IF you’re a man over the age of 50 who’s often robbed of a good night’s sleep by an ill-timed bathroom break, you may have an enlarged prostate gland—but not necessarily cancer.
Data sourced by global research-based healthcare company GlaxoSmithKline Philippines (GSK) reveal that 24 percent of Filipino men aged between 50 and 59 years old suffer from at least moderate symptoms of Benign Prostatic Hyperplasia, or BPH, a common, noncancerous disease wherein the prostate increases in size as a man ages, causing bothersome urinary problems.
The prevalence of BPH is supported by a Harvard Medical School finding published this year, called the Annual Report on Prostate Diseases, which states that most men eventually develop some type of prostate problem. The report named BPH as one of three most common prostate illnesses, along with prostatitis and prostate cancer.
The prostate, as explained in a recent media briefing by Dr. Carmela Lapitan, GSK regional medical expert for Urology, is an organ only men have that wraps around the urethra, or the passageway inside the penis that allows urine from the bladder to pass out of the body. When men reach the age of 40, she said, the prostate starts growing and tightens the urethra, making the outflow of urine more difficult.
“BPH is a progressive disease,” Lapitan said. “You can’t stop it as long as the man is aging because the prostate will continue to grow and it will eventually cause problems. And as time goes by, those problems get worse.”
There are three types of lower urinary tracts symptoms associated with BPH. First is Storage Symptoms, which includes nocturia, or the need to wake up at night to pass urine, increased daytime frequency and urgency. Next is Voiding Symptoms, the most common of the three, which includes weak stream, splitting or spraying and hesitancy, or taking a long time to start the void. Last is Post Micturition Symptoms, such as having the feeling of incomplete emptying of the bladder after urination.
These symptoms, according to Lapitan, can affect the life of a patient in a number of ways.
“It can change the patient’s lifestyle such that he becomes limited in certain activities, like playing golf or traveling long distances, especially with the traffic situation in Manila.” she said. There’s also a good correlation between the increasing severity of the symptoms and the decline in sexual activity and performance, Lapitan added, citing a research.
Another study, she said, posits that the level of lifestyle change BPH patients undergo equals that of patients with diabetes. “It can have that big of an impact to a man’s life.”
If left untreated, the symptoms can become so severe that it will leave the patient unable to urinate. Such instance leads to the use of a catheter. Lapitan said that she has seen a lot of men in her practice where the first time they’ll see a doctor is when it’s already too late.
“They say using a catheter is really the most excruciating pain that they have ever suffered, that it’s the probably the equivalent of giving birth,” she said.
Taking into account the pervasiveness and impact of BPH on the life of patients, GSK pioneered the “World BPH Day” last week, June 25, to raise prostate health awareness through the “FUN to be WISE on BPH” advocacy.
“The FUN to be WISE advocacy addresses the lack of knowledge about BPH, especially among the elderly men, that may lead to late diagnosis or late management,” said Dr. Jay Javier, GSK Medical Affairs for Urology. “The advocacy addresses not only the men, but also the women to take action, to share the information to the important men of their lives.”
Part of the campaign is the launch of GSK’s acronym “FUNWISE” for the simple recall of BPH’s telltale signs, based on the International Prostate Symptom Score. Each letter stands for a specific symptom that one can check how often he has observed over the past two months. They are as follows:
- F for Frequency. How often have you had to urinate over a two-hour span?
- U for Urgency. How often have you had difficulty in postponing urination?
- N for Nocturia. How many times have you had to get up at night to urinate?
- W for Weak Stream. How often have you had a weak urinary stream?
- I for Intermittency. How often have you had a disrupted urinary stream?
- S for Straining. How often have you had to exert effort to begin urination?
- E for Incomplete Emptying. How often have you had a sensation of not completely emptying the bladder after you finish urinating?
Lapitan said one doesn’t need to exhibit all the symptoms before consulting the doctor. Ticking even just one or two of the boxes should be enough to make a trip to the clinic, depending on how much the patient is bothered by the symptom.
“We check if the cause of the symptom, like frequency, is an enlarged prostate or simply the patient’s bladder diary, or the volume of fluids he takes in,” Lapitan said. “But at the same time, we also have to check if the symptoms is caused by prostate cancer, because it shares the same symptoms with BPH.” She added that while it’s that exact possibility that scares most men from consulting a doctor, the chances of being diagnosed with prostate cancer is much, much lower than having BPH.
“If a person exhibits a symptom, I can bet that 90 percent of the time, or even more, that its just BPH, especially if he’s between 50 and 59. But still, they need to act fast. If it is, indeed, prostate cancer, if they consult us early enough, then we can catch it at a stage where it’s still curable.”
When the tests (prostate exam, study of the patient’s medical history, urine test, among others) do result to a BPH diagnosis, Lapitan said there’s “an entire spectrum” of treatment options available today as compared to 30 years ago when surgery was the only choice.
Conservative treatments include basic lifestyle change. Limiting fluid intake at night or when traveling far and timing of voids to create sufficient interval can significantly improve symptoms. If these don’t afford patients satisfactory relief, medications are available.
There’s a variant that can shrink the prostate, and another that relaxes the muscles of the prostate glands to open up the urethra and allow better urine flow. Also available are drugs that can control the bladder to address the symptoms of frequency, urgency and nocturia.
For extreme cases that require surgical treatment, minimally invasive treatments are at hand. Lapitan said that they can now do everything by telescopes, either by scraping or vaporization of the prostate.
“But as I said, we hope that by getting them to us early enough, we can prevent that need for surgical treatment,” she added. “And if they do need it, hopefully we can give it to them before it’s too late.”