Opinion

Prostate enlargement and the Ghanaian man

Benign prostatic hyperplasia (BPH) popularly referred to as enlarged prostate, is a noncancerous enlargement of the prostate gland and the most common benign tumor found in men. Not long ago, a study found that enlarged prostate was quite high in Ghana. BPH produces symptoms by obstructing the flow of urine through the urethra. Symptoms related to BPH are present in about one in four men by age 55, and in half of 75-year-old men. However, in Ghana, men in their mid 30s are showing classical signs of prostate disease. This could be attributed to improperly treated sexually transmitted diseases and urinary tract infections. Acute Prostatitis (Inflammation of the prostate) is usually caused by bacteria that travel to ones prostate from the blood. Surgery used to be the only option for men with enlarged prostate until the recent approval of drugs that can relieve symptoms either by shrinking the prostate or by relaxing the prostate muscle tissue that constricts the urethra.

The Signs and Symptoms of Enlarged prostate include; Difficulty in starting to urinate despite pushing and straining, A weak stream of urine; several interruptions in the stream, Dribbling at the end of urination, A sudden strong desire to urinate (urgency), Frequent urination, The sensation that the bladder is not empty after urination is completed and Frequent awakening at night to urinate (nocturia).

As the bladder becomes more sensitive to retained urine, a man may be unable to control the bladder causing bed wetting at night, or inability to respond quickly enough to urinary urgency. A properly taken medical history will give clues to conditions that can mimic BPH. This includes questions about previous urinary tract infections or Prostatitis and a digital rectal exam (DRE) which allows the Doctor to assess the size, shape, and consistency of the prostate. This important examination involves the insertion of a gloved finger into the rectum, but is only mildly uncomfortable. The detection of hard or firm areas in the prostate raises the suspicion of prostate cancer. Measuring prostate specific antigen (PSA) levels in the blood to screen for prostate cancer is recommended as well as the DRE. PSA testing alone cannot determine whether symptoms are due to BPH or prostate cancer because both conditions can elevate PSA levels.

When selecting a treatment, both patient and doctor must balance the effectiveness of different forms of therapy against their side effects and costs. Currently, the main treatment options for BPH are: Watchful waiting, Medication and Surgery (prostatectomy).

If medications prove ineffective in a man who is unable to withstand the rigors of surgery, urethral obstruction and incontinence may be managed by intermittent catheterization or an indwelling Foley catheter. Currently, two types of drugs-5-alpha-reductase inhibitors and alpha-adrenergic blockers-are used to treat BPH. 5-alpha-reductase inhibitors (Finasteride) blocks the conversion of testosterone to dihydrotestosterone, the major male sex hormone found within cells of the prostate. It may take as long as six months, however, to achieve maximum benefits from finasteride. In addition, Finasteride causes relatively few side effects. Impotence occurs in 3 to 4% of men taking the drug. Finasteride may also decrease the size of the ejaculate. Another adverse effect is gynecomastia (breast enlargement). About 80% of those who stopped taking the drug had a partial or full remission of their breast enlargement.

Another group of medicines is Alpha-adrenergic blockers (Tamsulosin).There are also useful in improving urinary flow in men with enlarged prostate. Possible side effects include; orthostatic hypotension (dizziness upon standing, due to a fall in blood pressure), fatigue, and headaches.

Surgery (Prostatectomy) is a very common-operation. It involves removal of only the inner portion of the prostate (simple prostatectomy). This operation differs from a radical prostatectomy for cancer, in which all prostate tissue is removed. Surgery is also associated with the greatest number of long-term complications, including: Impotence, Incontinence, Retrograde ejaculation (Ejaculation of semen into the bladder rather than through the penis) and the need for a second operation (in 10% of patients after five years) due to continued prostate growth or a urethra stricture resulting from surgery. While retrograde ejaculation carries no risk, it may cause infertility and anxiety. The frequency of these complications depends on the type of surgery. Transurethral prostatectomy (TURP) is considered the “gold standard” of BPH treatment-the one against which other therapeutic measures are compared. It involves removal of the core of the prostate with a resectoscope-an instrument passed through the urethra into the bladder. The mortality from TURP is very low (0.1%); however, impotence follows TURP in about 5 to 10% of men and incontinence occurs in 2 to 4%.
Open prostatectomy is the operation of choice when the prostate is very large (>80 grams) since transurethral surgery cannot be performed safely in these men). However, it carries a greater risk of life-threatening complications in men with serious cardiovascular disease, since the surgery is more extensive than TURP or TUIP. More serious potential complications include heart attack, pneumonia, and pulmonary embolus (blood clot to the lungs). Breathing exercises, leg movements in bed, and early ambulation are aimed at preventing these complications. The recovery period and hospital stay are longer than for transurethral prostate surgery.

However, one thing that is certain as men age is the usage of supplements to support prostate health. One supplement that stands out amongst the lot is PROSTAT 60. I will recommend it for men 35 and above who want to escape the embarrassment of an enlarged prostate. One prostat 60 a day keeps the Urologist away forever. It is effective for prophylaxis and well as therapeutics (for management of prostate enlargement). I personally prescribed prostat 60 for a 65 year old man on indwelling urinary catheter and after two weeks his catheter fell out. I was very amazed and have decided to recommend this product to all Ghanaian men.

As father’s day (17th June) approaches, If there is any gift you consider valuable to any male above 35, don’t think far; just get him a PROSTAT 60 bottle or blister and he will forever remain grateful and indebted to you.

By MH/Dr Ernest Aggrey, 0543999776/donmirage77@yahoo.com

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