The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

Tuesday, January 3, 2012

Prostate Size Matters


Having a large prostate is generally considered to be a bad thing because it is associated with urinary malfunction -- slow urination, getting up frequently at night and,  in the worst case scenario, total urinary blockage—an emergency condition that requires insertion of a catheter.

Treating urinary problems such as these is a big business.  A variety of herbal extracts containing ingredients such as saw palmetto as well as medications such as Flomax and Proscar are commonly prescribed and used with varying success. When total blockage occurs the urologists swings into action with lasers, microwave treatments or a good old-fashioned TURP, Transurethral Resection of the Prostate, sometimes referred to by laymen as the “rotorooter job.”

It should be made clear that many large prostate glands cause no urinary symptoms whatsoever.  Also, urinary problems like those described above can occur in men with normal sized glands.  Therefore you need to be aware that the connection between prostate size and urinary symptoms is a loose one.

A normal, healthy prostate gland is a walnut-sized organ that weighs approximately 15 grams in young men and around 30 grams (about an ounce) in men age 50 or older. The prostate gland is the only organ in the body that keeps growing as you get older. Enlarged prostates can weigh as much as 100 grams or more (the size of an orange or small grapefruit), and are more likely to lead to urinary problems.

However, as it turns out, having a large prostate can actually be a good thing, at least as far as prostate cancer concerned. Several studies show that men with big prostate glands tend to have lower Gleason scores. When men with big prostates are treated with radical prostatectomy, studies also show that they are less likely to have cancers that have spread through the capsule or into the seminal vesicles.

No one knows for sure why big (where cancer is concerned) is often better. One theory is that men with bigger prostate glands get biopsied more frequently and at a younger age because their PSA levels run higher. Therefore the cancer is being caught at an earlier stage and monitored.

Another theory is that bigger prostate glands result from hormonal changes within the gland and that these hormonal changes somehow have an inhibitory effect on cancer growth. The particulars of these purported hormonal changes are never specifically elucidated.

Regardless of the cause, men with smaller glands—say with prostate volumes less than 40 grams should be aware that, all other things being equal, their risk of harboring a higher Gleason score or a type of cancer that invades through the capsule is somewhat greater than it is for the men who have larger glands.

Prostate size is an additional factor besides Gleason score, PSA and the percentage of core biopsies involved with cancer that needs to be considered when going through the treatment selection process.   

1 comment:

ashok shukla said...

Very informative analysis