Prioritising the Prostate

King Charles III was recently hospitalised for surgery related to an enlarged prostate. So, what is the prostate and why does it get enlarged?

The prostate is an accessory gland of male reproductive system. It is situated below the urinary bladder and encircles the urinary passage. It provides nutrition to sperm and plays an important role in male sexual activity. Normally around 15cc, it increases in size with age. This condition is known as Benign Enlargement of Prostate (BEP) or Benign Prostatic Hyperplasia (BPH).

Age-related problem

Dr. Gopichand Mutyalapati, Consultant Urologist at KIMS Hospitals, says prostate enlargement becomes more common as men age. “The risk of prostate issues, including cancer and enlargement, increases with age. Men over 50, particularly those over 65, are at higher risk,” he says.

The gland gets enlarged mostly due to the downstream effect of testosterone, the male hormone, says Dr Arabind Panda, senior consultant urologist, Asian Institute of Gastroenterology. “There is also some evidence that oxidative stress and genetics play a role too,” he explains.

The prostate gland is surrounded by a layer of fibrous tissue. This pseudo capsule prevents the gland from expanding outwards, and leads to the urinary passage getting compressed.

Signs of prostate issues

“Symptoms of an enlarged prostate include difficulty urinating, frequent urination, weak urine stream, and a feeling of incomplete bladder emptying,” says Dr Gopichand.

Dr. Md. Taif Bendigeri, Senior Consultant Urologist, Asian Institute of Nephrology and Urology (AINU) adds that an enlarged prostate also results in the person experiencing a sense of urgency to empty the bladder, and waking up frequently at night to urinate. “It might also lead to blood in urine, repeated urinary infections, sudden, complete stoppage of urine and even damage to kidneys,” he warns.

He also cautions that prostate cancer presents with similar and overlapping symptoms.

According to Dr Arabind Panda, research has shown that an ageing bladder, long-standing diabetes mellitus and certain other diseases of the bladder can produce similar symptoms. “So, proper diagnosis, and confirmation that the symptoms are indeed due to the prostatic enlargement are necessary before offering treatment,” he says.

Treatment regimen

Before the 1990’s, surgery was the most popular method to treat an enlarged prostate. Now, medicines are prescribed that both relieve the obstruction and reduce the size of the prostate gland. These however, work only in some cases.

“Lifestyle changes and medication are used to manage the condition in modern times. If other methods of management fail or are not suitable, surgery is recommended to remove the portion of the gland that is blocking the urine flow,” Dr Taif explains.

The patient’s condition may even necessitate the removal of the obstructive gland. It is now commonly done through the urinary passage without any external incision. Advances in technology present options — laser prostate surgery is extremely safe and effective even in those who are aged and have co-existing health concerns like heart ailments, Dr Taif adds.

Preventive measures

Regular check-ups

Dr Gopichand says early detection can significantly improve outcomes in cases of prostate conditions. “While it’s a natural part of aging process, not all men experience significant symptoms. To detect and monitor prostate issues, regular check-ups are crucial,” he stresses.

Healthy lifestyle

Meanwhile, to reduce the risk of an enlarged prostate, a healthy lifestyle, including regular exercise, a balanced diet, and effective stress management, is important, Dr Gopichand emphasises.

New methods of treatment

Rezum: Treatment uses injections of sterile steam (water) into the prostate to shrink the prostate tissue that is obstructing the urinary flow, resulting in obstruction being reduced for over 3 months.

Aquablation: High-pressure saline is used to cut prostatic tissue.

Every male in his lifetime will have some Prostate enlargement, says Dr. Gopichand adding that symptoms occur only in a small proportion — around 20-25% - of men.

All prostate enlargements do not need surgery. Maintaining a healthy lifestyle with regular physical activity, balanced diet, regulated fluid intake and avoiding excessive alcohol consumption help to a great extent.

A prostate-friendly diet includes

Fruits and Vegetables: Rich in antioxidants, vitamins and minerals. Aim for a variety of colourful fruits and vegetables.

Healthy Fats: Sources of Omega-3 fatty acids, like oil fish (salmon, mackerel), flaxseeds and walnuts.

Green Tea: Contains antioxidants that may be beneficial for prostate health.

Tomatoes: High in lycopene, a carotenoid with potential prostate health benefits. Cooking tomatoes can enhance lycopene absorption.

Broccoli and Cruciferous Vegetables: These vegetables contain compounds that may support prostate health.

Soy Products: Some studies suggest that soy-based foods may have a protective effect on the prostate.

Whole Grains: Opt for brown rice, quinoa, and oats for fibre and nutrients.

Limit Red Meat and Dairy: High intake of red meat and dairy may be associated with an increased risk of prostate issues. Moderation is key.