The Quiet Enemy: Non-Cancerous Prostate Growth

You might not notice the problem. You write it off to advancing age. You haven't got cancer and you'd rather avoid medical procedures. So you just strain a little harder to pee and think nothing of it. But this partial blockage can be a silent menace that ultimately can cause major problems.
05/28/2014 01:42 pm ET Updated Jul 28, 2014

It started with a crisis. On a peaceful Sunday morning last year, I did not follow my usual weekend ritual of arising late and remaining for hours under my down comforter accompanied by my newspaper and coffee. Instead, I woke up at 5:00 a.m., writhing in pain and completely unable to pee, even though I badly needed to. I was rushed to the emergency room at the local hospital, where they forced in a catheter, drained large amounts of pent-up urine, and referred me to a urologist for expert treatment.

What had just happened? The doctors explained that my prostate had grown so large that it was preventing me from urinating. Was it cancer? Probably not. It was a condition called "chronic urinary retention" resulting from non-cancerous prostate growth and it would severely impede my normal routines. The technical name is benign prostatic hyperplasia (BPH).

I would have to learn how to use a catheter several times a day, they said, and be prepared for the possibility of discomfort, inconvenience and possibly recurring infections for the rest of my life.

Fortunately, I found a dynamic surgeon who proposed an effective treatment for my condition: holmium laser surgery. Several months later, I lay on an operating table while he inserted an ultramodern laser scalpel to remove the bits of my over-enlarged prostate that were preventing me from urinating. These bits were taken for histology and, luckily, the tests confirmed that the growing prostate was benign. It was not cancer. And I would be okay. And I could urinate like a normal person again. Hoorah! Problem solved.

But how did this sneak up on me? Did I miss any warning signals? Could I have prevented this nasty episode? Yes. Are other men at risk? Also, yes.

There is a lurking problem of non-cancerous prostate growth that we men need to be aware of. With a few simple tests, we can avoid some major problems such as those that I just went through.

Unfortunately, those tests don't seem to be part of a standard physical examination in a GP's office. You have to get them at a specialist's office. Perhaps these tests should become routine.

After age 50 or 55, we men start to realize that our bodies are not working quite as well as they used to. Urination problems are common. That horse's stream that used to exit so easily might be drying up to a dribble. Maybe it's a little painful.

If you get annual checkups, your GP is probably on the lookout for prostate cancer, which is a major killer of older men. But if your blood tests and physical examination rule out cancer, the doctor's interest might subside.

If you still have problems peeing, the doctor might give you medication. Or you might take an herbal medication such as saw palmetto. That's what I did. For years it seemed to work. In fact, it might have covered up symptoms I should have noticed.

Most of us take urination for granted. I certainly did. But several things have to work properly in order for all to run smoothly.

To begin with, urine gathers in the bladder, which is a balloon-like muscle that expands to hold the liquid. When you urinate, the urine passes out via a channel called the urethra. On the way out, the urine must get past a latent gatekeeper, the prostate, which is an organ that sits next to the urethra. For most of our lives, the prostate and urethra are good neighbors. But as we grow older, tensions can arise.

In order to pee correctly, you need two things: (a) the urethra needs to be open and clear for the urine to pass, and (b) the bladder muscle must be strong enough to push the urine out. If either of those is lacking, you have a problem that could become very serious, requiring catheterization and possibly surgery.

Like your ears, the prostate keeps growing into old age. Nobody really knows why. And if grows too large it can start strangling the urethra in a slow death grip. That's where the problem arises.

You might not notice the problem. You write it off to advancing age. You haven't got cancer and you'd rather avoid medical procedures. So you just strain a little harder to pee and think nothing of it.

But this partial blockage can be a silent menace that ultimately can cause major problems.

If the prostate is slowly squeezing the urethra, then the bladder has to work harder and harder to push the urine out. The bladder will struggle, if needed, to empty itself. But this can only go so far.

At a certain point, the bladder becomes exhausted and gives up the fight. Then the unexpelled urine risks expanding the bladder way beyond all normal dimensions. Think of a blowing up a balloon until it is about to burst. For the bladder, you are filling it with larger and larger amounts of urine that cannot get out, and possibly even exhausting it to the point where the bladder muscle no longer functions. And excess urine could even back up to the point of damaging vital kidney functions and lead to serious urine infections.

Beware! Bladders do not regenerate. The damage you can cause can be permanent. It seems that the doctors can do very little to repair a distended and damaged bladder.

Why didn't I notice this problem before? After all, I get an annual physical.

Typically, my physical examinations in recent years have consisted of two basic items as they relate to the prostate: The doctor does a "digital" examination in which he inserts his finger via the anus to feel the prostate to see if the prostate is enlarged. In addition, the doctor has done a "PSA" test as part of the blood work. The PSA test is a key indicator of whether there is a danger of cancer of the prostate. If the PSA numbers are low enough, cancer is unlikely. This PSA test has been controversial recently because apparently they can lead to over-diagnosis and needless medical procedures in some cases.

But these two routine examinations only tell half the story. The digital examination only indicates whether the prostate is enlarged on the side that the physician can touch. It tells you nothing about whether the prostate has grown on the other side of the urethra and is starting to squeeze. You need an ultrasound sonogram to accurately measure bladder size.

The other problem is that my physical examinations never included a flow test and a simple "bladder scan." A bladder scan is a sort of sonogram that the doctor can perform very quickly and easily. By touching the instrument to your lower belly right after urination, the doctor can determine how much urine is not coming out. This retention amount is a key indicator of whether a man is urinating correctly.

But bladder scan devices don't seem to be commonly available in general practitioners' offices. You have to go to the urologist to get these scans, and you only go to the urologist if something is wrong. So I never had the scan done because nothing ever seemed to be wrong.

For years I had been receiving reassuring remarks from my general practitioner in New York City, who told me "my prostate was small" and the "PSA results are low" all of which made me think that nothing was wrong.

But something was very wrong. And although I certainly ignored it for too long, I think perhaps the medical system did that as well.

To be fair, when I complained about peeing problems, my GP in New York suggested I see a urologist. I wanted to avoid needless expense and treatments, and I was getting along okay with herbal medications. So took the doctor's reassuring words to heart and I did not go to the specialist. But I was wrong.

In the end, I was lucky. Laser surgery on the prostate cleared an adequate passage in the urethra and fixed the problem. And my bladder muscles still had the necessary strength to function correctly.

I do hope that other men will not have to go through what I went through. It wasn't fun. I urge every older man to be sure he is being adequately tested against the dangers of non-cancerous enlarged prostate.
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