BPH

Prostate Gland Size: Why is it important?

Thousands of men are diagnosed with a prostate condition every year. They experience both disease and treatment-associated complications that impair normal functions.

The impact of prostate conditions on quality of life remains a major concern for aging men. Common prostate conditions (including prostatitis, benign prostatic hyperplasia, and prostate cancer) have a complicated relationship with the prostate gland’s volume.

On the one hand, these conditions enlarge the prostate gland. An enlarged prostate presses on the surrounding tissues/organs to cause urinary, sexual, and bowel symptoms that reduce your quality of life. On the other, the effectiveness of different therapeutic approaches for prostate disease may depend on the prostate gland’s size.

A significant proportion of men with enlarged prostate require surgery to treat their symptoms. However, balancing the benefit of surgical interventions for a large prostate with the risk of treatment side effects is a significant challenge.

Despite the apparent improvements in the treatment of this condition by less invasive options, immediate clinical intervention is not always necessary. Here, we discuss the relationship between prostate size, prostate health, and quality of life. The article also offers some insight into the potential ways to maintain a healthy prostate.

What is a prostate?

The prostate gland is a small organ located between the bladder and the penis. The primary function of the prostate is to secrete the fluid that nourishes and protects sperm. This function is primarily controlled by the male sex hormone “testosterone” produced in the testicles.

The prostate contains 5-alpha-reductase that converts testosterone to the active dihydrotestosterone (DHT). DHT is essential for normal prostate development and function and controls the development of male secondary sex characteristics.

Structurally, the gland has two main parts, including the muscle and glandular tissues. The latter tissue has a lobe that grows throughout a man’s life, causing BPH and the associated symptoms. Further, the glandular part is the source of prostate-specific antigen (PSA) protein that helps liquefy semen and is implicated in prostate cancer.

What is the normal size of a prostate?

The prostate gland is approximately the size of a walnut and weighs around 30 grams, with a volume of 34-38ml. The exact size of a normal prostate depends on your age because it gets bigger as men get older.

Why does prostate size matter?

The prostate gland sits between the penis and the bladder. Thus, an abnormally sized prostate can put pressure on the bladder and the urethra. Obstruction of the urethra and bladder is the chief source of the symptoms associated with an enlarged prostate and the subsequent reduction in quality of life.

These effects reduce urinary, sexual, and bowel functions, range from mild to very troublesome. An enlarged prostate can sometimes cause serious complications, like urinary tract infection and urinary retention.

Does the size of prostate affect PSA?

Because PSA , also known as Prostate Specific Antigen, is almost exclusively produced in the prostate gland, changes in the prostate’s size invariably lead to more PSA-producing cells and an increase in PSA levels (Bo et al., 2003). If the prostate gland structure is severely impaired, then this size-dependent increase causes a marked increase in blood PSA level (Roehrborn et al., 1999).

Men may worry that the link between an enlarged prostate and PSA increases their risk of developing prostate cancer. However, the available evidence suggests otherwise. The risk of prostate cancer is the same between men with an enlarged prostate and those without an enlarged prostate. 

What size of prostate requires surgery?

Prostate enlargement presents with lower urinary tract symptoms that range from mild to severe. Some of the men with severe symptoms may require surgery to manage the condition.

Prostate size rarely dictates the type of treatment offered by clinicians. This situation is related to the fact that men with similar prostate sizes will have variable levels of symptoms.  

Therefore, the decision for surgical treatment derives from the type and extent of your symptoms (Hashem et al., 2020). Invasive treatments are recommended for patients whose symptoms are not controlled or those who experience severe side effects (Wilt and N’Dow, 2008).

Transurethral resection of the prostate (TURP) and open prostatectomy (OP) are the standard methods for treating lower urinary tract symptoms caused by prostate enlargement. Your doctor may recommend surgery if you have severe bph symptoms, including partial blockage of the urethra with repeated urinary tract infection, kidney damage, or severe side effects from medicines (Wilt and N’Dow, 2008). 

Surgery can help some men whose symptoms impact their quality of life but have an increased risk of side effects (Rassweiler et al., 2006). The side effects of both traditional procedures mentioned above led to the development of several minimally invasive techniques (Smith et al., 2017). Although the newer surgical therapies reduce the risk of treatment complications, they have higher clinical failure rates requiring further treatment (Oelke et al., 2013).

For men with mild to moderate urinary tract symptoms, lifestyle changes, watchful waiting, and medications are usually tried first. Lifestyle changes can help relieve the symptoms of BPH, while some drugs may improve urine flow.

Can you reduce an enlarged prostate?

Yes – anti-androgens that block the production of androgens or inhibit their biological activity can starve the prostate of essential growth factors. Inhibiting the growth-promoting effects of these factors shj,rinks the prostate gland, reducing the impact of an enlarged prostate.

Common medicines include:

  • 5-alpha reductase inhibitors – block the conversion of testosterone to the active DTH.  Finasteride is an example of a 5-alpha-reductase inhibitor. However, there are certain associated with the use of 5-alpha reductase inhibitors that patients do need to be aware of. These side-effects can be unpleasant. Retrograde ejaculation has been noted in some patients.The patient may also note a reduction in their erectile function. This can cause symptoms associated with erectile dysfunction.

  • Alpha blockers- Alpha-Blockers are a class of prescription medications used to relax muscles around small blood vessels. There are several medications available as alpha-blockers, with Flomax being one of the most commonly prescribed.

Though these medications shrink the prostate, they often leave most of the prostate gland untouched, allowing the condition to return. Aim to maintain a healthy prostate by reducing inflammation, healthy diet, and physical activity.

Lifestyle changes and home treatment will not stop the prostate from growing bigger but can help with your symptoms. 

These lifestyle changes have utility in reducing the symptoms of enlarged prostate:

  • Minimising bladder irritation by reducing the intake of carbonated drinks, alcohol, and caffeine. 

  • Reduce fluid intake in the evening and before long travels to help with urinary symptoms. 

  • Do bladder training to give you more urinary control and reduce the impact of an enlarged prostate.

  • Consume food rich in fruit and fiber to help reduce constipation, in turn reducing bladder pressure.

Conclusion 

Prostate enlargement is a common disease that affects aging men, dramatically reducing their quality of life. Under androgen control, prostate cells proliferate, causing the prostate volume to increase. The exact cause of this aberrant growth is not fully understood; an enlarged prostate can cause a range of urinary tract symptoms.

Most men with this condition will have mild symptoms that can be managed with lifestyle changes and medications. However, for some men, they might not always be enough to reduce symptoms. Your doctor may consider invasive surgery for long-term management of severe symptoms. When deciding if surgery is the best option for you, it is good to discuss the advantages and disadvantages of surgery.

The decision will also depend on personal factors such as your age and how healthy you are otherwise. Surgery is not always available for severe cases. You may not be fit or well enough for an operation. Your doctor may suggest using a catheter if lifestyle changes and medicines have not worked.

Sources

  1. Bo, M., Ventura, M., Marinello, R., Capello, S., Casetta, G., Fabris, F., 2003. Relationship between Prostatic Specific Antigen (PSA) and volume of the prostate in the Benign Prostatic Hyperplasia in the elderly. Crit. Rev. Oncol. Hematol. 47, 207–211.
  2. Hashem, E., Elsobky, S., Khalifa, M., 2020. Prostate Artery Embolisation for Benign Prostate Hyperplasia Review: Patient Selection, Outcomes and Technique. Presented at the Seminars in Ultrasound, CT and MRI, Elsevier.
  3. Oelke, M., Bachmann, A., Descazeaud, A., Emberton, M., Gravas, S., Michel, M.C., N’dow, J., Nordling, J., Jean, J., 2013. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur. Urol. 64, 118–140.
  4. Rassweiler, J., Teber, D., Kuntz, R., Hofmann, R., 2006. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur. Urol. 50, 969–980.
  5. Roehrborn, C.G., Boyle, P., Gould, A.L., Waldstreicher, J., 1999. Serum prostate-specific antigen as a predictor of prostate volume in men with benign prostatic hyperplasia. Urology 53, 581–589.
  6. Smith, C., Craig, P., Taleb, S., Young, S., Golzarian, J., 2017. Comparison of traditional and emerging surgical therapies for lower urinary tract symptoms in men: a review. Cardiovasc. Intervent. Radiol. 40, 1176–1184.
  7. Wilt, T.J., N’Dow, J., 2008. Benign prostatic hyperplasia. Part 2—management. Bmj 336, 206–210.

 

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