Need help with a Prostate Problem? - Doctor Q&A

Posted by nelsontan

I read from a health magazine and it mentioned that saw palmetto is a good source of natural protection for the male prostate from several illnesses. Is it true? Are there any side effects for taking saw palmetto? And how do we protect our prostate?

Answered by Dr. Ng Kok Kit, Consultant, General Urology, Changi General Hospital

Saw Palmetto has been thought to help alleviate the problems due to Benign Prostatic Hyperplasia (BPH).

Therefore, it may help with older men with problems passing urine, like needing to wait before passing urine, poor stream, incomplete voiding and frequency. However, scientific evidence of whether Saw Palmetto works or not is still conflicting. Some small scale studies show that it works.

However, recent more vigorous larger scale studies show that it is no different from a placebo (dummy pill). Currently, there is no evidence that saw palmetto protects men from prostate cancer.

The most common side effects of saw palmetto include stomach pain, vomiting, nausea, bad breath, diarrhea or constipation. Less common but worse side effects include stomach ulcer, liver damage and jaundice, however, the role of saw palmetto in causing these side effects is still unclear.

There are 2 diseases of prostate associated with aging – Benign Prostatic Hyperplasia (BPH) and prostate cancer.

The role of various food stuff in preventing prostate cancer is still unclear, as long term studies are not available.

Currently, tomatoes could be protective, but there is no long term studies for this. Certain drugs for BPH (5 alpha-reductase inhibitors) prescribed by doctors may be protective against prostate cancer, but again, the evidence is conflicting and far from conclusive.

Posted by hlatun20

I am 57yrs old,I had small dribbling of urine after emptying my bladder.No frequency of urine during night time.No other urinary problem..such as hotness, burning or painful urination.Dribbling is two to three drops. I check with my doctor ,rectal examination..and ultra sound abdomen..found small enlargement of prostate. I haven't done PSA yet.
No sexual problem,no cancer in my family, not drinking and smoking,no diabetes , no high blood pressure and no high cholesterol.
I am 70kg,165cm, slight over weight.Do daily walking exercise for one hour.
What is your advise to do?
If PSA is marginally high, can I go for medication?
How often to go for full examination and investigation?
Any life style changes need to do ?
thank you.

Answered by Dr. Ng Kok Kit, Consultant, General Urology, Changi General Hospital

You seem to have symptoms of Benign Prostatic Hyperplasia (BPH). If your symptoms bother you, you can consult your doctor about the treatment options. If you happen to see an Urologist (a doctor specializing in the urinary system), you may be asked to do a uroflow test which basically checks the speed of your urine flow. Your Urologist may also scan your bladder after you pass urine to check whether you empty your bladder well.

If your symptoms bother you, the doctor can discuss various treatment options including medicine or minimally invasive surgery for your problem.Regarding PSA screening, the doctor can assess your risk factors and discuss with you the pros and cons of it.

If medicine is started, it is mainly meant to relieve the symptoms arising form BPH, and not for a high PSA. If you test for PSA and your PSA is marginally high, it might mean that you have a higher risk of prostate cancer, and the doctor will discuss with you regarding the diagnostic procedures to check for prostate cancer. A Transrectal Ultrasound and Biopsy of the prostate may be recommended for this purpose.

The length and extent of examination varies according to individuals, so your doctor may be best suited to advise you on it. It ranges from 3 monthly to yearly examination.

BPH is a natural part of aging, and there is little evidence that any lifestyle changes will affect its evolution. However, some studies have shown that taking tomatoes might help, but evidence is still inconclusive.

Posted by john

I've heard that eating pumpkin seeds is good for men. Is that true? How much and how often, then?

Also, how can I tell if I have a problem or not w my prostate? What are the signs and symptoms that I should look out for? What's just part of normal ageing and what is not? At what age onwards should I start to worry?

Answered by Dr. Ng Kok Kit, Consultant, General Urology, Changi General Hospital

Pumpkin seeds are thought to decrease the conversion of the male hormone testosterone to dihydrotestosterone (the hormone that encourages prostate growth), and therefore helps with BPH. It is also thought to have high levels of zinc which is thought to be beneficial for the prostate. However, there is still no conclusive evidence that pumpkin seeds, saw palmetto and other herbal therapies will help to prevent prostate problems.

The prostate is the organ between your bladder and the urethra (the tube bring urine out of your body). As it enlarges due to BPH, it obstructs your urinary flow. You may find that:

• You need to wait longer before passing urine
• Your urine stream is weak
• After passing urine, you feel that you have not completely empty your bladder
• You have a few drops of urine dribbling out after passing urine
• You want to go to toilet again shortly after completing your first void

Also, you may have:
• Frequent urination in daytime or night time
• Difficulty in postponing your urination when the urge comes

Having BPH is a normal sign of aging. It generally happens to men above the age of 50 years old. The severity of BPH ranges from mild to severe, the latter may cause kidney failure. Your doctor is the best person to tell you whether your condition is severe or not.

Posted by parn_hexnap

Is prostate cancer hereditary? What are my chances of getting it if my dad has this cancer? Can I take any supplement to prevent this from happening to me?

Answered by Dr. Ng Kok Kit, Consultant, General Urology, Changi General Hospital

Prostate cancer is mostly not hereditary. However, if your close male relatives (father, brother etc) have prostate cancer at an early age, eg., in their forties, then you could have a higher risk of having a prostate cancer, and the recommendation is to go for early screening with PSA testing.

There are currently little evidence that supplements will prevent prostate cancer. If you have suspicion that you may have prostate cancer, early screening may help to detect early cancers which are more curable.

Posted by jeremmy9012

My father has prostate problem. He has been seeing a doc for the past 3 years and each visit, he will undergo a prostate biopsy. Why constant biopsy is needed? It is because the doc is worry that it might be cancerous?

He does not dare to drink water at night as he has to constantly go to toilet. Do you have any advice for him?

Answered by Dr. Ng Kok Kit, Consultant, General Urology, Changi General Hospital

Prostate biopsy is a procedure to look for prostate cancer. Your father may have a high or rising PSA, which means that he may have a higher chance of having prostate cancer. Another reason for constant biopsy may be that some past biopsy results show worrisome features but is not conclusive of cancer.

The need to constantly wake up at night to pass urine (nocturia) may be a symptom of BPH and/or aging bladder. Medications may help with his condition. Some doctors would advise not drinking water before bed time to decrease the frequency of night time void, and it should be okay if it works for him. Just remember to drink adequate amount of water throughout the 24 hour period.