prostate diseases
article written by Dr. Gobinrajh Bajrangee

Benign Prosatatic Hyperplasia (BPH)

BPH is a non-cancerous enlargement of the prostate as the man grows older. Fifty percent of men, aged 50 to 60 years have BPH. The development of BPH requires the presence of certain hormones called testicular androgens during prostate development at puberty and in aging.

Androgens act on the prostate via receptors. Androgen receptor levels remain high in the prostate throughout aging. There is also an age-related increase in oestrogen in the male, which increases androgen receptor expression in the prostate with further growth of the prostate.

Growth factors, peptide (protein) molecules, present in the prostate also stimulate growth.

BPH also has an inheritable genetic component consistent with an autosomal dominant inheritance pattern. Approximately 50 % of men under the age of 60 who undergo surgery for BPH may have a heritable form of the disease. First degree male relatives of such patients carry an increased relative risk of approximately four-fold.

The symptoms which arise from BPH can be perceived as irritable and obstructive.

Irritable symptoms are:

1. Frequency – urinating within 2 hours
2. Urgency – inability to postpone urinating
3. Nocturia - urinating at night

Obstructive symptoms are:

1. Straining – pushing to initiate urinating weak stream
2. Intermittency – stopping and starting during the stream and sensation on incomplete emptying of the bladder

Additional symptoms include haematuria (blood in the urine) or infections of the urine. In severe cases kidney failure may be present.

Prostate Cancer

Prostate cancer is the most common cause of male cancer death in Trinidad and Tobago according to the nation Cancer Registry of Trinidad and Tobago. In the United States of America, it is the second most common cause.

Worldwide death from prostate cancer is highest in Jamaica, Nigeria United States and Scandinavian countries. It is lowest in Asian countries, notably Japan and China.

Environment influences prostate cancer mortality. Japanese and Chinese men in the United States have a higher risk of dying from prostate cancer than their relatives in Japan and China.

Inherited prostate cancer comprises of 9% of all prostate cancer. In early onset cases, men younger than 55 years, 43% may be inherited.

Symptons of Prostate Cancer

1. Early stage prostate cancer usually has absolutely no symptoms. This is the best stage for obtaining a cure for the patient.
2. Symptoms often suggest local spread of the cancer
3. Symptoms may be similar to that of BPH

Symptoms of widespread cancer (metastatic disease) include:

• Weight loss.
• Bone pain (especially lumbar spine and pelvis).
• Weakness and numbness of the legs. This occurs when there is spread to the spine with compression of the spinal cord.
• Swelling of the legs (hymphoedema), caused by cancer blockage of the lymph gland. The lymph glands drain tissue fluid.
• Fatigue and anaemia (low blood count). Anaemia may be caused by blood loss, cancer involvement of the bone marrow, or kidney failure. Kidney failure may arise from obstruction of the kidneys.

© Trinidad & Tobago Prostate Brachytherapy Ltd