Prostate enlargement or increase in the size of the prostate gland is a widespread medical condition in people above the age of 60.
According to Harvard Medical School, half of all men experience prostate enlargement by the age of 60 and more than 90 per cent experience it by the age of 90.
Though one has not been able to pinpoint the exact cause of prostate enlargement, medical experts believe it can be one or a combination of factors like hormonal changes, genetic coding, familial lineage, dietary habits, geographical and racial factors etc.
What is prostate gland?
Prostate is a walnut-shaped gland located at the base of the bladder surrounding the urinary passage (urethra) and is present only in males. The prostate gland is an important part of the male reproductive system and its main function is the formation of semen.
Causes of prostate enlargement
The prostate gland enlargement can occur in three conditions:
- Benign prostate hyperplasia (BPH): Non-cancerous prostate enlargement which occurs due to an overgrowth of cells.
- Prostatitis: An inflammation or infection in your prostate that causes pain in your genitals, lead to urinary problems, cause abdominal pain and get fever or chills.
- Prostate cancer: Increase in size due to cancerous growth of the prostate.
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Signs of prostate enlargement
As the prostate gland is located around the urinary passage, the enlarged prostate puts pressure on the urethra leading to various symptoms called LUTS (Lower urinary tract symptoms). The most common signs and symptoms of prostate enlargement include:
Decrease in urine stream: Patients with enlarged prostate find it difficult to initiate urination and may occasionally strain to void.
Urinary frequency: Due to obstruction to urine flow by an enlarged prostate the bladder pressures are raised as the bladder tries to empty urine against the enlarged prostate leading to symptoms like frequent urination, urgency and occasional leak of urine.
Nocturia: Getting up frequently at night to urinate is one of the earliest and most common signs of prostate enlargement.
Painful micturition in patients with inflamed or infected prostate may cause painful urination.
Sense of incomplete voiding: Post-void dribbling of urine due to prostatic compression bladder may not empty and residual urine may remain in the bladder.
Intermittency or hesitancy while voiding: Interrupted urine stream due to compression by prostate
Blood in urine: If the prostate is inflamed or if there is an associated stone in the bladder due to chronic prostate enlargement hematuria can happen
Urinary retention: When an enlarged prostate compresses urine passage completely, urinary retention can happen and you may need a Foleys catheterisation and surgery.
Patients with these symptoms should consult a urologist immediately to further evaluate the prostate.
Diagnosis of prostate enlargement
Evaluation starts with a history of symptoms like their severity and duration. A scoring system was developed for these prostatic symptoms and patients are categorized to have mild, moderate or severe LUTS. Physical examination is later done where a urologist does a finger examination of the prostate (Digital Rectal Examination) and check its size and consistency. A hard or nodular prostate is suspicious of cancer and needs further evaluation.
Tests like urine examination and serum creatinine are done to look for any signs of infection in the urinary tract and to assess kidney function. Serum PSA (Prostate-specific antigen) is a blood test done to screen for prostate cancer.
PSA is a protein made by the prostate and it is normal to have PSA in blood. PSA is prostate-specific and not cancer-specific, meaning its levels can be elevated with any disease of the prostate and not only in prostate cancer. Patients with raised PSA should be evaluated further with tests like MRI prostate, PET scan and Biopsy of the prostate to confirm the diagnosis of prostate cancer.
Ultrasound scan of the abdomen is a reliable and easily available test to diagnose prostate enlargement. In ultrasound, we look for prostate size and, the condition of the bladder and kidneys. A scan is done after the patient voids to look for any residual urine in the bladder after voiding.
The normal prostate measures around 15-20 cc (cubic centimeters) and depending on the size of the scan they are graded from 1-4.
A urine flow test (Uroflowmetry) can be done in specialised urology centres. This test involves passing urine into a machine that measures the speed of your urine flow. If you are passing urine slowly, it may mean that your prostate is pressing on the urethra significantly.
Other tests like urodynamics, cystoscopy etc. are done in special circumstances as deemed necessary by the treating urologist.
Treatment and prevention
Treatment for an enlarged prostate depends on the severity of the symptoms.
If the patient has only mild symptoms there is no need for immediate treatment. You can prevent it by making some lifestyle changes, such as:
- Drinking less alcohol, caffeine and fizzy drinks
- Limiting intake of artificial sweeteners
- Exercising regularly
- Drinking less fluid in the evening
If the symptoms are moderate to severe, medicines to reduce the size of the prostate and relax bladder outlet may be recommended.
Surgery is usually only recommended for moderate to severe symptoms that have not responded to medicine or patients who have prostate enlargement causing severe complications like urinary retention, recurrent urinary infections, bladder stones or kidney failure.
Consulting an expert urologist when there are warning symptoms or signs is pivotal for early detection and prompt treatment.
