Every day, patients enter Dr. Michael O’Leary’s office thinking they have prostate cancer. They have urinary symptoms that worry them. They’re assuming the worst.
Dr. Michael O’Leary, a urologist and Director of the Men’s Health Center at Brigham and Women’s Faulkner Hospital, listens calmly as his patients describe their symptoms of frequent urination, including getting up in the middle of the night.
Dr. O’Leary explains that he will perform a physical evaluation, often including a digital rectum exam, as well as order the standard screening test for prostate cancer, but he’s quick to reassure a worried patient that it is most likely not cancer.
Why is prostate health important?
The prostate, a small walnut-shaped gland that produces seminal fluid, naturally increases in volume with age. It begins growing at puberty and never stops. Once the prostate reaches a certain size, some men develop urinary symptoms, including weak stream of urine, leaking or dribbling of urine, and more frequent urination, especially at night.
“These are normal symptoms of aging, and in the vast majority of people, it’s not a sign of cancer. I explain to patients that while these symptoms can sometimes be a nuisance, they are often symptoms of a non-cancerous condition called benign prostatic hyperplasia (BPH), a condition most men eventually develop later in life,” says Dr. O’Leary.
About half of all men older than 75-years-old have some symptoms of BPH. The condition does not cause cancer, affect a man’s fertility, or cause erection problems.
Do you need medication to treat prostate symptoms?
Many patients leave Dr. O’Leary’s office accepting their symptoms as a natural part of aging. “This is just a part of getting older,” is a common remark. They go on with their lives, reassured that BPH is common, normal and completely benign.
“However, if urinary symptoms are bothersome or interfere with patient’s quality of life, there are medications,” says Dr. O’Leary. “The main class of drugs is known as alpha blockers, which help relax blood vessels and improve blood flow. There are many of these medications available; they have few side effects and have been used widely for decades. However, if medication doesn’t work there are also potential surgical options.”
Should I get checked for prostate cancer?
It’s a sobering reality, but many men will develop prostate cancer if they live long enough, according to Dr. O’Leary. That is why even men with BPH still receive a full physical evaluation and blood work.
The PSA test is now the standard screening test for prostate cancer. Most urologists recommend PSA screening between the ages of 55 and 69. Men with an increased risk of prostate cancer should begin screening at 40. Those at increased risk include men with a first-degree relative with prostate cancer and African Americans who are at higher risk.
Other non-cancerous prostate problems
In addition to BPH, other inflammatory conditions of the prostate can cause urinary symptoms. One benign condition of the prostate is called prostatitis, which is inflammation of the prostate. Nine percent of visits to urologists are coded as prostatitis, according to Dr. O’Leary.
Dr. O’Leary says the condition is not well understood among health care providers, including urologists. If a bacterial culture reveals an infection, the treatment is antibiotics, but in some cases the inflammation does not have an identifiable cause. Alternatively, acute bacterial prostatitis is a rare condition, where patients have an infection and present with a fever and require antibiotics.
Other causes of urinary problems
Not all urinary symptoms are due to an enlarged prostate. Some men “train” their bladders to go more frequently. “The more you urinate, the more you urinate,” says Dr. O’Leary. “But patients can learn to re-train their bladders by not going to the bathroom immediately when they feel the urge.”
Another factor to consider is sleep patterns, which change with age. Dr. O’Leary has seen many patients who were told that their prostate was causing their urinary symptoms. The patients saw a sleep specialist who diagnosed them with sleep apnea. They began using a continuous positive airway pressure (CPAP) machine and slept through the night, proving that their symptoms were not related to their prostate.
Another point to consider: “Many men wake up at night and become aware that they have to urinate, so they get up and go. However, are they awake because they really have to urinate, or are they simply thinking, ‘Since I’m up, I guess I could go now?’” If you hold it, the bladder will learn to send urges only when it is full.
One other factor involves the pelvic floor muscles, a layer of muscles that support the pelvic organs and span the bottom of the pelvis. “A lot of men who have high pelvic floor tone typically have higher than average urinary symptoms. Many years ago, doctors used to say these men had chronic prostatitis, but it’s not that simple,” says Dr. O’Leary.
The majority of men leave Dr. O’Leary’s office without a pill, which they would need to take for the rest of their lives. Some patients learn about BPH and make lifestyle changes, such altering their diet, limiting caffeine intake and avoiding fluids before bedtime.
All men of a certain age should remember that the prostate grows larger with age, and this can cause urinary symptoms. It’s just a part of getting older.