PROSTATE PROS Episode 3: The Beat on Big Prostates

Listen: https://soundcloud.com/prostate-oncology/the-beat-on-big-prostates

“BPH is an incredibly common thing as men get older. There’s so much confusion since everything is related to the prostate and many men don’t even know what a prostate is.  All of this information seems to get rolled into a confusing mishmash of high PSA, big prostates, and prostate cancer. It can all be sorted out if you have an imaging study to see how big the gland is, that’ll help put the PSA in perspective and make sure that there’s no cancer lurking in the gland.”

Many men who have urinary symptoms and elevated PSAs may believe they have prostate cancer.  In reality, prostate cancer is a silent disease, meaning there are no symptoms until very late stages.  Many of these men simply have large prostate glands, also known as Benign Prostatic Hyperplasia (BPH). BPH is not uncommon.  There are over 2 million men in the United States living with enlarged prostates.   

How is BPH diagnosed? 

Like hair and nails, prostate glands grow with age.  The average prostate size for men in their 60s is 40 cc.   A big prostate is a prostate that is 50 cc or larger. The larger the prostate gland, the higher the PSA.  When interpreting PSA, the size of the prostate must be taken into consideration. The general rule for deciding if a PSA is normal in relation to gland size is to divide gland size by 10. For example, a normal PSA for a man with a 40 cc prostate is 4, for a 30 cc prostate, a normal PSA is 3.  If the PSA is 50% higher than expected, PSA is considered abnormal and further testing such as imaging should be conducted.    

A patient will usually consult his doctor with a high PSA or urinary symptoms.  A digital rectal exam (DRE) will indicate if the prostate is enlarged. To get a better idea of the gland’s size imaging with a Color-Doppler Ultrasound or a 3-Tesla multiparametric MRI is necessary.  These tests will tell the exact size (cubic centimeters) of the prostate. If the imaging shows no suspicious lesions and a prostate size larger than 40 cc, the patient has an enlarged prostate.

How is BPH Treated? 

There are many treatment options and symptom relief available.  BPH can be managed by medication or procedure. Consider using medications before agreeing to a procedure.  If there are unwanted side effects from medication, they are typically reversed once the medication has stopped. Be aware that side effects of procedures may be irreversible.

Medications to Treat Urinary Symptoms: 

The following medications help relieve urinary symptoms such as urgency, frequency, and difficulty urinating.  The side effects from these medications are reversible once medication is stopped.   

  • Flomax
  • Noctiva/Nocdurna
  • Alfuzosin
  • Rapaflo
  • Myrbetriq
  • Cialis

Medications to Shrink the Prostate: 

The following medications are used to shrink the prostate.  These work by blocking 5-alpha reductase which is an enzyme that converts testosterone into dihydrotestosterone (DHT).  DHT is the growth hormone in the prostate. By limiting DHT, the prostate shrinks. A smaller prostate means fewer urinary complications.  Keep in mind, these medications can lead to loss of libido (sexual desire) and potential impotence.      

  • Proscar (finasteride)
  • Avodart (dutasteride)

Common Procedures: 

Similarly to prostate cancer, the urologist is in the driver’s seat when it comes to treating BPH.  Due to their training, urologists are often inclined to recommend patients treat their BPH with a procedure instead of a medication.  Common procedures for BPH include:

  • UroLift:  Permanent implants pin the prostate away from the urethra, leaving the flow of urine unobstructed.  This procedure is reversible.
  • Rezum: Steam is injected into the prostate to shrink the gland. 
  • Transurethral resection (TURP): A surgical procedure performed with a scalpel to carve out the core of the prostate gland.
  • Laser TURP:  A laser to removal of the anterior portion of the prostate.
  • Simple Prostatectomy:  Removing the majority of the prostate via an incision in the lower abdomen. Unlike a radical prostatectomy, simple prostatectomies preserve the lateral portion of the gland, where the nerves for erections run and so erectile dysfunction.

Prostate Size Matters Blog: https://pcri.org/insights-blog/2017/3/17/prostate-size-matters 

Prostate Cancer Staging Quiz: keytopc.com

Register for the PCRI Patient Conference: https://pcri.org/2019-conference 

Have questions or topics you think would be great for PROSTATE PROS? Email podcast@prostateoncology.com

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