostates checked when they are already in their forties.  The treatment option would depend on the combination of their history, physical examination and laboratory results.