When it comes to men’s health and particularly male fertility, the prostate is an essential gland. This explains why the awareness for prostate enlargement and health is not only necessary but timely.

Even with how vital the prostate is, many people, including men, do not have a good knowledge and fair understanding of what the prostate is, the functions it plays in the male reproductive system and why it deserves great attention and routine checks. Therefore, in this article, we outline in very simple terms;

• an overview of the prostate as an organ

• the major prostatic problems that exist

• the risk factors of prostate diseases and cancer.

• prostate screening and clinical manifestations of prostatic cancer.

What exactly is the Prostate?

The prostate is a walnut-shaped gland that is sited at the base of the penis, and ordinarily weighs approximately 26 grams at the end of puberty in males. The Androgens are the major hormones responsible for the growth and development of the prostate gland.

What Does the Prostate Do?

Since it sits at the base of the penis, the prostate wraps itself around the duct through which urine leaves the body, called the urethra. Prostatic fluid accounts for up to 30% of the volume of semen, and its production is the primary role of the prostate. Prostatic fluid constituents ensure the nourishment and proper motility of sperm.

What are the Major Prostate Enlargement Problems?

As with other crucial glands of the body, the prostate is sensitive which is why it is medically advisable that every adult male takes his prostate health seriously. This is because, as men grow older, they begin to experience prostate enlargement as this gland begins to increase in size rather than shrink.

This is to say that the prostate gland of a 60 year old is bigger than that of a 40 year old whose prostate gland is also bigger than that of a 20 year old. Most of the time, this enlargement, if care is not taken, spells doom. It is absolutely natural that the prostate grows bigger as one ages, so it is safe to say that the increase is inevitable and unpreventable.

Consequently, prostate problems usually begin to affect men from age 50 and above; although, there are a few exceptions where some men below 50 experience symptoms.

When the prostate enlargement becomes unhealthy, the common issue it results to is difficulty in urinating because it causes a blockage to the free flow of urine (remember it surrounds some part of the urethra). This is the most common prostate issue in older men, and it is medically known as Benign prostatic hyperplasia (BPH). Whenone develops BPH, it does not automatically translate to prostate cancer, but may lead to other conditions such as kidney, bladder or urinary tract problems.

A recent study has shown that many developing countries that have long battled with largely communicable diseases are now also facing higher occurrence of non-communicable diseases. In Nigeria, for instance, the prevalence of prostate cancer, Benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostates) are as high as figures reported in some advanced nations. Hence, Prostate diseases are becoming a worldwide issue.

As a matter of fact, about 11% of all cancers affecting men in Nigeria are reported to be of the prostate, whereas as many as 25% and 12% of adult male Nigerians were reported to have BPH and prostatitis, respectively. If these figures make you uncomfortable, you’d understand why it is crucial at this point to spread prostate health awareness as much as possible.

The Risk Factors of Prostatic Diseases

Although the prevalence of prostatic diseases has generated little or no attention among policy makers, the threat they pose to our health care system is quite enormous.

• Age

From the foregoing, Age is a major risk factor for having prostatic issues, since the gland gets enlarged as one ages. Hence, any man above 40 is at risk. It is rare to find prostate related conditions affecting younger men.

• Heredity

A family history of Benign Prostatic Hyperplasia (BPH) can make one most likely to have it too. Risk is doubled when the person who had it is a first degree relative and more likely if they are more than two in number.

• Race

Prostate cancer affects more African men than their Western counterparts. In fact, there’s lower incidence of clinically evident prostatic disease in Japanese and Chinese men.

• Diet

Men who consume foods that are high in saturated fat have an increased tendency to have prostate issues in the future.

• Obesity

Among the many downsides to obesity is the risk to have prostatic problems because obesity increases calcium absorption which leads to the likelihood of developing prostate cancer. Obese men also have larger prostates, increasing the surface area that prostate cancer could occur.

Studies have also shown that prostatic diseases may be associated with conditions such as diabetes, insulin resistance, hypercholesterolemia, and hypertension, the prevalence of which are reportedly high in Nigeria. Notably, these diseases are amenable to lifestyle modifications in both prevention and treatment strategies.

How you can Improve your Prostate Health

• Having sufficiently highlighted on prostate challenges, men at higher risk for prostate cancer, especially older blacks, should limit their calcium intake. High calcium consumption has been linked to a higher chance of having prostate cancer. Taking calcium can lower vitamin-D levels in the body which will enhance increased differentiation of the cancer cells, and is therefore unsafe for the prostate.

• Increased exercise helps protect against aggressive forms of prostate cancer, which are more prevalent in blacks. So, regular exercise (at least 3 times weekly) improves your general health and helps to keep your prostate healthy.

• For obese men, devoting a few months to weight loss can decrease the chances of having prostatic diseases.

• Routine visits to your doctor for prostate screening can help one know the state of the prostate gland, and have proven to be more beneficial for the early detection of prostate issues. Speak to a Doctor Now if you are already experiencing symptoms associated with passing out urine effectively.

• At the heart of prostate health is a lifestyle change. Always endeavour to drink enough water to stay hydrated and eat right to maintain a healthy weight.

Prostate Cancer and Screening

Even though there are three major disorders that afflict the prostate gland – prostate cancer, benign prostatic hyperplasia (BPH), and prostatitis, most men worry about prostate cancer for very valid reasons.

Prostate cancer is a common and a frequent cause of cancer death in men.

Worldwide, in 2008 there were estimated to be 903,000 new cases of prostate cancer and 258,000 prostate cancer deaths making it the 2nd most commonly diagnosed cancer in men and the 6th leading cause of male cancer death.

Why We Must Be Concerned

• 1 in every 6 men get Prostate Cancer

• 1 in every 4 Black men get Prostate Cancer

• Blacks and Latinos are diagnosed at advanced disease stages at a 144% greater rate than whites

• The 5-year survival rate for Blacks and Latinos is worse than for whites and getting worse

• Black men die at a rate 240% higher than whites

READ OUR FULL ARTICLE ON Prostate Cancer: Need for Testing and Early Detection

Screening for Prostate Cancer

Investigations:

• Full Blood Count (FBC), Urea and electrolytes

• Liver function tests

• Prostate Specific Antigen (PSA)

• Alkaline phosphatase

• Transrectal Ultrasound (TRUS) and Biopsy

• Computed Tomography (CT)

• Bone Scan

SCREENING

Accepted criteria for successful population screening programme

• Important health problem? YES

• Natural history understood? YES and NO

• Detectable latent or pre-clinical phase? YES

• Diagnostic test of suitable sensitivity and specificity? NO

• Adequate facilities to both diagnose and treat? YES

• Tests must be acceptable to general population? YES

• Benefits should outweigh adverse effects of screening? NOT IN ALL CASES

• Overall cost acceptable in relation to overall expenditure? YES

• On-going process? YES

All You Need to Know about the Prostate Specific Antigen (PSA):

• Produced by the glandular epithelium of the prostate

• Trace amounts in salivary, pancreatic and breast tissue

• Found in semen, urine and blood

• Serine protease that liquefies semen to improve sperm mobility

• Found in 3 forms in serum:

• Bound to α-1-Antichymotrypsin

• Bound to α-2-Macroglobulin

• Free PSA

Prostate Antigen Test and Results:

• Lacks sensitivity and specificity

• False Negatives: BPH, Prostatitis, Post-Ejaculation, Urinary Retention.

• 4ng/ml – 22% Probability of Cancer.

• >10ng/ml – 63% Probability of Cancer.

TRUS biopsy in those with life expectancy greater than 10 years with an elevated PSA:

• Prostate Specific Antigen is useful in the detection, staging and monitoring of prostate cancer. PSA is prostate-related but not cancer specific.

• An ultrasound probe with automated biopsy gun is used to take up to 3 cores of prostate tissue

• Antibiotic cover is required due to risk of infection

• Shortcomings of Standard Systematic Prostate Biopsy

• False-negative rate

• Incorrect risk stratification (up to 45%)

• Detection of clinically insignificant disease

• Need for repeat biopsy

• Disease overtreatment

Increasing the core number (saturation or repeat biopsy) does not significantly reduce the risk of under-sampling and incorrect risk stratification. It is also important to note that more biopsy episodes increase the risk of detecting indolent cancers. So, the goal is to detect high-grade disease while avoiding low risk disease.

The test can be concluded as prostate cancer and best diagnosed when the Prostate Specific Antigen is greater than 20, sufficient clinical suspicion, metastases are sensitive and there are false positives with arthritis, osteomyelitis and healing fracture.

Medically reviewed by Dr. Ngong Cyprian

References

Cushieri, A. et al. (1996) Clinical Surgery 2^nd Ed. ,Blackwell Science Ltd.

George, H. Burkitt , Clive, R.G.Quick and Joanna, B. Reed (1990) Essential surgery 4^th. Ed. Churchill Livingstone/Elsevier.

Chukwunonso Ejike. Towards the Prevention and Management of Prostatic Diseases in Nigeria: A Framework, Malaysian J Med Sci. Jul-Sep 2011; 18(3): 65-70