Your Prostate

When Bigger is NOT Better

The job of your prostate gland is to produce the fluid, known as semen, that transports sperm. The muscles of the prostate then force the semen into the urethra to be expelled during ejaculation. It’s normal for the prostate to enlarge as a man gets older. In fact, it ––an ed prostate gland. It’s known as benign prostatic hyperplasia, (BPH) because it’s benign or non-cancerous. In fact, it is such a common aspect of aging in men that if you live long enough you will very likely have it–– 90% of men over 80 years old have an enlarged prostate gland.

The prostate gland sits below the bladder and wraps around the urethra, which carries urine out of the body. Over time, this can become a problem, as the prostate gets bigger, it squeezes the urethra interfering with the normal flow of urine, causing a backup of urine and interfering with the normal flow

This illustration shows a small prostate and one that’s enlarged.

Join the club guys, we ladies have our flow issues too. If you’re having any issues, this quick questionnaire can help you determine if this is something to be concerned about. This is the International Prostate Symptom Score:

In the past month: 

( 0 = not at all 5 = almost always)

How often have you had the sensation of not emptying your bladder?	0	1	2	3	4	5
How often have you had to urinate less than every two hours?	0	1	2	3	4	5
How often have you found you have stopped and started again several times when you urinated?	0	1	2	3	4	5
How often have you had the sensation of not emptying your bladder?	0	1	2	3	4	5
How often have you found it difficult to postpone urination?	0	1	2	3	4	5
How often have you had a weak urinary stream?	0	1	2	3	4	5
How often have you had to strain to start urination?	0	1	2	3	4	5
How many times typically did you get up in the night to urinate?	0	1	2	3	4	5

1-7 MILD

8-19 MODERATE

20-35 SEVERE

Most men will see  their health care provider if they’re experiencing some of these urination issues:

• Incomplete emptying
• Frequent urination
• Stopping and starting
• Urgency
• Weaker flow
• Needing to push
• Many nighttime visits to the bathroom

The Exam

Your examination will include a “digital” exam, which does not mean it’s high-tech. The digit is your provider’s gloved finger reaching gently up through the rectum to feel for changes or enlargement of your prostate gland. 

PSA Test

The Prostate Specific Antigen (PSA) test is a blood test usually given starting at age 55 to identify the presence of a protein found in some cancers. But it can also miss cancers, issuing a “false-negative.” Some health organizations no longer recommend the test be taken routinely except by men who have risk factors such as a family history or genetic mutations. Many cancers of the prostate are slow growing and will never move outside of the gland itself. Whether or not to take the test should be discussed with your health care provider.

BPH Facts

• It’s normal for the prostate to enlarge with age
• It’s the most common urologic diagnosis for men 45-74
• It is NOT linked to prostate cancer
• Risk factors include: family history, aging, hormonal changes, obesity, lack of exercise

If Left Untreated It Could Cause:

• Damage to the bladder
• Damage to the kidneys
• Urinary tract infections
• Stones in the bladder

Treatments Include:

• Observation – watch carefully and re-evaluate
• Medications to shrink the prostate
• Minimally invasive treatments:
• Robotic and laser treatments – use very small incisions to reduce the size of the prostate
• Water Vapor Therapy – shrinks the prostate
• Microwave treatment – shrinks the prostate
• Urolift – lifts the prostate up and away from the urethra

As you can see, it doesn’t pay to ignore, or just suffer through these symptoms. Get checked out and have a conversation with your health care professional about next steps.