Former President Biden recently revealed he has an aggressive form of prostate cancer that has spread to his bones.
The news may have provoked concern in men with an enlarged prostate. But Dr. Pat Fulgham, a urologist with Texas Health Presbyterian Hospital Dallas, explains to KERA’s Sam Baker why they needn’t worry.
Dr. Fulgham: An enlarged prostate is a common consequence of aging, and a fairly high percentage of men in their 50s, 60s, and 70s have symptoms of an enlarged prostate, but there's no evidence that that puts them at increased risk for prostate cancer.
Of course, it's also true that prostate cancer is more common as men age. So, both get more common with age, but they're not directly related.
Baker: Are there any similarities even in symptoms between the two?
Prostate cancer has very few symptoms in its early phases, in fact, none until it becomes advanced in most cases. If it's very advanced, it can cause some blockage of the urinary tract, some irritative voiding symptoms, frequency, and urgency. Those are also symptoms associated with benign enlargement of the prostate. But prostate cancer causes no symptoms until it's far advanced.
Does enlarged prostate ever lead to something more serious than that?
The only significant health consequences of an enlarged prostate, aside from the bother associated with the symptoms, is if you develop a condition where the bladder is not empty completely, you may be more prone to get urinary tract infections.
Over a very long period of time, it can compromise kidney function by increasing the pressure in the bladder. That pressure is transmitted back up to the kidneys. And then the kidneys stop cleansing the blood effectively. That's called renal failure, but that's a very uncommon consequence of untreated benign enlargement of the prostate.
How do you treat an enlarged prostate?
Well, there are several ways:
- If the symptoms are mild, you can treat it by surveillance only.
- If the symptoms are more concerning, for instance, frequency and urgency so that you occasionally lose control of your urine or getting up very frequently to urinate or going to the bathroom every hour or two during the day and night, those symptoms can be treated initially usually with medication.
We have two kinds of medicine. One relaxes the opening of the bladder and makes it easier to urinate, and the other physically shrinks the size of the prostate gland.
Who's at risk for enlarged prostate?
Any man who's aging is at risk for benign enlargement of the prostate. We don't know precisely what causes it.
It may be a change in the balance between certain hormones in a man's system as he ages.
It's associated sometimes with obesity or metabolic syndrome or diabetes, but it's unclear exactly how those conditions would lead to an enlarged prostate. So, they're more likely to be associations than cause and effect.
It also appears to be true that there's a genetic component, so that if you can have a male relative, a father or a brother with a benign enlargement of the prostate, you're also more likely to have that.
Is there anything you'd like to add to that?
Yeah, I think as men think about their prostates, the condition that's more likely to cause them significant harm in their lifetime is prostate cancer. And this should be a wake-up call for all of those who don't get an annual physical exam to consider doing that and to include the PSA blood test as a screening examination for prostate cancer on an annual basis once you reach age 45.
Men who have a first-degree male relative with prostate cancer, father, brother, uncle, should start at age 40.
African American men should start at age forty since there's a racial predilection to get prostate cancer earlier in black men. And for all others, begin at age 45 with an annual PSA blood test.
RESOURCES:
Enlarged Prostate Versus Prostate Cancer: What's the Difference?
Benign Prostatic Hyperplasia and the Risk of Prostate Cancer and Bladder Cancer
