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Prostate Problem Guide
Enlarged Prostate - The Cause Remains A Mystery
Every day a large number of men (approximately 13,000 in the US alone) consult their doctors about various problems associated with urination and come away having learned that they are suffering from an enlarged prostate.
To give it one of its proper medical names, benign prostatic hyperplasia, benign prostatic hypertrophy or BPH is a very common and treatable problem seen in many men over the age of 65 and is suffered by as many as fifty percent of all men in their sixties and ninety percent of men in their seventies and eighties.
But what causes this condition which is a simple part of the normal aging process and is as common as your hair turning grey and thinning with age?
The answer is that, in spite of all the advances in medicine, we simply don't know. We do, however, have sufficient evidence to begin to unravel the mystery.
Men are more likely to suffer from BPH if their father, or a brother, has suffered from an enlarged prostate suggesting that there is a genetic component to the problem.
One theory here is that genetic instructions given to the cells of the prostate to control its growth during puberty are activated again in later life and either cause further growth in their own right or make the cells of the prostate more sensitive to growth promoting hormones.
It is also know that men who have their testes removed before puberty do not suffer from BHP and there is therefore a link between the aging of the testes and the development of an enlarged prostate.
Although the exact part played by the testes is unclear we know that men produce both the male hormone testosterone and small quantities of the female hormone estrogen throughout life. As age increases however the quantity of testosterone present in the blood falls although the level of estrogen does not fall in the same proportion. The theory is that the higher proportion of estrogen present in the prostate promotes the activity of other hormones which are responsible for cell growth.
Although this theory is not new, researchers have found it difficult to explain satisfactorily the link between the theory and the fact that the removal of the testes before puberty results in a failure to develop the problem of an enlarged prostate.
CLINICAL TRIAL: a carefully planned experiment to evaluate a treatment or a medication (often a new pharmaceutical) for an unproven use; Phase I trials are very preliminary short-term trials involving a few patients to see if drugs have any activity or any serious side effects; Phase II trials may involve 20 to 50 patients and are designed to estimate the most active dose of a new drug and determine its side effects; Phase III trials involve many patients and compare a new therapy against the current standard or best available therapy.
G1 ARREST: arrest or halting the cell cycle at the stage of G1; the normal sequence is G1-S-G2-M.
LYMPHADENECTOMY: also known as a pelvic lymph node dissection, this procedure involves the removal and microscopic examination of selected lymph nodes, a common site of metastatic disease with prostate cancer; this procedure can be performed during surgery prior to the removal of the prostate gland, or by means of a small incision a 'laparoscopic lymphadenectomy' may be performed, a simple operation requiring only an overnight stay in the hospital.
SIMULATED ANNEALING: an optimization method used to solve many-dimensional problems in which there is no direct path to a solution. The method is slower than other optimization methods, but is capable of finding optimal solutions where other methods fail.
The last, and possibly the most credible, theory is that an enlarged prostate is caused by the presence of a hormone known as dihydrotestosterone (DHT).
DHT plays a crucial role in the development of the sex organs during pregnancy and is also largely responsible for the development of facial hair, the deepening of the voice and the development of the prostate during puberty.
DHT is derived from testosterone and is found in the prostate where it is believed to play a role in the growth of the prostate gland. However, as testosterone levels drop with age the body's ability to produce DHT does not appear to diminish and indeed DHT accumulates in the prostate and continues to promote growth. It is also interesting to note that men who lose their ability to produce this hormone derived from testosterone do not develop enlarged prostate glands.
It is likely that researchers will take several years yet to uncover the exact cause of BPH and, while it is almost certainly the result of hormonal changes resulting from the aging process, the precise nature of these changes and the effects which they trigger remain something of a mystery today.
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