KOCHI: Prostatic diseases are common among aging men causing significant morbidity. Most chalk-up the problem of the prostate to the current circumstances, some blame aging, weather change, travel-related stress, the water of different places, etc. However, due to the sedentary lifestyle, the age factor is blurring the line. The quality of life gets hampered as the prostate enlargement can cause “lower urinary tract symptoms.”
Benign Prostatic Hyperplasia (BPH) is defined by at least microscopic excessive growth, which over a period, translates into the gross enlargement of the gland visible to the naked eye.
It begins before 30 years and approximately 8 per cent of men are affected by microscopic BPH by 40 years, 50 per cent by 60 years and 90 per cent by 90 years of age. The prevalence of BPH range from 14 per cent to 30 per cent for men aged 50 or older, depending on the definition used. While BPH prevalence in India is by 25 per cent for 40 - 49; 37 per cent for 50 - 59; 37 per cent for 60 - 69; 50 per cent for 70 - 79. Approximately, two out of every five Indian men have bothersome lower urinary tract symptoms due to BPH. However, many will not consult a doctor, as many will normalise it, linking it with aging, the weather, travel-related to stress, change in water, etc. They will cope with the bother of the disease until it becomes too severe and causes all sorts of complications.
The prostate goes through two main growth period with age. The first occurs early in puberty when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. BPH often occurs with the second growth phase.
Patients with BPH commonly complain of frequent urination at night, difficulty in passing urine, incomplete emptying of the bladder. The quality of life gets hampered as the prostate enlargement can cause lower urinary tract symptoms. To cope with these symptoms, the patient starts restricting water and other fluid intake and being conscious of his urination, for example, being on the look-out of toilet location wherever he goes, urinating before going on long trips outdoors, where he might not have access to loos such as on a long-distance bus journey. These coping strategies further restrict the patient’s quality of life.
It is also important to note that the size of the prostate doesn’t necessarily determine the severity of your symptoms. Some men with slightly enlarged prostates can have significant symptoms, while other men with enlarged prostates can have minor urinary symptoms. And if left untreated, the urinary problems might lead to obstruction of the urinary tract and affect prostate health.
How can a doctor help?
It is critical to consult your doctor and not shy away from the issue. The doctor can help the patient choose the best care based on his or her age, health, and how the condition affects him or her. Also, important to note is the fact that the symptoms of BPH are like those produced by more lethal diseases, such as prostate cancer. Therefore, it is vital to visit a doctor or specialist to understand how severe the actual problem is.
Dr Datson George, consultant at Lakeshore Hospital highlights that “It revolves around the home, the office and places nearby the home. During a weekday, apart from commuting to and from office, there seems to be less movement to other places. Weekends are limited to the home or places near the home. While they do not articulate it, their behaviour reveals that they protect themselves by remaining accessible to a bathroom. This is especially true for patients who are not being treated. Those who are treated also have a similar lifestyle but are more open and confident to move out of this perimeter should the need arise.”
Diagnosis of BPH is made by a mixture of physical, radiographic examinations and a few lab tests. Physical examination includes DRE (digital rectal examination), which involves a physical examination of prostate by a urologist. Abdominal and pelvic ultrasound also indicates the size of the prostate gland. Lab tests include PSA (Prostate-specific antigen). PSA is a protein that is made only by the prostate. When the prostate is healthy, very little PSA is found in the blood.
According to Dr Kishore T A, Aster Medcity, “Patients are largely unaware of this condition despite high prevalence rates as they consider it a normal part of aging, which can be rectified through a targeted patient awareness campaign. BPH is diagnosed through a combination of methods including patient history, IPSS scorecard, ultrasound, and PSA tests.”
BPH management involves management of symptoms through medications like alpha-blockers, most commonly tamsulosin. BPH symptoms are measured by using IPSS (International Prostate symptom Score). If symptoms are uncontrolled, a combination treatment is offered. Surgical removal of prostatic tissue is the last step if symptoms are uncontrolled on medication. Since alpha-blockers are chronic treatments, there are different molecules available with alpha-blockers for comorbid patients, sexually active patients, and the general population. BPH symptoms are usually neglected until they become very bothersome, which should not be the case.