Before midlife, most men give little or any thought to the health of the prostate. The changes that often occur after age 60 demand more attention.
Amr Farouk Fergany, MD, a urologist at Orlando Health Sebastian River Hospital, says the good news is that the most frequently diagnosed condition affecting the aging prostate has nothing to do with cancer.
“BPH (benign prostatic hyperplasia) is the most common prostate condition for men 50 and older. It’s a size enlargement that comes with age and almost everyone winds up getting it,” Dr. Fergany says.
Mayo Clinic says that BPH affects about 70 percent of men between the ages of 60 to 70 and by the time they’re 80, close to 90 percent have some degree of BPH.
Dr. Fergany says, “We don’t know exactly what causes BPH and, unfortunately, there’s no way to prevent it.
“Although there does seem to be a family connection, lifestyle changes will not affect your risk of developing BPH.”
Cleveland Clinic says that the prostate is a gland below the bladder, in front of the rectum that’s made up of connective and glandular tissues. It adds fluids to your semen. Its muscles also help push semen through your urethra and out of your body. It naturally gets bigger as you get older.
As it grows, it tends to crowd the bladder and constrict the urethra, causing greater urinary frequency and urgency.
“BPH and prostate cancer are completely unrelated,” says Dr. Fergany. “One doesn’t cause or lead to the other. And it’s important to remember that prostate cancer isn’t nearly as common as BPH.”
The Medical University of South Carolina outlines the differences between symptoms of BPH and prostate cancer.
Most early cases of prostate cancer are asymptomatic and diagnosed based on an elevated PSA blood test or abnormal rectal exam. Prostate cancers rarely cause urinary or sexual symptoms until later stages. Having an elevated PSA does not mean someone has cancer; likewise, some men will be diagnosed with prostate cancer despite a PSA in the normal range.
BPH can cause elevated PSA as well as an enlarged prostate. Symptoms can include difficulty urinating, a slow urine stream, frequent urination at night and a feeling that the bladder is not empty. Prostate cancer often doesn’t show symptoms in its earliest stages.
“A lot of older men think an enlarged prostate is responsible for ED (erectile dysfunction),” says Dr. Fergany. “The enlargement has no effect on ED – there’s no anatomical correlation between the two. And you can take ED medications when you’re taking prostate medications.”
There are some things that exacerbate symptoms that you can control, Dr. Fergany says. “Limit alcohol intake, avoid being in the weather, don’t hold urine for too long, don’t engage in sexual excitement for too long.
“Although maintaining a healthy weight and exercising regularly don’t specifically impact the prostate, they will better help you tolerate any procedures,” he adds.
The American Prostate Centers adds some recommendations.
1. Incorporate Kegel exercises into your daily routine. They will help stimulate your pelvic floor muscles to strengthen bladder control function.
2. Adjust your dietary choices. Instead of regularly eating processed carbs, red meats, saturated fats, and foods with high amounts of dairy, consider a diet that is rich in colorful fruits and vegetables, nuts, seeds, legumes and lean proteins to reduce inflammation.
3. Avoid diuretics. Diuretics are medicines that are often prescribed for conditions that cause fluids to accumulate in the body. By prompting urination, they can aid the kidneys to flush out salt and water contents through the urine. Caffeine-filled beverages like coffee, certain teas and sodas should be avoided.
4. Manage your stress. Stress can make your BPH worse. Through “flight or fight,” it releases high amounts of the hormone adrenaline, which causes the bladder and prostate muscles to contract and the pelvic floor muscles to tighten.
5. Practice healthy urinary habits. Urinate when you get the urge. Don’t drink before bed. Avoid straining.
If you do need treatment for your enlarged prostate, Dr. Fergany says there are a variety of medications available. “They work in different ways – from relaxing the bladder muscles to shrinking your prostate to treating symptoms of an overactive bladder.
Your medical professional will make the most appropriate choice.”
In the event the medications don’t work, there are an ever-increasing number of surgical interventions available. Age and personal preference are two of the factors that will determine the one best suited for you, explains Dr. Fergany.
“Keep in mind that if you choose a minimally invasive option now, chances are that you’ll need a more invasive one in the future.”
There are many procedures from which to choose, including these two well-tolerated ones.
“The gold standard of prostate procedures is the transurethral resection of the prostate, a common surgery that’s used to treat urinary problems that are caused by an enlarged prostate.”
An instrument called a resectoscope is placed through the tip of the penis. It is then passed through the tube that carries urine from your bladder, called the urethra. The resectoscope helps a surgeon see and trim away extra prostate tissue that’s blocking urine flow.
TURP tends to be considered an effective treatment choice for men who have moderate to serious urinary problems that haven’t gotten better with medicine.
“Water vapor thermal therapy is another option,” he says. “A special device injects water vapor energy to ablate excess prostate tissue. Potential damage to nearby tissues is reduced.”
These are just two examples of an impressive list of options available for men who require more intensive treatment of their enlarged prostate.
Dr. Fergany explains that the early stages of enlargement often don’t cause symptoms. “It’s important to start regular doctor visits by your late 40s for preventative healthcare and to have a baseline test that will indicate any problems,” he says.
Amr Farouk Fergany, MD, is a urologist at Orlando Health Sebastian River Hospital. He received a baccalaureate of medicine and surgery degree from Cairo University Faculty of Medicine, and a master’s degree in urology and a doctorate of urology from Cairo University. He is a Diplomate of the American Board of Urology. His office is located at 8005 83rd Ave., Suite 4, Sebastian. Call 772-918-4327 for an appointment.
