Credit King Charles III for raising awareness about prostate health
As the world sends its good thoughts to King Charles III as he embarks on his cancer battle, we need to also give him kudos for sharing with the public last month that he was being treated surgically for a condition that afflicts untold millions of men: benign prostate hyperplasia (BPH) — i.e., an enlarged prostate.
In late January, prior to King Charles' brief hospitalization, Buckingham Palace said “in common with thousands of men each year, The king has sought treatment for an enlarged prostate” and that he'd be undergoing an unspecified “corrective procedure.”
Last week Buckingham Palace updated the king's condition, noting that been diagnosed with cancer that's unrelated to his BPH and isn't prostate cancer: "During the king's recent hospital procedure for benign prostate enlargement, a separate issue of concern was noted. Subsequent diagnostic tests have identified a form of cancer."
Reports also stated that he'd started outpatient treatment for his cancer and would be stepping back from publicfacing duties.
Nevertheless, the potential positive impact of King Charles' revealing his BPH and subsequent treatment cannot be overstated when it comes to starting conversations about a condition that men often ignore.
Online searches for terms related to the condition skyrocketed during January, with Google Trends noting that data searches for “what is enlarged prostate” increased worldwide by 528%, and that the terms “prostate symptoms” and “check prostate” increased by nearly 300% immediately after the announcement.
All of these were record-setting numbers for BPH-related searches.
Understanding the prostate and BPH
The prostate is a small gland located just below the bladder and helps men produce semen. As men age, it's common for the prostate to grow larger.
Sometimes an enlarged prostate can cause an array of symptoms, while other times it does not. In addition, the size of the prostate is not necessarily determinative of one's symptoms. It's a highly individualized condition.
The Mayo Clinic says that “some people with slightly enlarged prostates can have major symptoms. Others who have very enlarged prostates can have minor problems. And some people with enlarged prostates don't have any symptoms at all.”
Symptoms you shouldn’t ignore
According to the Urology Care Foundation, BPH affects nearly half of all men by age 60, and 90% of men by age 85. Among the most common symp
toms are the following:
Frequent and/or urgent urination Feeling that the bladder is full, even right after urinating
Feeling that urinating "can't wait" A weak flow of urine
Needing to stop and start urinating several times
Trouble starting to urinate Needing to push or strain to urinate Of course, these urinary symptoms can also be caused by other conditions and/or medications, some of which include the following:
Urinary tract infection
Inflamed prostate
Narrowing of the urethra, the tube that carries urine out of the body Scarring in the bladder neck Bladder or kidney stones
Problems with nerves that control the bladder
Cancer of the prostate or bladder Usage of opioids, cold and allergy medicines, and/or antidepressant medication called tricyclics
For anyone experiencing urinary symptoms, the best course of action is to have a urologist to determine whether it's being caused by BPH.
Potential treatment options for BPH
Those suffering from severe BPH symptoms have a multitude of treatment options.
The most conservative course of action is for the patient to try medication first.
According to Cleveland Clinic the most commonly prescribed medications relax the muscle in the prostate, thus reducing tension on the urethra. Brand-name examples of these medications include Flomax, Hytrin, Cardura, Uroxatral and Rapaflo.
Additionally, some medications decrease the production of the hormone DHT, which can slow the growth of the prostate gland. For those with especially enlarged prostates, medications made with finasteride or dutasteride may be beneficial.
However, it can take anywhere from weeks to months for these medications to have any effect.
If medications prove ineffective, the next potential treatments are either traditional surgery or some of the newly developed minimally invasive procedures.
As Dr. Jamin Brahmbhatt, a urologist and robotic surgeon with Orlando Health and past president of the Florida Urological Society, explained to CNN, the most invasive — and thus rarely performed — surgical intervention is an open prostatectomy: “This procedure can be done with an incision in the lower abdomen or with robotic surgery to remove part of the prostate. This option is usually reserved for extremely large prostates and carries a higher risk of complications such as bleeding and infection ... [and] require one or two days in the hospital."
Some of the more newfangled, and less invasive, procedures include:
Transurethral resection of the prostate: Known colloquially as TURP, Brahmbhatt says this “involves inserting a scope through the urethra to trim away excess prostate tissue with bipolar energy. The procedure improves urinary symptoms with a shorter recovery time but has risks such as bleeding and potential effects on sexual function.”
Prostate lift: With a prostate lift, the surgeon “uses small implants to lift and hold enlarged prostate tissue, thus unblocking urine flow. The surgery is quick, and it has a short recovery time and lower risk of sexual dysfunction.”
Steam vaporization: This quick in-office treatment uses “steam [to] destroy excess prostate cells. [It] is effective, with a low risk of side effects and a quick return to normal activities.”
Loxahatchee urologist Dr. Diego Rubinowicz, founder of Urology Center of Palm Beach, says that steam vaporization has been an extremely effective option for his patients since he began performing it in 2018.
He explains that the way the painless procedure works is that “a handheld device releases radiofrequency energy to a few drops of water. This creates vapor — that is, steam. The water vapor is injected into the prostate tissue that is blocking the flow of urine from the bladder, where it immediately turns back to water. The stored energy in the vapor is released into the cell membranes. The goal is to gently and immediately damage these cells so that, over the ensuing days and weeks, the patient's body reabsorbs the treated tissue through natural healing.”