Prostate problems

Do I have a prostate infection?

My father has had removal of the postate and a hernia

My prostate operation hasn't worked

Prostatitis

Sex and prostatitis

What are the symptoms of prostate trouble?

Worried about prostate problems

Question
I am 37 and have just been diagnosed by my GP as having an enlarged prostate (BPH).

I have been prescribed tamsulosin for it.

Given my age, I am concerned that the problem will be exceptionally bad by the time I reach the age when most men get BPH. Is this necessarily true and how common is it for people at my age?

Are there any alternative or dietary remedies to help alleviate the problem?

Answer
In my experience, it is most uncommon for a man of your age to have an enlarged prostate sufficient to cause objective obstructive symptoms such as difficulty starting off the flow of urine, slow stream, stopping and starting during the passage of urine, terminal dribbling after finishing and a feeling of incomplete emptying of the bladder.

It is far more common for obstructive symptoms as outlined above in a young man to be the result of a tight bladder neck or possibly a narrowing of the tube leading from the bladder to the outside (urethra) secondary to injury or previous infection.

Both of these problems can be dealt with surgically, although I should mention that a bladder neck incision procedure might lead to backwards or retrograde ejaculation and therefore the inability to father a family naturally, should that still be a factor for you.

You don't mention the exact nature of the symptoms you have experienced, but irritable lower urinary tract symptoms, such as increased frequency of passing urine, urgency with or without urge incontinence and getting up at night to pass urine can be associated with instability of the bladder muscle in the presence of a normal size prostate gland.

If this is suspected, further investigation to look into how your bladder fills and empties (urodynamics) is indicated.

Similarly, infection of the genitalia, bladder (cystitis) or of the prostate (prostatitis) may cause the symptoms mentioned above, along with pain on passing urine (dysuria) and a dull ache either in the scrotum, above the pubic bone (pubic symphysis) or between the back passage and the scrotum (perineum) sometimes associated with fever.

The treatment of these problems involves antibiotic therapy, and prostatitis can be particularly difficult to diagnose and treat adequately. Bladder stones and/or polyps can also cause irritable symptoms and as a rule any excessive irritability should be investigated by looking in the bladder with a telescope (cystoscopy).

Tamsulosin may help any of the obstructive or irritable symptoms outlined above, by acting on muscle receptors in the base of the bladder, prostate and urethra.

I have known a number of patients of your age with irritable symptoms in the absence of infection or bladder pathology to respond well to treatment with either microwave therapy or radio-frequency treatment.

These treatments may not be appropriate in your case and are not available at all NHS urology departments.

If having been thoroughly investigated, the diagnosis is clearly shown to be an enlarged prostate gland causing narrowing of the urethra and thereby affecting the flow of urine such that medical treatment is indicated at your age, then it is quite likely that as you get older, your prostate will enlarge further, and a time may come when surgery is advisable.

After all, approximately half of all men aged over 65 are said to suffer with lower urinary tract symptoms to the extent that they interfere with their activities of daily living.

I would advise further discussion of your problems with your doctor after you have given the treatment at least four weeks to work, so that they can clarify the diagnosis and put your mind at rest.

Yours sincerely

Dr John Pillinger, GP

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