Enlarged prostate: benign or cancerous?

>> Friday, June 17, 2022


Victor Romulo Gallardo Dumaguing, MD

June is Men’s Health Awareness month. Just as women are scared of breast cancer, so are men terrified of having prostate cancer. Admittedly, the fear, anxiety, the worry are perfectly warranted and understandable.     Except for the gender, breast cancer and prostate cancer have some disturbing similarities; both are hormone-dependent or rather hormone-sensitive e.g. estrogen and testosterone, and while debate is still raging as to whether they are genetically-predisposed, the yes has more votes. Add to that the increasing evidence that dyslipidemias- cholesterol and triglyceride - is a common finding in the clinical profile of victims of breast and prostate cancer.
    At this juncture, it must be clarified that prostate problems do not necessarily start with middle age of men. Adolescents or young adults who are sexually-active may suffer from prostatitis, that is, infection of the prostate by microbes like streptococcus, staphylococcus or by Neisseria gonorrhea in which pus cells come out thru the urethra, with painful urination, fever  and pain at the groin, buttocks and the lower back. In these cases, a regimen of antibiotic therapy is needed.
    Changes in the size and shape of the prostate usually occurs in men who are 45 years old due to changes in hormone levels that occur with aging. In time the flow of urine is obstructed. As a result, the muscles of the urinary bladder becomes larger and stronger in order to push the urine through.
    However, when the man urinates, the bladder does not empty completely and as a result the urine stagnates and becomes a culture medium for infection, which if not attended to immediately would later lead to stone formation and kidney problems. Most men complain of hesitancy or difficulty in initiating urination, others notice they now urinate more frequently but with smaller amounts.
Moreover, there is the disturbing nocturnal- need to urinate several times at night disrupting a restful sleep. Of course, members of the household would tell the man, in the nicest way they can so as not to hurt his feelings, that his pants or his pajamas has the acrid smell of urine and this is due to terminal dribbling or the flow of small amount of urine as the man zips up his pants because he thought the urination is over.
With some men, because of the incomplete evacuation of the bladder, it may sson overflow, this time leading into urinary incontinence- an urgent need to look for a restroom to urinate immediately otherwise, he would wet his pants, a truly embarrassing situation.
Most doctors and family physicians advise the head of the family- husbands, unless otherwise agreed upon by the couple - to undergo DRE or digital rectal examination done by urologist or surgeons. With a lubricated gloved , the forefinger is gently inserted into the anus of the man to evaluate the consistency of the prostate- soft, firm- hard- tender or painful, presence of nodules or other masses. Based on this, and of course, with a detailed medical history and a thorough physical exam, the urologist may suggest a blood test, PSA or prostate specific antigen.
It must be stressed that a high PSA level is not a death sentence confirming prostate cancer. There are false positives, i.e., elevated PSA but it's not cancer. In the same manner, a Normal PSA does not rule out prostate cancer either. So, it is he call of the urologist to do other tests like biopsy of the nodule to examine the cells in the mass.
For those diagnosed to have prostate cancer, although it is known to grow slowly, there is always the fear that it would metastasize or spread to other organs like lungs, liver and brain, although the most common site is the skeleton- ribs, pelvis and vertebral column. Thus, another test might be needed, blood levels of the enzyme acid phosphatase indicate active bone erosion and destruction.
Gentlemen, let us find consolation in the fact that most enlarged prostate is benign thus, with a mindset, we have to contend with the inconveniences it brings into our lives like difficulty in initiating urination, weak and reduced stream of urine which at times wet our pants and feet, many trips to the toilet at night.
Another positive development is the availability of medicines that could alleviate the signs and symptoms. For the few men who are diagnosed with prostate cancer, surgery is the ultimate and definitive management, but not without some complications and sequelae like urinary incontinence and some erectile dysfunction. Castration or removal of both testicle is also an option, and mind you, it takes a real man, sure of his manhood to take that choice. After all, there would be more happy fulfilling years to enjoy life to its fullest. Cheers to manhood!


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