July 13, 2008

When the Old Man’s Disease Strikes

By Annie Freeda Cruez

MOST irritating. Annoying, to say the least, for it comes in dribs and drabs. This is the lot of men suffering from enlarged prostate, writes ANNIE FREEDA CRUEZ.

It is called the "old man's disease" for it's rare in men below the age of 40. Generally, about half the men in their 60s have the symptoms, which worsen with age.

The incidence of enlarged prostate or benign prostatic hyperplasia (BPH) in Malaysia is of concern, says Dr Rohan Malek, head of the Urology Department at Hospital Selayang.

It is a worrying situation as the ageing population in Malaysia is on the increase.

Where BHP is concerned, the prostrate, for reasons to be determined, begins to grow bigger from the age of 40. Experts say that at least half the men over the age of 70 suffer distinctly from it.

The over-60 bracket in Malaysia has increased from 4.1 per cent of the population in 2003 to 4.4 per cent last year. This means that 1.195 million people are over the age of 60 from a population of 27.17 million Malaysians.

Assuming a 50:50 men-women ratio, there were about 597,000 men over the age of 70 and, going by general medical findings, there are at least 288,000 Malaysian men with various degree of "drib-drab" problems.

"Despite the apparently low incidence of BPH complications in general, the absolute number of patients with irksome symptoms, especially in government hospitals, is worrying," says Dr Malek.

"Most who come to government hospital are suffering from an advanced stage of the condition. Many think prostrate problems are part of the ageing process and they assume there is no treatment.

"There are also those who come in with advanced stage of prostrate cancer."

Awareness and early detection is at the heart of any treatment procedure.

"It is important for men past the age of 40 to go for regular prostrate screening," says Dr Malek, who is president of the Malaysian Urological Association.

He says the first step to managing the problem is to understand the condition.

BPH evolves when the number of cells within the prostate begin to multiply, giving rise to a much bigger prostate.

This enlargement is slow and gradual. Most men remain unaware of the problem until the prostate is large enough to cause symptoms.

The first symptom of BPH is usually a reduction in the speed of urine flow.

When the prostate enlarges, it compresses the urethra, thus making the urethra narrower and slowing down the flow.

The prostate, which is made up of smooth muscles, can also contract involuntarily and compress the urethra, again interfering with urination.

* A new treatment regime that holds much hope for men suffering from a variety of benign prostrate problems has emerged from an ongoing study.

The study, by one of the world's leading research based pharmaceutical and healthcare company, showed that the are advantages when treatment is combined with a 5-alpha-reductase inhibitor (5-ARI) and alpha-blocker oral medication.

The combined treatment offers a significant and greater improvement from the irksome pain and discomfort of BPH than treatment with just either one of these drugs.

The study, that included 4,800 men with moderate to severe BPH symptoms, has also established that combination management eases symptoms, including acute urinary retention to a very large and positive extent.

Dr Claus G. Roehrborn, professor and chairman of the Department of Urology at University of Texas Southwestern Medical Centre, said in the post study period it was discovered that 5-ARI showed a pattern of "decreasing" enlarged prostate symptoms over a 24-month period.

"The results suggested that physicians should consider combining both these medications in the early treatment stages of BPH to achieve improved symptom relief for men with enlarged prostate."

The findings are on-going and researchers will issue a final report soon at the end of four-year study.

UNLESS you are suffering from a very enlarged prostate that needs surgery, you can probable limit the problem by taking these steps:

* Drinks before bedtime: Don't drink anything for an hour or two before bedtime to avoid going to the bathroom at night.

* Limit caffeine/alcohol: These drinks can increase urine production, irritate the bladder and worsen symptoms.

* Limit diuretics: If you take diuretics (water pills), talk to your doctor. Maybe a lower dose, a milder diuretic or a change in the time you take your medication will help.

* Limit decongestants and antihistamines: These drugs tighten the band of muscles around the urethra that control urine flow, which makes it harder to urinate.

* Go when you feel the urge: Try to urinate when you first feel the urge. Waiting too long to urinate may overstretch the bladder muscle and cause damage.

* Stay active: Inactivity causes you to retain urine. Even a small amount of exercise can help reduce urinary problems caused by BPH.

* Keep warm: Don't have the fan blowing at you and switch off the air-conditioner after your room is moderately cool. A colder temperature will likely cause urine retention and increase your urgency to urinate.


The prostrate is the male organ that produces semen, the milky- coloured fluid that nourishes and transports sperm during ejaculation. It sits immediately beneath the bladder and surrounds the urethra, the tube that drains urine from the bladder.

From birth to young adulthood, the prostate gland grows from the size of a pea to about the size of a walnut. In the mid- to late 40s, the gland begins a second growth spurt. During this growth spurt, the prostate grows more rapidly in the central interior part of the gland where the prostate surrounds the urethra.

As it grows, the prostate can cause two main growth-related problems.

It can compress the urethra and partially or completely block urine flow; and it can cause the muscles around the urethra to contract, making it difficult for the urethra to relax and let urine flow.

Either problem causes the bladder to not empty completely when you urinate.

Source: Mayo



* Alpha-blocker drugs are taken orally to relax the smooth muscles in the prostate.

This relieves the compression exerted on the urethra and urinary symptoms may improve in one or two weeks.

* 5-Alpha reductase inhibitors shrink the enlarged prostate by decreasing dihydrotestosterone.


* The most common and effective treatment is transurethral resection of the prostate. The patient is anaesthetised and a special instrument is inserted into the urethra through the penis to remove a portion of the prostate.

* In transurethral incision, an instrument will be inserted into the urethra to make one or two cuts in the prostate to reduce the pressure on the urethra.

* Open prostatectomy, to remove part of the inside, may be used for prostate that has been enlarged tremendously.

* Laser prostatectomy is when a laser fibre is inserted through the resectoscope and laser energy is used to destroy prostatic tissue and create a larger channel.

* Transurethral needle ablation of the prostate removes obstructing tissue through heating probes placed into the prostate.

* In microwave therapy, an instrument that sends out microwave energy is inserted through the urethra to a location inside the prostate.

Microwaves heat the inside of the prostate and cooling fluid is circulated around the microwave antenna to prevent heat from damaging the wall of the urethra.

When the temperature becomes high enough, the surrounding tissue inside the prostate is damaged.


* Weak urine stream

* Incomplete urination

* Dribbling

* Intermittent urine

* Hesitancy - need to push or strain to start urinating

* Nocturia - Waking up often at night to urinate

* Incontinence - A strong and sudden desire to urinate that is hard to delay

* Urgency - A strong desire to urinate as soon as possible

* Frequency - Having to urinate more frequently

* Urinary retention - Being completely unable to urinate

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