Why Big Prostates Are Good

BY MARK SCHOLZ, MD

Whenever the prostate gets mentioned, excess enlargement is frequently mentioned, as if increased size is the root of all evils. So what follows may surprise you: Having a big prostate can be desirable. For example, studies show that as the prostate gets larger, prostate cancer grade tends to become lower. And the frequent urinary problems that are so often blamed on a big gland often result from other causes.

Sound strange?  The urinary tract is far 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.  Or consider the companion complaint, urinary urgency, which results in getting up frequent urination at night. Clearly these common problems are not restricted only to men with big prostate glands. Men with normal sized and even small glands have the same problem.  Even women suffer these problems and they have no prostate at all.

In this short blog 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. Come on people!  The body does not digest water.  All the water that enters the body must come out somewhere. Need I say more?

But completely separate from the fact that our culture slugs down huge amounts of water daily, older people also typically experience a strengthening urge to urinate as we get on in years.  Why is this?  Think about it.  Most urges and sensations grow weaker with age.  Eyesight dims, libido fails, hearing diminishes. What a mess we would be in if our urge to urinate faded away too. The progressively stronger urge to urinate is a built in protective measure to ensure continued healthy function of the urinary tract. If a man loses his urge to urinate he ends up with a chronically indwelling catheter to drain his nonfunctioning bladder. 

This is not to say that the increasing urge to urinate is convenient.  And a variety of over-the-counter and pharmaceutical agents have been marketed to help temper the intensity of the urge. It’s just not accurate to place all the blame on prostate enlargement. Moreover, several studies 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 have postulated that men with big prostate glands, since they run higher PSA levels, get subjected to biopsy more frequently, and thus are diagnosed with cancer at an earlier stage. However, studies of men who have been diagnosed by the detection of a palpable abnormality (a semi-advanced stage) rather than by PSA, show the same pattern of having a better grade when the prostate is enlarged.

Perhaps someday scientists will be able to explain these mysterious disease patterns.  And having a big gland is not always good; there are indeed some men with big glands who suffer urinary blockage symptoms. For now, however, men with big prostates can be thankful that their large gland has some sort of a protective influence over prostate cancer.  

Article originally posted November 25, 2014, on Prostate Snatchers: The Blog, by Mark Scholz, MD


About Dr. Scholz: 

A board-certified medical oncologist, Mark C. Scholz, MD, serves as medical director of Prostate Oncology Specialists Inc. in Marina del Rey, CA, a medical practice exclusively focused on prostate cancer. He is also the Executive Director of the Prostate Cancer Research Institute. He received his medical degree from Creighton University in Omaha, NE. Dr. Scholz completed his Internal Medicine internship and Medical Oncology fellowship at University of Southern California Medical Center. He is the co-author of the book Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Potency.  He is a strong advocate for patient empowerment.

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