The Scoop on Enlarged Prostate

QUESTION: I am 58 years old and recently went to my doctor because of some difficulty passing urine. He feels that I might have an enlarged prostate and has referred me to a urologist.

What is likely to happen when I go for my clinic appointment?

What does an enlargement of the prostate mean and what medical treatments are available to treat this condition?

ANSWER: The prostate gland is just below the bladder and in front of the rectum. It surrounds the first inch of the urethra (the tube through which urine and sperm exit the body).

Usually, the prostate gland starts to enlarge after middle age. When the prostate becomes enlarged, the condition is called benign prostatic hyperplasia (BPH).

BPH affects 40 percent of men in their 50s and 90 percent of men in their 80s. If the enlarged gland begins to press on the urethra and to interfere with urination, then treatment may be needed.

The main symptoms of BPH are: difficulty initiating a urine stream; a hesitant, interrupted and weak stream; and urgency and leaking or dribbling.

Over time, as the urethra becomes narrower, the bladder wall may become thicker and the bladder itself may get smaller, causing more frequent urination; bladder irritability; a sudden, strong urge to urinate, especially at night; and urge incontinence (occurs when bladder muscles are too active). People with urge incontinence lose urine as soon as they feel a strong desire to go to the bathroom.

If a man suddenly becomes unable to pass any urine at all, this condition is called acute urinary retention.

The size of the prostate does not always determine how severe the obstruction or the symptoms will be.

Some men with greatly enlarged glands have little obstruction and few symptoms, while others whose glands are less enlarged may have more of a blockage and greater problems.

To diagnose BPH, a full medical history will be taken when you attend the hospital. Specific questions relating to your urinary symptoms will be recorded in a special questionnaire called International Prostate Symptom Score (IPSS) which allows a more objective assessment of your urinary difficulties.

A digital rectal examination will be performed by inserting a gloved finger into your rectum.

This enables the doctor to assess the size of the prostate and also to determine whether there are any abnormal areas which would increase the suspicion of prostate cancer.

Blood will be collected for a Prostate-Specific Antigen (PSA) blood test (which has been covered previously in this column).

Higher than normal levels of prostate-specific antigen in the bloodstream may indicate BPH, prostate cancer or prostatitis (inflammation of the prostate).