‘Frequency of s3xual intercourse has nothing to do with enlarged prostate’

Many men are not aware that with age, they stand a higher chance of developing difficulty urinating. In this interview by Sade Oguntola, a consultant urologist at the University College Hospital, Ibadan. Dr Augustus Takure says prostate enlargement, whose symptoms could include difficulty in urination, is inevitable in all men.

Can constant ejaculation be a panacea to prostate cancer?

Constant ejaculation may be interpreted by the patient to be the number of times he has contact with the sexual partners. Also, the frequency of sexual intercourse may be what they mean by frequent ejaculation. But, the frequency of sexual intercourse is not an indication of an enlarged prostate.

Now, can constant ejaculation be a panacea to prostate enlargement? No, it is not a panacea to simple prostate enlargement. Studies have shown that people who have frequent sexual intercourse or what some term constant ejaculation do not necessarily have enlarged prostate. But in another context, if a man has frequent intercourse, that could delay the onset of prostate cancer, so they are different issues.


Why is the notion that frequent ejaculation is a panacea to prostate enlargement?

It is very simple. The reason is that the men around them who have prostate enlargement were those labelled to be promiscuous and they concluded that promiscuity may be responsible for their problem. But it is not correct. The frequency of ejaculation has nothing to do with prostate enlargement.


What causes prostate enlargement?

All men have tester which are the external balls in all men. The prostate is an internal ball in all men and it only grows because of the testosterone, the male hormones produced by the testes. When the testosterone breaks down, it produces substances that stimulate the growth of the prostate, causing either a simple growth that is termed enlarged prostate or cancer of the prostate. But its effect may be different from one man to another.

So, all men because they have testes are likely to have an enlarged prostate. But that does not mean that if they develop an enlarged prostate, it will cause such symptoms as increased frequency of urination that will make them need medical attentions.


What are the other symptoms of prostate enlargement aside from increased frequency of urination?

It is important to first understand why the prostate predisposes a man to having those urinary symptoms? It is by the virtue of it being located below the reservoir of urine, the urinary bladder, which is also referred to as the urine bag. The urine bag has a pipe, the urethra that takes urine outside. So, if the prostate grows, it is likely to squeeze this pipe. Therefore, people who have a prostate that is going to cause trouble will have these symptoms; they wake up in the night several times to pass a small quantity of urine.

Some will feel the desire to pass urine, which they cannot postpone and so will have to run immediately to the toilet. During the day, they pass urine like every other hour, which was unlike how it used to be.

During the day, if they feel like passing urine, it may not come immediately. There may be a delay and when the urine is coming, it comes with a poor stream. They end up straining to force the urine out. Unfortunately, the more they strain, the more the urine will not come. And because they are not passing all the urine, they have a feeling of incompletely emptying of the bladder. Therefore, these are the symptoms.

However, in the extremes when they ignore these symptoms or they are not aware that there is a serious problem, it leads to complications such as sudden, painful inability to pass urine which is what brings most of them to the hospital. Some may start passing blood with their urine, which is also the second thing that brings most people to the hospital or they may have evidence of kidney failure which is the third thing that brings them to the hospital.


Why do men tend to notice it more from age 40?

Before the age 40, the hormone from the testes has no effect on the prostate. But after the age of 40, the prostate has an intrinsic ability to start getting bigger due to the hormones that come from the testes. Its rate of growth is however dependent on a lot of factors. But its rate of growth does not determine whether a man will experience an increased frequency of urination. What makes a man have increased frequency of urination is individualistic and may also be genetic.

The simple prostate enlargement tends to occur as a man ages; also, the chances of it causing trouble increases with age. So, about six out of every 10 men after the age of 60 will have an enlarged prostate. And about 60 per cent of these men will also experience urinary problems as a result of it.


Is it also related to why some men at age 40 start to have erection problem?

No. erection is a neurovascular process that involves the brain, nervous system and the lower segment of the spine called the sacral region. It involves nerve ending stimulating the release of substances that cause increased blood flow to the phallus as well as smooth muscle contraction.


Are there tips to ensure a man copes with problems of urination due to an enlarged prostate?

To start with, a man needs to realise that he is likely to have its symptoms as he grows older. Symptoms of an enlarged prostate can include a weak or slow urinary stream; a feeling of incomplete bladder emptying, difficulty starting urination, frequent urination, the urgency to urinate and getting up frequently at night to urinate. Others are a urinary stream that starts and stops and straining to urinate.

All conditions can be controlled, so coping with it starts with identifying these symptoms and presenting to the hospital to be treated. It is inevitable for all men, but they can cope with it if they are educated better on the condition.


In the lay man’s parlance, frequent urination at night is said to be indicative of diabetes. So, how is urination due to an enlarged prostate different?

They are different; waking up several times to pass urine in small quantity is what is suggestive of an enlarged prostate. With diabetes, the passage of urine occurs both at night and in the day. It is always a large quantity of urine because the excess sugar in the blood is what pulls the fluid into the blood vessels.


In some instance, you see men carrying urinary bags. Could it also be as a result of an enlarged prostate?

Those you see carrying or wearing a urine bag are those who have gone to the hospital with complications related to the prostate; they have developed a sudden inability to pass urine. The catheter is then inserted to ensure that they can pass urine. After some days of medications, the catheter is removed to see if they can pass urine without it. If the inability to pass urine persists, the catheter is replaced pending the time the problem can be resolved through surgical operation.


What is the difference between prostate enlargement and prostate cancer? Can one lead to the other?

Prostate enlargement cannot lead to prostate cancer; it is a myth; it is an assumption. They are two different conditions. Prostate enlargement is a non-cancerous increase in the size of the prostate while prostate cancer is an increase in the size of the prostate due to the presence of cancer cells.

Prostate cancer is very interesting; it is not like other cancers. It is a very unique cancer that we now know that even if you have it, it does not mean that it will kill you.  Postmortem reports of about 15 to 20 per cent of men who have died from other causes found that they also had cancer in their prostate.

However, if prostate cancer is detected early, it can be cured. So, people must be aware of them. Even if it is detected late, it can still be managed.

Importantly, all men need to have the regular prostate test done from the age of 40 years. This is particularly important in those with a family history of prostate cancer. A substance produced by the prostate called the prostate-specific antigen (PSA) is checked. We have PSA level based on age groups. If it falls beyond the range for the age group, we may suspect cancer and then go ahead to do a prostate biopsy to confirm if there is cancer.

Mind you, the same symptoms of simple prostate enlargement can also occur in those who have prostate cancer. Likewise, the same complications in simple prostate enlargement can also occur in patients with prostate cancer. Also, when prostate cancer is advanced, it tends to spread to the backbone and affect their legs. It can cause back pain, progressive weakness of their legs and they may not be able to walk aside from not being able to pass urine.  So, when a man gets to the stage that he cannot walk and we do a test and we discover that it is related to the prostate cancer, then it is a complication of the prostate cancer.


Is it possible to have both conditions in a single individual?

Yes, it is very possible. Some men who had been treated for simple prostate enlargement, if they live old and long enough, may also develop prostate cancer. The cancer can appear on a different part of the prostate, different from where the simple enlargement had initially occurred.



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