MANILA, Philippines?Men know they?ve hit middle age when they start getting advice to have their prostate checked or, worse, noticing symptoms related to the enlargement of this gland.

?The prostate is an important part of the male reproductive system that commonly increases in size as a man matures,? according to Dr. Josefino Castillo, a consultant urologist of St. Luke?s Medical Center and Head of the Section of Urology at St. Luke?s Medical Center-Bonifacio Global City. ?This condition is called benign prostatic hyperplasia or BPH.?

The walnut-sized prostate gland secretes a milky fluid that nourishes and energizes the sperm cells and renders the vaginal canal less acidic thereby aiding reproduction. It is located in front of the rectum (where stool passes out into the anus), just below the urinary bladder (where urine is stored) and surrounds the urethra (where urine passes from the bladder and is expelled out of the body).

?Over half of men in their 60s and nine out of 10 men in their 70s to 80s have LUTS or lower urinary tract symptoms associated with BPH,? revealed Castillo.

Symptoms

These include frequent urination, having to wake up at night several times to urinate, interrupted flow of urine, feeling of incomplete urination, urine leak, straining to expel urine, and difficulty in postponing the urge to urinate.

Men with LUTS should see a doctor as soon as possible, stressed Castillo. ?Untreated, BPH may lead to urinary tract infections, stone formation, and irreversible bladder and kidney damage.

Starting at age 40, men should consult a urologist about undergoing a digital rectal exam (DRE), Castillo added.

In DRE, the urologist puts on a glove and lubricates his index finger before gently inserting it in to the patient?s rectum through the anus to feel the prostate?s size and texture.

?Some degree of hardness in the prostate?s texture may indicate the initial stages of cancer,? said Castillo.

Another important diagnostic tool is a blood test called prostate specific antigen. PSA is produced mainly by the prostate and may be elevated in prostate diseases such as BPH, inflammation or infection of the prostate and prostate cancer.

Castillo quickly points out that an elevated PSA level does not automatically mean a man has BPH or prostate cancer.

The urologist will recommend further tests to confirm whether the patient simply has an enlarged prostate or prostate cancer.

Vital

This confirmation is vital because the management of prostate cancer is completely different from that of mere prostate enlargement.

?Since a patient may suffer from both conditions at the same time, prostate cancer must be confirmed or ruled out before starting BPH treatment,? he said.

A more accurate way to check prostate size is trans-rectal ultrasound of the prostate, which uses an ultrasound probe is inserted through the anus.

?A trans-rectal ultrasound may also be done prior to a biopsy in patients suspected of having prostate cancer.?

BPH treatment is usually based on bothersome symptoms and the complications associated with prolonged obstruction of urination.

?Surprisingly, a significantly enlarged prostate sometimes doesn?t lead to any difficulty in urination whereas a small prostate does. It?s actually not just the size but the disturbance in activities of daily living that matters,? Castillo added.

There are about half a dozen drugs approved by the United States? Food and Drug Administration to relieve common BPH symptoms.

Men with mild to moderate urinary symptoms are usually started on a medication that relaxes the prostate?s smooth muscle thereby improving urine flow and reducing obstruction.

Another class of medication reduces prostate size. ?These two types of drugs are commonly prescribed in combination,? informed Castillo.

However, drug treatment does not work for all BPH patients. ?Surgery may be considered for such patients,? Castillo suggested.

Minimally invasive

Video-assisted transurethral re-section of the prostate is a minimally-invasive, no incision procedure that involves scraping the portion of the prostate obstructing the urethra.

?Conventional surgery is indicated for patients with very large prostates that cannot be addressed through minimally-invasive procedures,? he said.

For patients wherein drug therapy does not work and are not good candidates for surgery (because they have other medical conditions), transurethral microwave thermotherapy may be considered.

?The TUMT uses a device that is inserted through the urethra, heats up and destroys obstructing prostate tissues,? the doctor suggested.

Castillo reminded that if you are a male and over 40, see a urologist because early detection is the key in preventing complications.

Angelo Palmones is a science and technology broadcaster. For feedback, please e-mail the Healthcare Technology and Outcomes Information Bureau at inquire@htoib.com.