When I was in primary school, learning how to wipe my nose, taking a bath only on Sundays and competing over who could urinate the furthest, my friends and I used to make fun of our head teacher because he couldn’t hold his urine. You see, mr. Onjote (not his real name). was in his mid-50s approaching his retirement. A healthy well-fed man with a “kitambi ya pesa”. He was an authoritative figure in the whole school. The students feared him and the teachers respected him despite all the nicknames. He was also a great teacher. His simplified illustrations of the then complex science phenomena still echo through my head to this day.
His only letdown was his urine, which I have come to realize was actually his prostate. If I knew what I know now, I would have at the very least not laughed at his situation. He used to arrive in school early, before the morning assembly for his early morning class. On good days he would walk comfortably to the teachers’ toilets to relieve himself. However, on most days he would literally run while desperately clenching onto his groin.
Sadly, to me and my deranged friends; some of whom were too old to be in primary school, leave alone laughing at an older man, this was hilarious. We would giggle and point with amusement. It didn’t help much when more often than not he would return from the loo with his pants wet with urine. It was sad.
As if that wasn’t enough, my dear headteacher had to make these trips several times a day, and the fact that the toilets were almost 100 meters away from his office didn’t help his situation much. At times he would turn around to go back even before reaching his office or class. His face showed desperation and embarrassment but he braved it everyday and showed up for work.
The Prostate Gland
The prostate gland is a male reproductive organ located just below the bladder. The urethra passes through the prostates complex structure. Its function is to secrete prostatic fluid which plays a role in activating sperms.
The gland generally increases in size as a man grows older or when they develop prostate cancer. It can also increase due to inflammation of the prostate gland, prostatitis. Regardless of the cause of the enlargement, the end result is usually obstruction of urine flow also known as Bladder outlet obstruction.
Bladder outlet obstruction usually results in urine symptoms, manifested by Mr. Onjote.
Benign Prostatic Hyperplasia (BPH)
The commonest cause of lower urinary tract symptoms is Benign Prostatic Hyperplasia (Enlargement), abbreviated as BPH. As the name suggests, this is not prostate cancer. It is simply an enlargement of the prostate gland that usually develops as men grow older. This enlargement may or may not cause symptoms. When symptomatic, BPH requires treatment.
Usually, treatment starts with the use of medication and surgical removal of the prostatewhen this fails.
The elephant in the room, however, is prostate cancer. Unlike most cancers, cancer of the prostate is not a silent cancer. Symptoms of the disease usually manifest relatively early in its onset. Just like BPH, prostate cancer will have symptoms of increased frequency, urge incontinence and nocturia. Other subtle symptoms include; weak urine stream, hesitance in initiating urination, dribbling and feeling of incomplete emptying of the bladder.
The main difference between BPH and Prostate Cancer is the fact that prostate cancer spreads to other parts of the body. In some instances, the main complaints, for example lower back pains may be as a result of metastasis of prostate cancer. These may come even without urine symptoms.
Screening of Prostate cancer
As discussed in other sections of this segment, the key to successfully combating any cancer is early diagnosis and timely intervention. Prostate cancer exclusively affects men above the age of 40. It is therefore a WHO recommendation that men above 40 years, especially those with family history of prostate cancer undergo periodic screening. This enables diagnosis of prostate cancer even before symptoms appear.
Prostate specific antigen (PSA), is an enzy7me produced primarily by the prostate. Most diseases of the prostate gland raise the PSA levels in the body. Normally daily activities such as riding a horse or a bike and even having sex have been shown to momentarily raise the levels of PSA in the body. The normal range of PSA is 0 to 4 ng/ml. these levels however increase with age and it is normal to have older men with PSA levels of up to 8ng/ml.
PSA levels however rise exponentially with BPH and levels above 70ng/ml are strongly suggestive of prostate cancer.
PSA levels above the normal range for age should be further investigated to exclude cancer of the prostate gland. These range from digital rectal examination, where the doctor examines the prostate through the rectum, to a prostate ultrasound and ultimately a biopsy.
Treatment and Management of Prostate cancer
Biopsy results are usually reported as benign or cancerous. Treatment options depend on the biopsy results and the presence or absence of symptoms and their severity. If a diagnosis of prostate cancer is made, further blood tests and imaging have to be done to stage the cancer for more effective treatment.
Luckily, prostate cancer is one of the most responsive cancers to treatment especially when it is caught early. Prostatectomy (surgical removal of the prostate gland) is the best treatment for localized prostate cancer. However, this does not amount to cure. Prostate cancer cells feed on testosterone. Medications that block the production of testosterone are effective in arresting growth and multiplication of cancerous prostate cells weather metastatic or localized.
Testosterone is primarily produced in the testicles. Removal of both testicles, orchidectomy, is therefore a reasonably effective form of stopping the growth, spread and multiplication of prostate cancer cells even without prostatectomy.
Prostatectomy archives instant relief of urine symptoms. It can be done by open surgery or laparoscopically. Symptom relief can also be achieved by use of catheters or by or by transurethral resection of the prostate (TURP).
The biggest risk factor for prostate cancer is age. Family history has also been shown to be a major contributing factor in the development of prostate cancer.
Can I lead a Normal life without A Prostate Gland?
The prostate gland serves a minimal purpose on the sex drive and or performance of a man. However, prostatectomy may result in retrograde ejaculation. this means that one does not ejaculate through the urethra as would be normally. they ejaculate into the bladder.
Hormonal treatment and orchidectomy, however, block the production of testosterone and may result in behavioral and sexual changes in the patient.
By Dr. Nyadimu