Professor Kirby gives you the low down on your prostate – what it is, where it is, how it changes, signs and symptoms to get checked, how to protect it, and what to expect when things do go wrong.
- The prostate is about the size of a ping pong ball and surrounds the urethra (the tube that empties urine from the bladder).
- From the age of 40 it grows – the majority of men over age 80 have benign prostatic enlargement (BPE, also known as Benign Prostatic Hyperplasia or BPH).
- A common ‘red flag’ that all is not well with your prostate is getting up in the night to pee more than you used to.
You might not know what it’s for or even where it is, but that elusive ping pong ball-sized gland can cause a whole heap of trouble if you ignore symptoms that suggest an examination would be wise.
Statistics show 57,192 new cases of prostate cancer were diagnosed in the UK in 2018 (the latest figures available). That’s a pretty big number.
The good news is that if you catch it early, your chances of survival are excellent.
What – and where – is the prostate?
The prostate is an integral part of the male reproductive system, which includes the penis, prostate, seminal vesicles, and testicles. It’s located just below the bladder and in front of the rectum.
Its job is to produce the fluid that nourishes and transports sperm.
It’s about the size of a ping pong ball and surrounds the urethra (the tube that empties urine from the bladder).
Things to check
A common ‘red flag’ that all is not well with your prostate is getting up in the night to pee more than you used to.
But urinary problems can also be caused by infections, diabetes, or some medicines, so it’s always best to have a proper consultation with your doc if you’re worried.
Your need to be within shouting distance of a loo could simply be a sign that you are aggravating your symptoms by drinking the wrong stuff – alcohol, caffeine and fizzy drinks can irritate the bladder and make you pee more.
Does it change?
Absolutely – it grows, starting from the age of 40, with the majority of men over age 80 having benign prostatic enlargement (BPE, also known as Benign Prostatic Hyperplasia or BPH).
- Obese men have a three and a half times increased risk of an enlarged prostate compared with slimmer chaps.
- The most common and most proven surgical option for benign prostatic enlargement BPE is something called Transurethral Resection of the Prostate, or TURP.
- Genetic factors may contribute as much as 72 % to the risk of lower urinary tract symptoms (LUTS) in your bladder, prostate and urethra.
Note, this isn’t a type of cancer, and it doesn’t increase your risk of developing prostate cancer.
BPE is a common condition and autopsies have shown BPE in eight percent of men in their 30s, 50 percent of men in their 50s, and 80 percent of men in their 80s.
Very large prostates can make it harder to pee (‘increased urinary retention’, if you’re a medical type).
They may require surgery, so don’t keep quiet if you’re suffering. It’s common and there’s lots of help available. It’s an age thing. Most of your mates are probably experiencing similar symptoms.
Who’s at risk of an enlarged prostate?
Genetics and geography influence your chances of having an enlarged prostate – it’s less likely in South East Asians, and more likely if your male relatives have BPE.
So it’s just my genes to blame?
Afraid not. Your lifestyle and diet play a big role, too.
It’s to do with something called ‘metabolic syndrome’. That’s health issues linked to a sedentary lifestyle , which include obesity, high glucose levels, cholesterol and high blood pressure. These all increase the risk of heart attacks, strokes and diabetes.
Metabolic syndrome is also associated with increased risks of BPE and LUTS.
Men diagnosed with at least three of these contributing factors have an 80 % increased prevalence of LUTS compared with those with none.
How big a deal is my weight?
It’s directly related – the higher your weight, the bigger your prostate volume. Obese men have a three and a half times increased risk of an enlarged prostate compared with slimmer chaps.
Not being able to control your blood sugar properly – aka pre- or full-blown diabetes – also seems to have a knock-on effect on your prostate, as well as affecting the effectiveness of treatments. Time to ditch the junk and fizzy drinks and get exercising?
There’s a direct positive correlation with exercise. Regular moderate to vigorous physical activity reduces the risk of BPE or LUTS by as much as 25 %.
Can what I eat affect it?
Yes – and it’s the usual suspects. Your prostate won’t thank you for a diet largely based around processed foods, including highly refined cereals and bread.
To lower your risk, load up on the following:
- Fruit and vegetables, particularly carotenoids like carrots and butternut squash.
- Nuts and seeds which are packed with polyunsaturated fatty acids and linoleic acid (for this also try tofu)
- Leafy green veg like spinach for vitamin A
- Oily fish like salmon for vitamin D – you can also get this from getting out into the sunshine.
So, what are the symptoms?
Less than half all men with BPE show symptoms – but they can include:
- Increased dribbling at the end of a pee
- Inability to urinate when you feel you need to go
- The strong and sudden need to urinate.
Tell the doctor about any unusual peeing symptoms you wouldn’t feel comfortable discussing in polite company.
Professor Mike’s quick tip: If you massage from under the scrotum forwards and upwards, you can massage out those drops that dribble out after you have finished. It’s a U-bend down there so this may help.
Ok, so what can my doctor do?
He or she will ask questions about your medical history – and likely conduct a rectal examination to feel the size and texture of the prostate gland (basically, they’ll put their finger up your bottom but it’s nowhere near as bad as it sounds).
Other tests include a urine flow and pressure rate assessment, to see how much urine is left in your bladder after you urinate, taking a sample to check for blood or infection, a Prostate-Specific Antigen (PSA) blood test to exclude prostate cancer or blood tests for kidney function.
You’ll also likely be asked to keep a diary of what you drink and when, as well as how often you pee. It’s arguably not a diary many publishers will be fighting over for rights, but potentially worth its weight in gold to you and your doctor.
What’s the treatment?
This will be affected by your symptoms, and how much they affect you. For mild symptoms, it might simply be a matter of ‘watch and wait’ and making lifestyle changes.
Often a course of antibiotics can improve the situation, but sometimes surgery’s the way forward.
Reasons to go under the knife include incontinence, blood in the urine, urinary retention, recurrent infections, bladder stones and kidney malfunction.
The most common and most proven surgical option for BPE is something called Transurethral Resection of the Prostate, or TURP. This rather delicate procedure involves inserting a scope through the penis and removing the prostate, piece by piece.
There are also heat and laser treatments to destroy excess prostate tissue, . These have a lower risk of erection problems and incontinence, which is already an uncommon problem of TURP.
What can I do to help my symptoms?
You can be proactive to protect your prostate, urinating as soon as you get the urge and making sure you empty your bladder.
Also avoiding alcohol and caffeine and general fluid consumption in the evening to limit your nocturnal bathroom pilgrimages. Keeping up your exercise will also help.
Simple medication solutions include alpha-blockers to relax the muscles of the bladder neck and prostate, making it easier to pass urine.
Finasteride and dutasteride lower levels of hormones in the prostate. These reduce the size of the gland to increase urine flow rate, and decrease symptoms of BPH.
A potential downside is they can sometimes diminish your sex drive and lead to erection problems. It’s best to take medical advice before throwing pills at the problem.
Talk to your Peppy practitioner if you’re confused about any of the issues raised in this article.