Big Prostates Dominate

Prostate Size and Prostate Cancer

Whenever an enlarged prostate is mentioned it is always discussed in a negative light. A large prostate is routinely blamed for every possible disruption of urinary function. So what follows may surprise you: From a cancer point of view, a big prostate is desirable.  Studies clearly show that as the prostate gets larger, prostate cancer tends to be less consequential. And in actuality, the frequent urinary problems that are so often blamed on a big gland often result from other causes.

Is this surprising?  Please realize that the urinary tract is way 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 especially at night.  Or consider the companion complaint of excess urinary urgency, which sometimes results in uncontrollable urination (aka incontinence). Clearly these common problems are not restricted only to men with big prostate glands. Men with normal sized glands have these same problems all the time.  Even women suffer these problems and we have to agree that their issues can’t be blamed on a misbehaving prostate. 
In this short article 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.

  Let’s use some logic. The body does not digest water.  All the water that you drink must come out somewhere. Need I say more? 
But completely separate from the fact that our culture slugs down huge amounts of water, older people also routinely experience an ever more intense urge to urinate as they get on in years.

  Why is this?  Let’s reflect on aging– most urges and sensations grow weaker with age.  Eyesight dims, libido fails and hearing diminishes.  Imagine the kind of problem you would have if the urge to urinate starts to fade.  The progressively increasing urge to urinate is a built-in part of the aging process that is designed to compensate for the generally fading function of the bodily urges in general.  The augmentation of the urge to urinate that comes with aging is actually a protective measure to ensure continued healthy survival of the organism.  If a man loses his urge to urinate and the urine starts backing up, kidney failure and death will follow.

This is not to say that the increasing urge to urinate is convenient.  A variety of over-the-counter and pharmaceutical agents have been developed to help tamp down these intense urges.  And returning to the issue of prostate size, having a big gland can indeed be one of the many causes for symptoms of increased urinary urgency that come with age.

  Therefore, medications to compensate for prostate enlargement can also be useful.  The point is that a major share of urinary bothers are related to the over activity of the bladder, not prostate enlargement.

Now let’s revisit the impact of an enlarged prostate on how prostate cancer behaves.  Studies clearly 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 postulate that men with big prostate glands, since they run higher PSA levels, are subjected to random biopsy more frequently, and thus are diagnosed with cancer at an earlier stage.  However, contradicting this theory are studies comparing outcomes between large and small prostates in men diagnosed with palpable cancer (a semi-advanced stage of cancer).  These studies of men with semi-advanced cancer also report that men do better when their prostate gland is larger.  
Perhaps someday scientists will be able to explain this mysterious connection between prostate size and better prostate cancer outcomes. For now, men with big prostates can be thankful—their large gland has some sort of a protective influence over prostate cancer. 

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