Male, over 50 and running to the loo?

With 50% of men in their 50s experiencing symptoms related to an enlarged prostate, health practitioners should be encouraging middle-aged men to have their prostate checked.

The call for check-ups coincides with a newly published Medial Journal of Australia Insight article, highlighting that benign prostatic hyperplasia (BPH) — or a benign enlargement of the prostate — compromises a man’s quality of life and his relationships with his partner and family.²

​According to the article author, Clinical Associate Professor of Urology at Macquarie University Bill Lynch, the prostate — a walnut-sized gland in the male reproductive system that surrounds the top of the urethra and is found under the bladder — has proven extremely burdensome to the lives of men. An enlarged prostate can cause difficulty in passing urine and over time can lead to the complete inability to pass urine, urinary infections, damage to the kidneys or bladder and eventually potential surgery — reportedly the major concern for men regarding their prostate.²

​“Prostate issues are a fact of life for men, and are just as relevant now as they have been through the ages.²

“BPH is a progressive, non-cancerous disease that tends to strike ageing men.¹ Fifty per cent of men aged in their 50s will experience BPH, increasing to 80% of men aged in their 80s,”³ A/Prof Lynch said.

“While not all men with BPH will show symptoms, more than 30% of those aged over 50 will experience moderate-to-severe lower urinary tract symptoms (LUTS), two-thirds of whose symptoms will be caused by BPH.^2,4,7

“This equates to more than a million Australian men experiencing significant symptoms due to BPH, noting most men aged over 50 must contend with LUTS,”^4,8 A/Prof Lynch said.

Impact of BPH

The quality of life for men with symptoms of BPH is significantly lower than for those exhibiting no symptoms, with daily activities, such as driving, sport, sleep and social activities considerably affected.⁵ Moreover, BPH is also linked to male sexual function, with a higher International Prostate Symptom Score (IPPS) — a scoring system used to screen for, diagnose and monitor symptoms — associated with more severe erectile dysfunction.⁶

“Men experience varying symptoms of BPH with different degrees of bother, including increased frequency and urgency of urination both day and night, difficulty starting, maintaining and finishing urination. They may also experience urine infections or urinary retention,” said urological surgeon Dr Martin Elmes, Gold Coast.

Business Development Manager, weekend skateboarder and father to three adult children, David, 61, Gold Coast, has first-hand experience of BPH, having lived with the disease for almost five years before being diagnosed and treated last year.

“I was constantly going to the bathroom. I had to plan my entire day around the next toilet, and I was getting up about four to five times a night to the toilet.

“I lived with these symptoms for so long having mistakenly assumed they were normal. It wasn’t until visiting my GP for an unrelated matter that he mentioned my frequent urination may be linked to my prostate,” David said.

Further testing confirmed David’s frequent urination was in fact due to BPH, and he was referred to urological surgeon Dr Elmes for treatment.

“I’d never heard of BPH until being diagnosed. Up until then, I thought prostate issues were a reflection of poor health, and given I was so healthy and active, it never crossed my mind,” said David.

Treatment improved David’s BPH symptoms and quality of life, and he now has a simple message to share with other blokes. “If you’ve got trouble with your waterworks, don’t muck around. Get checked out. Visit your doctor.”

Getting to the heart of the matter

In his article, A/Prof Lynch argues that it’s important to get to ‘the heart of the matter’, citing the management of prostate symptoms can have far-reaching benefits for a man’s general body health.

“Nearly all documented interventions or lifestyle changes beneficial for heart health have been shown to prevent or reduce the impact of BPH and LUTS, including moderate exercise, diet (regular vegetable and water consumption, fibre and Omega-3 intake) and weight control,” A/Prof Lynch said.

“High blood pressure, excessive calorie intake (particularly foods high in saturated fats), high cholesterol, heart disease and conditions that heighten your risk of developing diabetes, stroke and heart disease all negatively impact BPH.

“Making lifestyle and behavioural changes to positively support prostate health should prove even more beneficial to the heart, while helping to allay men’s fears over surgery,”² A/Prof Lynch said.

“All of this information provides a compelling argument for men to consider their prostate.”

Importantly, having BPH does not increase your chance of developing prostate cancer.¹

While the disease cannot be prevented, there are many options available to improve the symptoms of BPH. Oral medications can be prescribed by a GP or specialist (Urologist)² including alpha-blockers, 5-alpha-reductase inhibitors, phosphodiesterase-5 (PDE-5) inhibitors, anticholinergics or a combination of these agents.¹ In addition, “surgery is continually evolving, resulting in less invasive, less morbid and safer procedures,” said Dr Elmes.

BPH worsens over time if not treated.¹ Various tests are available to determine whether symptoms are indicative of BPH or another condition.¹

To learn more, visit: www.disappearingdave.com.au.

References

1. Andrology Australia. Prostate enlargement. A guide to urinary symptoms in men. 2017. Available at https://andrologyaustralia.org/wp-content/uploads/AA20193_Prostate-Enlargement-Guide_Web.pdf [last accessed July, 2018].

2. Lynch, B. Men and their prostates!. MJA Insight. August 13, 2018.

3. Berry SJ, Coffey DS, Walsh PC, et al. The development of human benign prostatic hyperplasia with age. Journal of Urology 1984; 132(3): 474-79.

4. Carballido j, Fourcade R, Paglarulo A et al. Can benign prostatic hyperplasia be identified in the primary care setting using only simple tests? Results of the Diagnosis IMprovement in PrimAry Care Trial (DIMPACT). International Journal of Clinical Practice 2011; 65(9): 989–96.

5. Garraway WM, Russell EB, Lee RJ et al. Impact of previously unrecognized benign prostatic hyperplasia on the daily activities of middle-aged and elderly men. British Journal of General Practice 1993; 43(373): 318-21.

6. Gacci M, Eardley I, Giuliano F, et al. Critical analysis of the relationship between sexual dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia. European Urology 2011; 60(4): 809-25.

7. Berges E et al. European Urology 1999; 36(3): 21-27.

8. Australian Bureau of Statistics. Australia: Age Structure in 2013.

Image credit: www.disappearingdave.com.au/