The Managing Director/Chief Executive Officer of Saseun Hospitals, Lagos, Dr Rowland Saseun, takes OLADIMEJI RAMON through the risk factors for, diagnosis, and treatment/management of prostate enlargement
Prostate is one of the organs in the male body. Can you give an insight into its anatomical position and what its exact function is?
The prostate gland is situated in the pelvic region of every man. It can be taken as the counterpart of the uterus in a woman. It is situated just at the neck of the bladder and it is made up of three lobes – two lateral lobes and one medial lobe.
The testes produce semen, which acts as a medium for the transmission of spermatozoa. During a sexual intercourse the spermatic cord opens directly into the prostate gland, so also are the seminiferous tubules that that are on each side of the lateral prostate glands. It is these seminiferous tubules that produce semen and both the semen and the sperm meet at the prostatic urethra and comes out through the penis because there is an urethra non-returning valve at the base of the bladder that prevents the sperm from going into the bladder.
Given your explanation, can we say the prostate gland is a collection point for semen?
Yes, in a sense because the prostate gland is the meeting point for semen and spermatozoa but it is not a storage point. Semen comes directly from the seminiferous tubules during sex, not that it is stored in the prostate gland prior to intercourse.
What are the causes of prostate enlargement?
There are no known causes of prostate enlargement. Every male child has the prostate gland from birth and it continues getting bigger as the person grows into an adult. It is not every adult male that will have benign prostate enlargement.
What are the predisposing or risk factors?
Some of the predisposing factors are being a male, age – ageing starts from about age 40. The onset of prostate enlargement differs in different men. I have operated on a 53-year-old with an enlarged prostate gland while his father had to be operated for the enlargement at 82 years of age.
Is the condition hereditary?
Every male has by right tendency to have benign prostatic enlargement if old enough but cancer of the prostate is more hereditary.
Does prostate enlargement have anything to do with a person’s body size or weight?
Yes, obesity is also a risk factor.
Is it correct that being sexually active reduces the chances of having prostate enlargement?
Being sexually active does not really have much to do with prostate enlargement but it has been said that to prevent cancer of the prostate (which is not the topic for today), a man should ejaculate at least 21 times in a month. I don’t know how practicable that is though. Cancer of the prostate is the commonest cancer in male worldwide.
Can prostate enlargement co-exist with prostate cancer in an individual?
Prostate cancer and enlargement do coexist most of the time and sometimes occur individually.
What are the unique symptoms or pathognomic signs of prostate enlargement?
The symptoms include frequent painless urination or very small flow while urinating; and sometimes, there is total inability to urinate, which is called acute urinary retention. Most of the time, patients will not present in the hospital until the above (acute urinary retention) happens.
What causes the urine retention is that in between the three lobes of the prostate gland there is a passage known as the urethra through which the urine passes through but as the three lobes of the prostate are getting enlarged they compress on the urethra until there is total blockage.
Are there other conditions with similar symptoms that can be confused with prostate enlargement?
Yes, other conditions that could be confused with prostate enlargement are (a) infection of the prostate gland known as prostatitis, (b) Infection of the bladder itself, known as urinary tract infection, (c) Urethra stricture, usually caused by improperly-treated gonorrhea at younger age or from trauma to the penis that affects the urethra or from urethra rupture, which may be iatrogenic, and (d) the ‘almighty’ cancer of the prostate itself.
How is a diagnosis arrived at in the hospital?
Diagnosis of BPH is made by (a) Clerking the patient, i.e. asking some direct questions, like how the inability to pass urine started till urine totally stopped coming; asking if there is any past history of improperly-treated gonorrhea infection in early age. Is there passage of blood with urine, which may be caused by severe gonorrhea infection or cancer of the prostate?
We then move to physical examination. There may be a mass in the lower abdomen in a restless man. Examination through the anus known, as recta examination done by putting a finger into the anus, can be done. The median lobe of the prostate, if enlarged, can easily be touched through the anus and one can actually have an idea too if it’s ordinary enlargement or cancerous.
Then the investigations, i.e. transrecta scan should be done to determine the sizes (b) Kidney function test is also carried out to rule out any complications on the kidneys.
(c) In addition, routine tests are also carried out, (d) Also, retrograde urethrography is carried out to rule out stricture (e) Prostate Specific Antigen (PSA) is also checked for to rule out cancer of the prostate (f) Prostate biopsy through the rectum is taken, (g) There may also be a need for CT scan or MRI, depending on the physician, if he really wishes to know more and if the patient can afford it.
At what point should a sufferer visit the hospital?
Any male above 40 years of age with any of the symptoms earlier highlighted should present in the hospital immediately. The earlier it is diagnosed the better the prognosis. And men above the age of 40 to 50 years should endeavour to have routine checkup annually or as suggested by their doctors.
What are the treatment options?
The treatment options include administering drugs to slow down the rate or speed of enlargement, if diagnosed early. A surgical operation may be carried out for the removal of the prostate gland.
Can a person whose prostate gland is surgically removed live a normal life or what kind of life adjustments would they have to make?
Yes, a man that has had prostatectomy for benign prostatic enlargement will surely live a normal life except he will not be able to impregnate a woman and this must be explained to the patient before removing his prostate glands.
As explained earlier, the spermatic cords open directly into the prostate glands, so also are the seminiferous tubules that are on each side of the lateral prostate glands. It is these seminiferous tubules that produces semen and both the semen and the spermatozoa meet at the prostatic urethra and come out through the penis because there is an urethra non-returning valve at the base of the bladder that prevents the sperm from going into the bladder. However, during the removal of the prostate gland, which is called prostatectomy, the non-returning valve will be damaged and this will cause retrograde ejaculation, i.e. during ejaculation, the sperm goes directly to the bladder first, which will kill the spermatozoa, and later come out with urine. So, a patient that has had his prostate glands removed will have erection but will no longer be able to impregnate a woman.
What are the possible complications in a case of untreated prostate enlargement?
The possible complications of untreated prostate enlargement are frequent urinary tract infection; prostate gland infection; backflow of urine in the bladder into the kidneys through the ureters, which can destroy the kidneys and leads to early death. The patient may have a catheter on for life to be constantly draining the bladder and this catheter needs to be changed once a month or sometimes more frequently as the physician deems necessary.
Are there home-made remedies?
I don’t know of any home-made remedies but there may be.
Since prostate enlargement is old-age-related, what lifestyle changes can be adopted as a preventive measure against the condition?
It is actually a very regular disease in males. However, preventive measures will include adequate routine checkup with family physician; reduction of alcohol consumption; going to the hospital with the very first symptoms listed above.
How exactly does alcohol consumption predispose to prostate enlargement?
Alcohol consumption may not predispose a man to prostate gland enlargement but mostly the first time a patient will have acute urinary retention is the night he drinks excessive alcohol, which acts as diuretic that produces a large volume of urine, which has to pass through a narrowed or totally blocked prostatic urethra.
What is the prevalence of the condition in Nigerian men?
The prevalence of benign prostate enlargement in Nigeria is 23.7 per cent. We can say 237 male out of 1,000 will have BPH.
Is there a government policy required for either the prevention or management of prostate enlargement?
There is nothing any government is doing in prevention or management of the disease, which is unfortunate.
What role do you think government can play in the prevention or management of prostate enlargement?
The government should create awareness through dissemination of information through media, jingles, etc, and make prostate enlargement screen free or subsidised and at the same time build some hospitals to be performing the surgeries at a reduced price.
Can you speak on the cost of treating or managing prostate enlargement?
Cost will differ from one region and location of the hospitals to another but generally it’s one of the expensive surgeries because of the expertise, duration of stay in hospital and drugs, fluids, nursing care, etc, that are required.