An enlarged prostate does not necessarily lead to cancer

But prostate cancer is a leading cause of cancer deaths in men

Conclusion of a two-part column

To maintain good prostate health, it is important for men (and women, for other reasons) to have regular general medical examinations. An enlarged prostate is easily detected by a rectal examination.

The rule of thumb is to have two general medical examinations in your 20s, three general medical examinations in your 30s, a general medical examination every two years in your 40s, and yearly after age 50. Of course, this schedule is just a general recommendation. Your physician will discuss with you the best timing of general medical examinations based on your personal medical history.

Benign prostatic hypertrophy (BPH), which we introduced last week, is a progressive medical disease. Left untreated, BPH can cause serious health problems such as kidney and/or bladder damage, kidney infections, and prostate infections. It can also be an extreme inconvenience with the above-mentioned urination problems, including multiple visits to the bathroom during normal sleeping hours.

Increased sexual activity has not been proven to decrease the incidence of prostate cancer, but, anecdotally, it seems to decrease the incidence of chronic prostate inflammation, a condition known as prostatitis. Having a vasectomy does not increase the incidence of prostate enlargement or prostate surgery. Having personal or family history of testicular cancer does not increase the risk of developing prostate cancer.

Tests for an enlarged prostate 

• Digital examination of the prostate (doctor palpates the prostate through the rectum)
• Imaging studies to check on bladder emptying
• Special urinals that can measure urine flow
• Prostatic Specific Antigen (“PSA” blood test), often elevated in prostate cancer

Of note: the PSA test is currently the only and best blood test available for the screening for prostate cancer. Unfortunately, using it is very controversial if it should be given to a man with NO prostate symptoms. Most experts agree that a man should have a conversation with his doctor to see if this is a good screening test for their particular case, or when it should be taken.

Treatments for BPH

BPH is a treatable condition. If you have BPH, there are several treatment options:

• Observation. Patients with early, mild BPH and who are not suffering any significant symptoms may be advised by their doctor to simply schedule an annual medical examination, which might include a variety of tests relating to BPH.
• Behavioral changes. These may include limiting fluid intake in the evening and/or before bed. Particularly important is limiting drinks containing alcohol or caffeine. Maintaining a healthy weight is also very important for a healthy prostate.
• Dietary supplements, such as Saw Palmetto. These are controversial, but if taken and the symptoms improve, it may be worthwhile. These supplements are not FDA regulated and, as a result, they should be used with skepticism and caution.
• Prescription Medication. These include medications called alpha-blockers and 5 alpha-reductase inhibitors. They can be taken together. They help to ease symptoms and can cause a decrease in the size of the prostate.

The FDA is currently examining these medications to see if they could possibly have any effect on increasing the risk for developing prostate cancer. The medications can be very helpful, but talk with your doctor about the risks and benefits if you are considering these medications.

• Surgical opening of the urethra, known as “TransUreathral Resection of the Prostate” (TURP). The tube carrying urine is surgically enlarged or “tunneled out” through the enlarged prostate gland. It opens up the urine tube by removing the overgrown prostate tissue using a very small surgical tool, or by using a laser. It can take a few months to completely clear.
• Euro-lift. This is a new treatment where surgical implants can be employed to keep the tube carrying the urine open. Unfortunately, long-term effects of this procedure are not known.

BPH and prostate cancer

BPH is not necessarily a precursor to prostate cancer. However, enlarged prostate glands can become cancerous. Prostate cancers can grow slowly or can be very aggressive. Prostate cancer is the second-overall leading cause of cancer death in men.

Suspicion of prostate cancer can come from an abnormal digital exam, or if a patient has a high PSA test or an abnormal imaging study, such as an MRI. Many doctors believe that a significant and gradual increase of the PSA number over time is probably more important than an elevated PSA that does not change.

When the clinical suspicion for prostate cancer is present, a biopsy is indicated. A biopsy is when a small sample of tissue is removed and examined under the microscope. Prostate cancer is diagnosed by this method.

Treatments for prostate cancer

• Radiation
• Traditional surgery
• Robotic surgery (DaVinci surgery)
• Hormonal treatment (Lupron) to decrease testosterone production. Lupron treatment is often combined with surgical treatment. Because it decreases testosterone production, it can have profound effects such as decreased sexual drive, lethargy, depression, hot flashes, and increasing the incidence of adverse cardiovascular events such as stroke and heart attacks. The risks and benefits of using Lupron should be carefully considered with your doctor or urologist

Prostate health is very important. If you are a man, make sure you have regular discussions with your doctor about optimizing your prostate health. If you are a woman, encourage the important men in your life to get regular checkups and discuss their prostate health with their doctors.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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