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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.
CELL-MEDIATED IMMUNITY: immunity dependent upon T-cells' recognition of an antigen and their subsequent destruction of cells bearing the antigen.
HOT FLASH: the sudden sensation of warmth in the face, neck and upper body; a side effect of many forms of hormone therapy.
NILUTAMIDE (NILANDRON®): a non-steroidal anti-androgen.
SERM (SELECTIVE ESTROGEN RECEPTOR MODULATOR): a drug that selectively blocks one estrogen receptor but allows the other receptors at specific sites to function normally with estrogen; Raloxifene® is an example of a SERM – it blocks the ER in the breast and uterine tissue but allows the ER in bone tissue to be operative.
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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