When it comes to a man’s prostate, it really is a growing problem. In fact, doctors say all men will develop at least an enlarged prostate if they live long enough – it’s just part of the aging process.
“Everybody’s prostate is growing throughout their lives,” says Dr. Brooke Johnson, a Dean & St. Mary’s urologist. “It starts in your 40s and by your 50s the size of the prostate can lead to difficulty in urination like a slow stream, not getting completely empty, having to get up multiple times at night, those types of things.”
The prostate is a walnut-sized gland located near the bladder. An enlarged prostate is known medically as benign prostatic hyperplasia or BPH. It starts out as a nuisance and can stay just that. But, for some men, it progresses into something more serious like urinary retention, urinary tract infection or bladder stones and that’s when it’s time to turn to your doctor for advice.
“In my mind when it starts to cause permanent damage, it’s serious,” says Dr. Johnson. “If it takes a long time to go to the bathroom, that’s an inconvenience. But if things get worse, you can develop bladder distention which ultimately can lead to the bladder no longer being able to contract and push urine out. People who aren’t able to empty their bladder can develop kidney issues. And bladder stones - while not damaging –also won’t go away on their own and require surgery to fix.”
BPH can be caused by prostatitis, an abnormal inflammation of the prostate potentially caused by an infection. A long course of antibiotics can sometimes clear up prostatitis. But alternative treatments also might be needed.
“Because we don’t always know definitively what we’re attacking, it’s hard to narrow down a specific treatment,” says Dr. Johnson. “Antibiotics are one choice, but others include anti-inflammatory medication, alpha blockers, or even something as simple as taking warm baths to relax the prostate.”
Some men swear that herbal supplements, such as palmetto, help to keep their prostates in check; doctors say the jury is still out.
“There are people who would advocate for something like palmetto, but when you look at the studies, although some show there may be a mild effect, there isn’t clinical evidence of a major benefit to taking the herb,” says Dr. Johnson. “Additionally, there’s not much you can change when it comes to diet or lifestyle to slow or stop the growth of your prostate.”
The most serious problem of all is prostate cancer which is the second most common cancer next to skin cancer in men. And for African American men, there’s a 60 percent greater risk of developing prostate cancer. But even the fastest growing prostate cancer is relatively slow when compared to other types of cancer.
Men who are diagnosed with prostate cancer have several treatment options. Which is best depends, in part, on the man’s age.
The first treatment option is surgery and radiation. This aggressive treatment is primarily for men who have the fast growing prostate cancer and many years life expectancy. However, there are potential side effects from surgery, so men may choose to follow what’s called “watchful waiting” or “active surveillance.” With this approach the cancer is monitored to see how fast it’s growing.
“With active surveillance you avoid the side effects of treatment,” says Dr. Johnson. “And many times we find, especially in older men, they will die from other natural causes before the cancer can grow large enough to cause harm.”
However, just hearing the word “cancer” can evoke some pretty strong emotions. But Dr. Johnson says not all forms are cancer are the same.
“Hearing the word cancer in the 1970s meant you were likely going to die, but as patients are becoming more educated they realize not all cancer carries the same weight,” he says. “Really, when you’re talking about screening for cancer I find most patients are willing to have the discussion. The danger comes in the patients who never have the discussion.”
So how do you detect prostate cancer? If you wait for signs and symptoms, the cancer could be already widespread. Instead, men should talk to their doctors about a prostate screening called PSA testing. Since this particular cancer seems to have a strong genetic component, you may want to have this discussion when you’re younger especially if your father, brother or son has prostate cancer.
“For men with no family history, PSA testing should be done beginning at age 50. But for people with a family history and African Americans, this testing should really begin around age 40,” says Dr. Johnson.
The question then becomes when to stop. Critics argue that long-term testing leads to overdiagnosing the cancer in men whose lives wouldn’t have been impacted because it grows slowly. Dr. Johnson says that’s why guidelines now say you can stop looking for prostate cancer beginning at age 75 or when your life expectancy is 10 years or less.
Dr. Johnson says there’s a lot of opinion out there on the topic of prostate health and it’s important for all men to be educated. “The key is for a patient to get informed and make a plan for themselves.”
Who’s at Risk for Prostate Cancer?
- Men between 40 and 80 years old
- Men with a brother, father or son with prostate cancer are 2-3 times more likely to develop the disease
- African American men have a 60 percent greater risk compared to their white counterparts
Prostate Problems by the Numbers
- 90% - the number of men over age 80 with an enlarged prostate
- 189,075 – number of men diagnosed with prostate cancer in 2004
- 30,870 – number of African American men diagnosed with prostate cancer in 2007
- 2 – Prostate cancer is the second leading cause of cancer death among all men
- 1 in 5 – the lifetime risk of an African American male to develop prostate cancer
- 1 in 6 – the lifetime risk of a white male to develop prostate cancer
- 1 in 35 – the number of men who die from prostate cancer
Prostate Cancer Treatment Options
If your doctor detects prostate cancer and recommends a prostatectomy, you have several options. The first is called open prostatectomy. In this surgery, doctors make an incision in the lower abdomen or groin and then remove the prostate. Recovery tends to be longer and there’s a greater risk for complications. In contrast, laparoscopic surgery requires several tiny incisions, has a much smaller risk for complications and better recovery time.
Dr. Brooke Johnson says the best option for many is the newest procedure, laparoscopic robot-assisted surgery. In this surgery small incisions are once again made and the surgeon guides tiny 8 mm robotic “hands” to remove the prostate gland. It had the shortest recovery time and patients report feeling less pain.