Prostate Size Matters

Is a Large Prostate Bad?

Everyone seems to think that a large prostate is bad.  Large glands get blamed for just about any abnormal urinary symptom that occurs: discomfort, slow urination, frequent urination, getting up frequently at night and of course, the more rare circumstance when total urinary blockage occurs, a condition that requires insertion of a catheter.

The prostate gland is the only organ in the body that keeps growing as you get older.

A normal-sized, healthy prostate gland is about the size of a walnut. In young men it weighs approximately 15 grams enlarging up to around 40 grams by the time men reach age 60. In certain individuals, however the prostate can weigh over 100 grams (the size of a lemon) and in rare cases reach 200 grams.  The biggest prostate I have ever seen was 400 grams.

Treating urinary problems is big business.  A variety of herbal extracts are on the market that contain ingredients such as saw palmetto.  In addition, there is a long list of prescription medications to alleviate urinary problems such as Flomax, Toviaz, Avodart, Proscar, Uroxatrol and Vesicare, which are commonly prescribed with varying success. And if an enlarged prostate causes total urinary blockage, a urinary catheter will be needed, possibly with additional invasive therapy such as laser, microwave or a transurethral resection of the prostate (TURP), sometimes referred to by laymen as the “roto-rooter job.”

There is a common misconception that prostate enlargement is somehow predisposed to cancer. This is not true in any fashion whatsoever. A diagnosis of cancer and the condition of having a big prostate are completely unrelated. In any specific individual a man can have one or the other, both or neither.

Each problem, a big prostate or prostate cancer, needs to be addressed separately as an individual condition.

It is true that urinary problems tend to occur more frequently as the prostate gland enlarges. However, it should be clearly understood that many large prostate glands cause no urinary symptoms whatsoever.  A big prostate by itself is not necessarily a bad thing.  Urinary problems can also occur in men with completely normal glands.  The connection between an enlarged prostate and increased urinary symptoms is a loose connection at best.

Actually, as it turns out, having a large prostate can actually be a positive thing, at least as far as prostate cancer is concerned. Several studies show that men with big prostate glands tend to have lower Gleason scores. When men with big prostates are treated with radical prostatectomy, studies also show that they are less likely to have cancers that have spread through the capsule or into the seminal vesicles.

No one knows why a big prostate leads to better cancer outcomes.

One theory is that men with bigger prostate glands get biopsied more frequently and at a younger age because the big prostate generates a higher PSA leading to more frequent biopsies. The idea behind this theory is that the cancer is being detected at an earlier stage when it is easier to cure.  Other studies, however, contradict this theory.  These studies, which evaluate cancer outcomes in men with more advanced disease at the time of diagnosis, report improved cure rates for men with big prostate glands, even in the situation where the disease is known to be fairly advanced, cases where the cancer is big enough to be felt with a finger on digital rectal exam.

Another theory is that bigger prostate glands result from hormonal changes within the gland and that these hormonal changes somehow have an inhibitory effect on cancer growth. The particulars of these purported hormonal changes have never been specifically elucidated.

Regardless of the cause, men with smaller glands—say with prostate volumes less than 40 grams—should be aware that, all other things being equal, their risk of harboring a higher Gleason score or a type of cancer that invades through the capsule is somewhat greater than it is for the men who have larger glands. Therefore, prostate size is an additional factor besides Gleason score, PSA and the percentage of core biopsies involved with cancer that needs to be considered when going through the treatment selection process.   

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