I love the years when we competed on whose urine stream could go the farthest, then as time went on we engaged in “more important” competitions but recently the topic quite often centres on how often one wakes up at night to urinate. Sleeping throughout the night with no interruptions is now worn as a badge of honour. An abrofo nkatie (or chest-nut sized if you prefer sophistication) sized structure has more control on all these competitions than you can imagine.

If you have not heard about the prostate gland yet then you are probably well below your fourth decade in life and it does not matter if you are male or female. This time our ladies have been spared the direct troubles that may accompany a prostate; MEN ONLY!
The prostate is sandwiched by the bladder and the penis and the rectum is behind it. The urethra then runs through its centre. We will realise soon that these structures closely associated to the prostate have a story to tell when changes occur. The primary role of the prostate is to secrete a fluid that nourishes, protects and transports the sperm safely to their destination.
Most people associate the prostate only with prostate cancer and who wouldn’t BUT the prostate has other challenges to contend with and we will focus on the main ones today;

1. Prostatitis
2. Benign Prostatic Hyperplasia (BPH)
3. Prostate Cancer
Fortunately for us all three above can be managed especially when we start early and do not wait for complications.

PROSTATITIS
Common in men below 50 years. May be classified as acute or chronic. It may be as a result of bacterial infection through sex or urinary tract infection but may also be as a result of trauma.

Symptoms
• Fever and chills, pus-like discharge through
• Frequent urination , burning sensation during urination or difficulty urinating
• Pain in groin, painful orgasms
• Pain in bladder, testes, penis
• Erectile dysfunction

BENIGN PROSTATIC HYPERLASIA (BPH)
This is not cancer! There is an increase in size of the prostate though the actual cause of the increase in size is unknown, there is an association with male hormones. The increase in size is also associated with age.
I have had the unpleasant experience of witnessing grown men sweating and crying in pain as they are unable to pass urine even though they have a full bladder and this is because the enlarged prostate has blocked the urethra where the urine exits. Fortunately medical science has made it possible to offer quick relief, well that is once the person can get to a professional.

Symptoms
• One urinates frequently especially at night
• There may be urgency; you need to “evacuate” urine once you get the urge otherwise you may wet yourself.
• There may be difficulty starting to urinate and you may have to strain
• Poor urine stream; remember the competitions of yesteryears?
• Intermittent urine stream; urine stops midstream and then resumes when you coax it enough
• Terminal dribbling; after urinating you may continue to drip and hence men beyond a certain age tend to shake the penis after the act
• Urinating may be painful
• Blood may be in the urine; sometimes the blood may not be visible to your eye

PROSTATE CANCER
This is one of the commonest diagnosed cancers in men. In Ghana the prevalence of prostate cancer is about 7% (among 50 to 74 year olds) and the average age of diagnosis is 66 years. Most prostate cancers are slow growing and many people die with the cancer and NOT FROM the cancer. This cancer is commoner among black males and may appear at an earlier age and often more aggressive and lethal.

Risk factors
• Age; increase change of getting this cancer as you grow older
• Race; being black may mean a higher risk
• Family History; when others in your blood line have had a brush with prostate cancer then be alert
• Fatty foods, sedentary life
• Obesity is often blamed as well but I have seen people slimmer than me have to deal with this. Get screened

Symptoms
When prostate cancer has not spread beyond its walls
• Frequency, nocturia, straining, blood in semen or urine
• Weak or interrupted urine flow
• New onset erectile dysfunction
• Pain at micturition ( not common)
When the cancer spreads
• Pain in back, hips, thighs etc.
• Unexplained weight loss
• Fatigue
• Change in bowel habits such as constipation etc.
There are various steps to diagnose prostate cancer, BPH or prostatitis and we will delve into these later but a few lines on the PSA is in order. The prostate specific antigen (PSA) is an enzyme that may be used to screen for prostate cancer but it should be noted that like all tests it has its downsides. It is elevated whenever there is an irritation of the prostate. It may be elevated in other conditions other than prostate cancer such as;
• Inflammation such as in prostatitis
• Certain anal/rectal examinations
• Severe constipation
• Extended sexual intercourse (I am not sure what extended means)
• Passing a urinary catheter

PROSTATE CARE/RISK REDUCTION
• Choose healthy foods; lots of fruits and vegetables
• Choose healthy foods over supplements
• Keep a healthy weight
• Exercise most days of the week
• Report symptoms discussed quickly
• Get screened. And do alert your doctor if you have a family history of prostate cancer
Men, it is time to take care of our prostates and dear ladies do keep an eye on the prostates that are dear to you.

AS ALWAYS LAUGH OFTEN, ENSURE HYGIENE, WALK AND PRAY EVERYDAY AND REMEMBER IT’S A PRICELESS GIFT TO KNOW YOUR NUMBERS (blood sugar, blood pressure, blood cholesterol, BMI)
Dr. Kojo Cobba Essel
Health Essentials Ltd/ St Andrews Clinic/Mobissel
(dressel@healthessentialsgh.com)

*Dr Essel is a medical doctor, holds an MBA and is ISSA certified in exercise therapy, fitness nutrition and corrective exercise.
Thought for the week – “Prostate cancer is the most common cancer in men with more than 1 million new cases diagnosed each year worldwide (according to the World Cancer Report 2014*: 1 111 689 cases identified in 2012).