My Prostate is Enlarged, What’s Next?

  • 04 Feb 2020

Have you noticed more frequent visits to the bathroom, or experienced difficulty starting urination? These problems could be disturbing. In this article, we speak to urologist Dr Jimmy Beng to learn more about a possible reason behind them: an enlarged prostate.
 

Why Should I Care If My Prostate Gland Is Enlarged?

An enlarged prostate is one that has grown abnormally, from the healthy size of a walnut[1] to potentially even that of a lemon. Anatomically, the prostate gland sits below the bladder and near the base of the penis. It secretes nutrient-rich fluids that protect and nourish the sperms (as semen), and contracts to push the semen out during ejaculation.

“Prostate enlargement by itself does not need treatment, but the patient will need to consult a urologist if it is obstructing urine flow or causing various flow issues,” explains Dr Beng.

As the prostate gland grows, it puts increasingly more pressure on the bladder and urethra that can lead to urination problems many aging men may experience.

The most common condition for the prostate gland is Benign Prostate Hyperplasia (BPH). This is a non-cancerous enlargement.

A normal prostate gland should feel smooth, with a rubbery surface and a soft groove down the middle. “For an enlarged prostate, doctors may find it firmer, or bulging with an enlarged feel (by experience),” shared Dr Beng.
 

A Dive into Benign Prostate Hyperplasia (BPH)

The cause of BPH is not fully clear but it has been attributed to the build-up over decades of a male hormone called dihydrotestosterone (DHT), which encourages prostate swelling.

“However, the problem also runs genetically amongst male members of the family,” added Dr Beng.

Statistics have shown that one in two men above 50 years of age suffer from an enlarged prostate, and the prevalence in Singapore has increased over the years especially with a greater life expectancy.
 

Risk factors to look out for [2]

  • Sedentary lifestyle
  • Age (over 50 years old)
  • Medical conditions such as heart disease
  • Diet high in red meat and fats
     

Symptoms to look out for

  • Weak urine stream
  • Passing urine more often
  • Interrupted urine flow with dribbling at the end
  • Incontinence (urine leakage)
  • Blood in urine
  • Nocturia (waking up at night to urine)
  • Sensation of incomplete bladder emptying
  • More effort needed to start the urine flow

If you start to experience more than two of the above-mentioned symptoms, especially the more severe ones like blood in urine, you should visit a doctor for further investigation.


Methods of Examination [3]

  • Digital rectal examination, which sees a doctor inserting a lubricated gloved finger into the rectum to feel the prostate. This method allows the doctor to detect an enlarged prostate and acts as the first step in detection
  • Abdominal Ultrasound Scan that detects the enlarged prostate, along with how well you can empty your bladder
  • Prostate-specific antigens (PSA) blood test that checks for the level of this antigen, which becomes elevated when the prostate is enlarged.
     

Treating BPH

For mild conditions, doctors often recommend a wait-and-see approach that involves observing the symptoms, adjusting fluid intake, increasing physical activity and eating more fruits and vegetables. If that is not enough and symptoms persist, further treatment will be prescribed.
 

Traditional Treatments

Medications

They come in two forms: those that help to block the production of DHT and those that relaxes the prostate. Drugs that relax the prostate are called alpha blockers[4] and they often act as the first line of treatment. It works by relaxing the muscles of the prostate and the bladder neck, easing the urine flow.


Surgery

Surgical methods include transurethral resection of the prostate (TURP) and open surgery. [5]TURP involves surgical removal of the inner portion of a prostate via the urethra. 90 percent of all prostate surgeries are done this way. The main benefit is its minimally- invasive nature, which quickens recovery time and lessens discomfort.

Open surgery is opted for when a prostate becomes too large to be inoperable through the transurethral route. This is the most invasive procedure and will require a longer hospital stay and recovery time.


Advanced Treatment

Thermodilatation Microwave Therapy

Thermodilatation Microwave Therapy is a non-surgical and medication-free outpatient treatment exclusively available at Farrer Park Hospital that provides BPH symptomatic relief to the patient.

This procedure uses low heat to shrink the prostate tissue and takes about 45 minutes under local anaesthesia. It has been proven to be safe (with minimal sexual side effects), effective with high patient tolerance and more affordable compared to surgery.


Will BPH re-occur after treatment?

“After treatment, the condition of a benign prostate enlargement can recur over 10 years or more. This is because the capsule is intact, which means the growth of the glandular portion can regrow,” emphasises Dr Jimmy Beng.

However, majority of elderly patients who undergo treatment will go through life without further prostate flow problems.


Keeping Your Prostate Happy

It is important to care for your prostate health so that you can enjoy high quality of life deep into your silver years. The key is to eat in moderation and exercise frequently. In the event that you develop symptoms associated with BPH, do seek medical help immediately as early detection and treatment will help to increase your chances of recovery.


References
[1] https://www.healthhub.sg/sites/assets/Assets/PDFs/HPB/Older%20Adult/luts_English.pdf
[2 ]https://res.cloudinary.com/pcf/image/upload/v1564607692/2019_PCF_PatientGuide_Interactive_7.31.19_FINAL_agvohj.pdf
[3] https://www.webmd.com/men/picture-of-the-prostate#1
[4] https://www.webmd.com/drugs/2/drug-1548-167/finasteride-oral/finasteride-oral/details
[5] https://www.healthymale.org.au/files/resources/bph_prostate_enlargement_fact_sheet_healthy_male_2019.pdf

Contributed by

Dr Jimmy Beng
Urologist
SMG Urology Centre with Beng Surgery
Farrer Park Hospital