As King Charles III recovers from a “corrective procedure” for an enlarged prostate, Canadian urologists say the condition is common among men and unlikely to become cancerous.
“There’s no danger of an enlarged prostate becoming cancerous,” said Dr. Dean Elterman, a urologist at the University Health Network in Toronto and an associate professor of urology at the University of Toronto, in a phone interview with CTVNews.ca. “Developing prostate cancer is very common, but just because you have an enlarged prostate, doesn’t mean it’s going to turn into cancer.”
Prostate enlargement, also known as benign prostatic hyperplasia (BPH), is different from prostate cancer, Elterman said.
“They’re not related to each other at all,” he explained.
Prostate cancer, the most common cancer among men, excluding non-melanoma skin cancers, affects about one in eight Canadian men, while BPH affects about one in two men, according to Elterman.
Buckingham Palace announced last week that King Charles III, 75, would undergo scheduled treatment for the benign condition after he experienced undisclosed symptoms. It said the monarch was doing well following the procedure Friday at the London Clinic, a private hospital in London. The Princess of Wales, his daughter-in-law, is recovering from abdominal surgery at the same hospital.
What is an enlarged prostate?
Shaped like a doughnut with a hole in the middle through which urine travels, the prostate is a gland involved in reproduction that sits below the bladder, Elterman explains. A normal-sized prostate is the size of a walnut, but as men get older, it starts to grow because of factors such as genetics and hormones.
“And what happens is, as the prostate grows, that little channel to the middle that the urine passes through gets narrower and it becomes increasingly more difficult to pass urine out, because the prostate has grown, causing an obstruction of the flow of urine,” Elterman said.
Elterman said it’s a very common condition affecting 50 per cent of 50-year-old men and up to 80 per cent of 80-year-old men.
Dr. Serge Carrier, a urologist and professor at McGill University in Montreal, said about 90 per cent of men will have growth in their prostate over time and an estimated 20 to 25 per cent may need surgery or some kind of treatment.
Carrier is president of the Sexual Medicine Society of North America and past president of the Quebec Urological Association.
Getting an enlarged prostate is part of aging, so it’s difficult to prevent it from happening, Carrier said.
“The growth of the prostate is a natural event,” he said in a phone interview with CTVNews.ca. “It grows with age in most men.”
Symptoms and treatments
One symptom of an enlarged prostate is weak urinary flow, “meaning the urinary flow stops and starts,” Elterman explained.
“They often find they have to strain or push to empty their bladder, or they don’t feel that they empty their bladder completely. They can also wake up at night because they’re not emptying their bladder entirely. … And that’s a very bothersome condition.”
Carrier said another symptom is a bleeding prostate, which will show up in the urine.
Although the condition can be painful and affect men’s quality of life, Dr. Hon Leong said it “is very treatable” and patients with concerns should see their family physician.
Leong is an associate professor at the Temerty Faculty of Medicine at the University of Toronto and senior scientist and director of the Translational Urology Research Laboratory at Sunnybrook Research Institute.
“There are a few drugs or medicines that can effectively reduce the size of the prostate that the urologist may recommend over doing surgery,” Leong said in an email to CTVNews.ca. “These have varying efficacy. Surgical removal of some if not all prostate tissue is the strongest way to fix these issues.”
Elterman said most people who have BPH will start on medicine and a smaller proportion of them will move on to surgery or a procedure.
“Many men will wait until their symptoms progress and then they will start something,” Elterman said.
Certain drugs can relax the prostate to help improve the urine flow or shrink the gland.
“But you have to stay on those medicines,” Elterman said, noting some patients choose not to do that, or the medicine becomes less effective over time or does not improve their symptoms.
In those cases, patients may opt for surgery. Traditional surgeries covered by public health insurance in Canada can be effective, though they require longer hospital stays and have higher risks, Elterman said.
But he said some men may decide to go with newer and more advanced procedures, which may be less invasive and allow them to recover more quickly and avoid possible complications and side effects.
These side effects can include urinary retention, when all the urine from the bladder can’t be emptied; urinary incontinence, when urine leaks unintentionally; or sexual dysfunction.
Dangers of untreated BPH
Although an enlarged prostate isn’t likely cancerous, Leong says there are “real dangers” to having the condition.
“Because of the potential backlog of urine, a higher chance of other urologic disorders may happen, such as higher incidence of urinary tract infections (UTI), higher incidence of kidney stones, and organ damage to the bladder and kidneys,” Leong said. “But these dangers take months if not years to happen if BPH is left untreated.”
Elterman said King Charles III’s transparency around his procedure raises awareness about BPH, which he said is becoming increasingly common as the population ages worldwide.
“Because (BPH) is such a common condition, it is impacting the quality of life of many men around the world,” he said. “So I think it’s important for people to know that very good treatments (are) available to help improve their quality of life, as well as preserve their bladder function.”