The prostate wake-up call

After the age of 50, the prostate gland may be affected by two main conditions: benign prostatic hypertrophy (BPH) and prostate cancer.—Picture from 123rf.com

FIFTY isn’t just a number for many men – it heralds an age of heightened awareness about health and wellbeing, especially one aspect that almost always goes unnoticed in the prime years: the prostate.

The prostate is a small gland located below the bladder, in front of the rectum.

It surrounds part of the urethra, the tube that carries urine out of the body, and produces fluid that nourishes sperm and forms part of semen.

In younger men, the prostate is often described as being about the size of a walnut (about 20 grams).

Hospital Picaso consultant urologist Dr Fam Xeng Inn emphasises that unlike many other organs, the prostate tends to enlarge with age.

And because of its position around the urethra, this growth can interfere with the flow of urine.

“This growth is a physiological change that occurs naturally. There’s nothing wrong or abnormal about it,” he explains. “However, for some men, this enlargement may lead to problems.”

After the age of 50, the prostate gland may be affected by two main conditions: benign prostatic hypertrophy (BPH) and prostate cancer.

A ‘normal’ enlargement

One of the most common prostate conditions is BPH, a non-cancerous enlargement of the prostate.

It becomes increasingly common as men age, particularly relevant after 50. However, not all men with an enlarged prostate experience significant or troublesome symptoms.

“Men who do experience symptoms could have difficulty starting urination, a weak or interrupted stream, hesitancy or straining, dribbling after urination, a sensation that the bladder has not emptied completely, increased frequency and a sudden urge to urinate,” says Dr Fam.

Waking repeatedly at night to use the toilet, known as nocturia, is another common complaint.

Not every enlarged prostate requires active treatment. Men with mild symptoms may simply be monitored, particularly if their quality of life is not significantly affected.

According to Dr Fam, when symptoms are more troublesome, medications can help relax the prostate and bladder outlet or help reduce the size of the prostate.

Such medications include alpha blockers, PDE5 inhibitors and 5-alpha reductase inhibitors.

For men who do not respond adequately to medication, or who develop complications such as bladder stones, bleeding from the prostate, frequent urinary tract infections, or renal function deterioration, surgical treatments are available.

The most established treatment is a transurethral resection of the prostate using bipolar electrical loop (bipolar TURP).

Dr Fam says, “Men with a family history may need this [prostate] conversation earlier, at 45 years.”

He says that besides bipolar TURP, there are other minimally invasive options (HoLEP, laser, water-vapour therapy), which are advised depending on the individual patient.

The important message is that men do not have to quietly tolerate years of disrupted sleep, urgency or difficulty urinating simply because they are getting older.

Beware prostate cancer

The condition that causes the greatest anxiety is prostate cancer. The risk increases with age, and family history is important.

Dr Fam says that a man with a family history of prostate cancer faces a much higher risk of the disease.

Interestingly, he reveals that some research has suggested that more frequent ejaculation may be associated with a lower risk of prostate cancer.

A crucial point about this cancer is that early prostate cancer may not lead to symptoms. This is why waiting for urinary problems before thinking about prostate cancer can be risky.

In fact, urinary symptoms in older men are frequently caused by benign enlargement rather than early cancer.

The prostate-specific antigen, or PSA, is a blood test that measures a protein produced by prostate cells.

Dr Fam says that a raised PSA level can be associated with prostate cancer, but it is not a cancer diagnosis.

PSA may also rise because of BPH, prostatitis and other factors. Hence, it is important to stress that a raised PSA does not automatically mean cancer.

Depending on the circumstances of a raised PSA test, he notes that a doctor may decide to examine the prostate further for any suspicious lesion with an MRI.

If the MRI confirms a suspicious lesion, then a biopsy is required.

“This is carried out through a transperineal biopsy, where a needle is passed through the skin between the scrotum and anus (the perineum) to collect small tissue samples from the prostate, under ultrasound guidance.

“Compared with the older transrectal biopsy, where the needle passes through the rectal wall, the transperineal approach has a lower risk of serious infection and sepsis because the needle does not pass through the bowel,” explains Dr Fam.

For many average-risk men, the 50s is an appropriate time to discuss the potential benefits and limitations of prostate cancer screening with a doctor.

“Men with a family history may need this conversation earlier, at 45 years,” he advises.

Not all prostate cancers require immediate treatment

Men should also understand that some prostate cancer tumours grow very slowly, while others are aggressive and can spread rapidly.

This wide variation is one reason screening and treatment decisions require careful discussion.

Dr Fam says that the biopsy tissue is sent for histopathological examination to confirm the diagnosis and assess the cancer’s aggressiveness (Gleason score).

The score traditionally ranges from six to 10 for prostate cancer in current clinical reporting.

For suitable men with low-risk, localised prostate cancer, active surveillance may be recommended instead of immediate surgery or radiotherapy.

“Active surveillance involves consistent monitoring, which include repeated PSA tests, clinical reviews, MRI scans and, when necessary, repeat biopsies”, he emphasises.

“If there are signs that the cancer is progressing, curative treatment can then be considered”.

Hence, for early-stage/localised prostate cancer, options may include active surveillance for low-risk disease, or curative treatment with surgery (robotic-assisted prostatectomy) or/and radiotherapy.

He says that robotic-assisted prostatectomy is a minimally invasive operation to remove the prostate gland.

The surgeon controls robotic instruments through small incisions, allowing precise movements and enhanced magnified vision. It generally offers less blood loss, smaller wounds and fast recovery.

In advanced or metastatic prostate cancer (disease spread assessed using PSMA PET scans), treatment may include androgen deprivation therapy (hormone therapy), chemotherapy (for suitable patients), or radioligand therapy, depending on the extent and biology of the cancer.

At this stage, the aim is to slow its progression, reduce symptoms and complications, prolong survival, and maintain quality of life for as long as possible.

In recent times, prostate cancer diagnosis and management has seen a shift towards risk-adapted, imaging-led and more personalised care.

MRI helps identify suspicious areas before biopsy; transperineal techniques allow safer and more targeted tissue sampling; and PSMA PET scans can detect the spread or recurrence of disease with greater sensitivity.

At the same time, men with low-risk cancers may be safely monitored through active surveillance, while those requiring treatment can increasingly receive therapy tailored to the stage and biological behaviour of their disease, with less complications and better outcomes.

Many men hesitate to seek help because they fear embarrassment or worry that prostate treatment will affect sexual function. That shouldn’t affect health-seeking behaviour.

Men should feel able to ask not only, “Will this treatment work?”, but also, “How might it affect my urination, erections, ejaculation and daily life?”

There is no diet, supplement or exercise programme that can prevent prostate disease.

“Men should also be very cautious about products marketed as ‘prostate support’ or natural cures,” warns Dr Fam. It is true though that the broader foundations of healthy ageing still matter.

Regular physical activity, maintaining a healthy weight, not smoking and eating a balanced diet support overall health and help reduce the burden of chronic disease.

For men entering their 50s, this is a good time to become more aware of urinary changes, understand personal risk factors and discuss prostate cancer screening with a doctor where appropriate.

Hospital Picaso, No 110, Jalan Professor Khoo Kay Kim, Seksyen 19, 46300 Petaling Jaya, Selangor Darul Ehsan

KKLIU: 3519 EXP 31.12.2028

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50岁以后，前列腺可能受到两种主要疾病的影响：良性前列腺增生（BPH）和前列腺癌。——图片来自123rf.com

对于许多男性来说，五十岁不仅仅是一个数字——它预示着一个对健康和福祉意识日益增强的时代，尤其是一个在黄金时期几乎总是被忽视的方面：前列腺。

前列腺是位于膀胱下方、直肠前方的一个小腺体。

它包围着部分尿道（将尿液排出体外的管道），并产生滋养精子并构成精液一部分的液体。

年轻男性的前列腺通常被描述为核桃大小（约 20 克）。

毕加索医院泌尿科顾问医生范兴因强调，与其他许多器官不同，前列腺往往会随着年龄的增长而增大。

由于该增生物位于尿道周围，因此会干扰尿液的流动。

“这种增长是一种自然发生的生理变化，没有任何问题或异常之处，”他解释说。“然而，对某些男性来说，这种增大可能会导致一些问题。”

50岁以后，前列腺可能会受到两种主要疾病的影响：良性前列腺增生（BPH）和前列腺癌。

正常增大

最常见的前列腺疾病之一是良性前列腺增生（BPH），即前列腺的非癌性增大。

随着男性年龄增长，前列腺肥大的情况越来越常见，尤其是在 50 岁以后。然而，并非所有前列腺肥大的男性都会出现明显或令人困扰的症状。

“出现症状的男性可能会出现排尿困难、尿流细弱或断断续续、排尿犹豫或费力、排尿后滴沥、膀胱未完全排空的感觉、尿频和突然的尿急，”Fam 医生说。

夜间反复醒来上厕所（即夜尿症）是另一种常见的症状。

并非所有前列腺肥大都需要积极治疗。症状较轻的男性患者可以接受观察，尤其是在生活质量未受到明显影响的情况下。

据 Fam 医生说，当症状比较严重时，药物可以帮助放松前列腺和膀胱出口，或者帮助缩小前列腺的体积。

此类药物包括α受体阻滞剂、PDE5抑制剂和5α还原酶抑制剂。

对于药物治疗效果不佳或出现膀胱结石、前列腺出血、尿路感染或肾功能恶化等并发症的男性，可以进行手术治疗。

最成熟的治疗方法是使用双极电环经尿道前列腺切除术（双极 TURP）。

Fam 医生说：“有家族病史的男性可能需要更早地进行（前列腺）方面的咨询，比如在 45 岁。”

他表示，除了双极电切术（TURP）之外，还有其他微创治疗方案（HoLEP、激光、水蒸气疗法），具体方案需根据患者个体情况而定。

重要的信息是，男性不必因为年纪大了就默默忍受多年的睡眠紊乱、尿急或排尿困难。

警惕前列腺癌

最令人焦虑的疾病是前列腺癌。患病风险随年龄增长而增加，家族史也至关重要。

法姆医生表示，有前列腺癌家族史的男性患此病的风险要高得多。

有趣的是，他透露一些研究表明，射精频率越高，患前列腺癌的风险可能越低。

关于这种癌症，一个关键点是早期前列腺癌可能不会出现任何症状。因此，等到出现泌尿系统问题才考虑前列腺癌可能存在风险。

事实上，老年男性的泌尿系统症状通常是由良性增生引起的，而不是早期癌症。

前列腺特异性抗原（PSA）是一种血液检测，用于测量前列腺细胞产生的一种蛋白质。

Fam 医生表示，PSA 水平升高可能与前列腺癌有关，但这并不意味着确诊患有癌症。

PSA升高也可能是良性前列腺增生、前列腺炎或其他因素所致。因此，必须强调的是，PSA升高并不一定意味着患有癌症。

他指出，根据 PSA 检测结果升高的具体情况，医生可能会决定通过 MRI 对前列腺进行进一步检查，以发现任何可疑病变。

如果核磁共振检查证实存在可疑病变，则需要进行活检。

“这是通过经会阴活检进行的，即在超声引导下，将一根针穿过阴囊和肛门之间的皮肤（会阴），从前列腺采集少量组织样本。

“与针头穿过直肠壁的旧式经直肠活检相比，经会阴活检发生严重感染和败血症的风险较低，因为针头不会穿过肠道，”Fam 医生解释说。

对于许多中等风险的男性来说，50多岁是与医生讨论前列腺癌筛查的潜在益处和局限性的合适时机。

他建议说：“有家族病史的男性可能需要更早地进行这方面的谈话，比如在 45 岁的时候。”

并非所有前列腺癌都需要立即治疗。

男性也应该了解，有些前列腺癌肿瘤生长非常缓慢，而另一些则具有侵袭性，会迅速扩散。

这种巨大的差异是筛查和治疗决策需要仔细讨论的原因之一。

Fam 医生表示，活检组织将被送去做组织病理学检查，以确认诊断并评估癌症的侵袭性（格里森评分）。

在目前的临床报告中，前列腺癌的评分通常为 6 到 10 分。

对于患有低风险、局限性前列腺癌的合适男性，建议采取积极监测，而不是立即进行手术或放射治疗。

他强调说：“主动监测包括持续监测，包括重复进行 PSA 检测、临床评估、MRI 扫描，并在必要时进行重复活检。”

“如果出现癌症进展的迹象，就可以考虑根治性治疗。”

因此，对于早期/局限性前列腺癌，治疗方案可能包括对低风险疾病进行积极监测，或采用手术（机器人辅助前列腺切除术）和/或放射疗法进行根治性治疗。

他表示，机器人辅助前列腺切除术是一种微创手术，用于切除前列腺。

外科医生通过微小的切口操控机器人手术器械，从而实现精准的操作和更清晰的放大视野。这种方法通常出血量更少、伤口更小、恢复更快。

对于晚期或转移性前列腺癌（使用 PSMA PET 扫描评估疾病扩散情况），治疗可能包括雄激素剥夺疗法（激素疗法）、化疗（适用于合适的患者）或放射性配体疗法，具体取决于癌症的程度和生物学特性。

现阶段的目标是减缓病情发展，减轻症状和并发症，延长生存期，并尽可能长时间地维持生活质量。

近年来，前列腺癌的诊断和治疗已经朝着风险适应性、影像学主导和更加个性化的治疗方向发展。

MRI 有助于在活检前识别可疑区域；经会阴技术可以更安全、更有针对性地进行组织取样；PSMA PET 扫描可以更灵敏地检测疾病的扩散或复发。

与此同时，低风险癌症患者可以通过积极监测进行安全监测，而需要治疗的患者可以越来越多地接受根据其疾病的阶段和生物学行为量身定制的治疗，从而减少并发症并获得更好的治疗效果。

许多男性因为害怕尴尬或担心前列腺治疗会影响性功能而犹豫不决，不愿寻求帮助。但这不应该影响他们寻求健康的行为。

男性不仅应该能够问“这种治疗方法是否有效？”，还应该能够问“它会对我的排尿、勃起、射精和日常生活产生什么影响？”

目前没有任何饮食、补充剂或运动方案可以预防前列腺疾病。

“男性也应该对那些标榜为‘前列腺保健’或‘天然疗法’的产品保持高度警惕，”法姆医生警告说。不过，健康老龄化的更广泛基础仍然至关重要。

规律的体育锻炼、保持健康的体重、不吸烟和均衡饮食有助于保持整体健康，并有助于减轻慢性疾病的负担。

对于即将步入 50 岁的男性来说，这是一个好时机，可以更加关注尿液变化，了解个人风险因素，并在适当的时候与医生讨论前列腺癌筛查。

Hospital Picaso, No 110, Jalan Professor Khoo Kay Kim, Seksyen 19, 46300 Petaling Jaya, Selangor Darul Ehsan

KKLIU：3519 有效期至2028年12月31日

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