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Why Your Prostate Grows with Age—and When to Worry
“Is it normal for my prostate to keep getting larger as I age?”
My answer: “Yes! If that’s all, take care and see you next time!”
Just kidding. While it is normal for the prostate to grow as you age there’s a bit more to talk about here.
Prostates keep Urologists in business.
Benign Prostatic Hyperplasia, or BPH, is the pathologic definition for a large prostate. We know not only that BPH is common in men, but that its prevalence increases with age. I often get asked ‘why.’ Many of my male patients want to know why they have a large prostate. I can’t answer that – and unless the data has changed – I don’t think that anyone has ever answered why some men have larger prostates than others. I see it as similar to breast tissue. Women have different-sized breasts, and men have different size prostates.
Maybe this answers their question or potentially, it just distracts them because now they are thinking about breasts.
The most important question for patients: does it bother you?
I saw a gentleman with an almost 100g prostate just this morning. He has no trouble peeing, wakes up once a night, and completely empties his bladder. He has BPH, but very mild symptoms, so I don’t recommend any treatment other than seeing if Flomax/tamsulosin once a day makes his life a little better.
I have also seen men with prostates around 30g who have a slow stream and wake up 5 times a night benefit from treatment. There is a great questionnaire that Urologists use to see how your bladder and prostate might be affecting you. It’s called the International Prostate Symptom Score. You can fill this out at home.
The most important question on this form is the last one – how much does this bother you?
International Prostate Symptom Score (I-PSS)
Incomplete Emptying: How often have you had the sensation of not emptying your bladder?
Not At All
0
Very Low
1
Low
2
Moderate
3
High
4
Very High
5
Frequency: How often have you had to urinate less than every two hours?
Not At All
0
Less Than 1 in 5 Times
1
Less than Half the Time
2
About Half the Time
3
More than half the Time
4
Almost Always
5
Intermittency: How often have you found you stopped and started again several times when you urinated?
Not At All
0
Less Than 1 in 5 Times
1
Less Than Half The Time
2
About Half The Time
3
More Than Half The Time
4
Almost Always
5
Urgency: How often have you found it difficult to postpone urination?
Not At All
0
Less Than 1 in 5 Times
1
Less Than Half The Time
2
About Half The Time
3
More Than Half The Time
4
Almost Always
5
Weak Stream: How often have you had a weak urinary stream?
Not At All
0
Less Than 1 in 5 Times
1
Less Than Half The Time
2
About Half The Time
3
More Than Half The Time
4
Almost Always
5
Straining: How often have you had to strain to start urinating?
Not At All
0
Less Than 1 in 5 Times
1
Less Than Half The Time
2
About Half The Time
3
More Than Half The Time
4
Almost Always
5
Nocturnia: How many times did you typically get up at night to urinate?
None
0
1 Time
1
2 Times
2
3 Times
3
4 Times
4
5 Times
5
Incomplete Emptying: How often have you had the sensation of not emptying your bladder?
- Very Low – 1 point
- Low – 2 points
- Moderate – 3 points
- High – 4 points
- Very High – 5 points
Frequency: How often have you had to urinate less than every two hours?
- Not At All – 0 points
- Less Than 1 in 5 Times – 1 point
- Less Than Half The Time – 2 points
- About Half The Time – 3 points
- More Than Half The Time – 4 points
- Always – 5 points
Intermittency: How often have you found you stopped and started again several times when you urinated?
- Not At All – 0 points
- Less Than 1 in 5 Times – 1 point
- Less Than Half The Time – 2 points
- About Half The Time – 3 points
- More Than Half The Time – 4 points
- Always – 5 points
Urgency: How often have you found it difficult to postpone urination?
- Not At All – 0 points
- Less Than 1 in 5 Times – 1 point
- Less Than Half The Time – 2 points
- Difficult – 3 points
- Slightly Difficult – 4 points
- Not Difficult – 5 points
Weak Stream: How often have you had a weak urinary stream?
- Not At All – 0 points
- Less Than 1 in 5 Times – 1 point
- Less Than Half The Time – 2 points
- About Half The Time – 3 points
- More Than Half The Time – 4 points
- Always – 5 points
Straining: How often have you had to strain to start urinating?
- Not At All – 0 points
- Less Than 1 in 5 Times – 1 point
- Less Than Half The Time – 2 points
- About Half The Time – 3 points
- More Than Half The Time – 4 points
- Always – 5 points
Nocturnia: How many times did you typically get up at night to urinate?
- None – 0 points
- 1 Time – 1 point
- 2 Times – 2 points
- 3 Times – 3 points
- 4 Times – 4 points
- 5 Times – 5 points
Quality of Life Due to Urinary Symptoms
If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?
Delighted
0
Pleased
1
Mostly Satisfied
2
Mixed
3
Mostly Dissatisfied
4
Unhappy
5
Terrible
6
Scoring Comparisons
20-35
Severe
8-19
Moderate
1-7
Mild
b
b
What’s Off The Record?
Off The Record is a column about life, love, relationships, and sex. Our anonymous urologist will pick questions submitted by menMD patient members and provide some insights, in the most entertaining way. The answers are meant to be thought provoking, engaging, honest, and fun. You can view all Off The Record posts in the Off The Record section of our blog. Better yet, submit your own anonymous question to be answered Off The Record.
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