For Men Only; how does my prostate grow?

Of our many organs, the prostate gland seems to offer the most annoyance to men as we age. The prostate produces most of the fluid that carries semen and so is critical to reproduction. It is located near the bladder outlet and in young men is about the size of a walnut. As men age, the prostate grows. Unlike heart disease, there is nothing one can do with diet or healthy habits that impacts the prostate.

The two major problems that impact men’s health are prostate cancer and blockage of urine flow from a growing gland.

Growth of the prostate, called benign prostatic hypertrophy (BPH), is a normal part of aging, and occurs in essentially all men. Because of the location of the gland, it can impede flow of urine out of the bladder. It is a good rule that a 60-year-old man, however healthy, should not expect the urine flow of a 20-year-old.

What one does about BPH is entirely based on symptoms. The hallmark of BPH is incomplete emptying of the bladder. You may finish urinating and then feel you need to go again. Most older men will get up at night to void. It may cause urgency – the feeling that if you do not get to the bathroom you are going to lose control.

If these symptoms are mild, no treatment is needed. If they are more severe, medication can help. One class is alpha-blockers, that make it easier to void, that were originally developed to treat high blood pressure. They are generally easy to take, though may be a problem if you tend to have low blood pressure.

The more definitive treatment is to take a testosterone-blocker. Finasteride in low dose is used to treat male-pattern baldness (Propecia) and in high dose to shrink the prostate. It has been shown to reduce the need for surgery and the likelihood of complete urinary blockage. The downside is reduced sexual drive and erectile dysfunction (ED).

ED drugs like tadalafil help urinary flow and may be a good option to improve flow while also treating erectile dysfunction. Your insurance may not pay for this, as most still ration these drugs.

If medicines fail, surgery will usually work.

Prostate cancer occurs in the same organ, but otherwise is unrelated. Cancer occurs in small glands and huge ones equally. As men age, prostate cancer occurs more often and at the same time becomes less aggressive. If a 50-year-old has prostate cancer, unless it is surgically cured, he will probably die of this cancer. If an 80-year-old has prostate cancer, he will almost certainly die of something else, with his cancer but not due to his cancer.

I must also note that African-American men have almost twice the risk of white men.

While prostate cancer can be detected on a rectal exam, by this time it is usually advanced. Early detection is done with a blood test, the PSA (prostate-specific antigen). To say that PSA testing is controversial is an understatement; arguments for and against have raged in the medical literature for years.

I can best sum up the thousands of pages written by saying that screening men with regular PSA testing modestly reduces death from prostate cancer but has minimal effects on overall death rates. There is also consensus that PSA testing should stop at advanced age, though exactly when is debated. I would suggest 75.

If the PSA is elevated, in 2025 the best next step is an MRI of the prostate to detect and quantify any cancer. In low-risk patients, “watchful waiting” is a very viable option. In high-risk men, complete removal of the prostate offers the best chance for cure, with radiation therapy an acceptable alternative. Both treatments have significant side-effects, including bowel and/or urinary incontinence and loss of erection, hence the idea that not all cancers should be treated.

Prostate disorders are clearly conditions in which dialogue between the patient and doctor are key and second opinions critical. Do not accept the first option offered.


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