BY MARK SCHOLZ, MD
prostate gets mentioned, excess enlargement
is frequently mentioned, as if increased size is the root of all evils. So what
follows may surprise you: Having a big prostate can be desirable. For example,
studies show that as the prostate gets larger, prostate cancer grade tends to
become lower. And the frequent urinary problems that are so often blamed on a
big gland often result from other causes.
strange? The urinary tract is far too
complex to simply blame everything on a big prostate gland. For example, take
the almost universal complaint of aging males who say that they go to the
bathroom too often. Or consider the
companion complaint, urinary urgency, which results in getting up frequent
urination at night. Clearly these common problems are not restricted only to
men with big prostate glands. Men with normal sized and even small glands have
the same problem. Even women suffer these problems and they have no prostate at
In this short
blog it’s impossible to address every possible reason for urinary frequency.
However, a couple of rather obvious matters are often overlooked. First, consider the common mantra that it’s
healthy to drink eight glasses of water daily.
Come on people! The body does not
digest water. All the water that enters
the body must come out somewhere. Need I say more?
completely separate from the fact that our culture slugs down huge amounts of
water daily, older people also typically experience a strengthening urge to urinate as we get on in years. Why is this?
Think about it. Most urges and
sensations grow weaker with age.
Eyesight dims, libido fails, hearing diminishes. What a mess we would be
in if our urge to urinate faded away too. The progressively stronger urge to
urinate is a built in protective measure
to ensure continued healthy function of the urinary tract. If a man loses his
urge to urinate he ends up with a chronically indwelling catheter to drain his
This is not
to say that the increasing urge to urinate is convenient. And a variety of over-the-counter and
pharmaceutical agents have been marketed to help temper the intensity of the
urge. It’s just not accurate to place all the blame on prostate enlargement. Moreover,
several studies show that larger glands tend to generate lower grade cancers.
Studies also show that men with smaller prostate glands have more
extra-capsular spread and higher cancer recurrence rates after surgery compared
to men with big glands.
The cause for
less aggressive disease in men with larger prostate glands is unknown. Some
researchers have postulated that men with big prostate glands, since they run
higher PSA levels, get subjected to biopsy more frequently, and thus are
diagnosed with cancer at an earlier stage. However, studies of men who have
been diagnosed by the detection of a palpable abnormality (a semi-advanced
stage) rather than by PSA, show the same pattern of having a better grade when
the prostate is enlarged.
someday scientists will be able to explain these mysterious disease
patterns. And having a big gland is not
always good; there are indeed some men with big glands who suffer urinary
blockage symptoms. For now, however, men with big prostates can be thankful
that their large gland has some sort of a protective influence over prostate