It plays a major supporting role in both intimate pleasure and procreation. But like the Rodney Dangerfield of the male reproductive system, the prostate gets no respect.
No bigger than a walnut, the humble gland -- its name comes from the Greek word for "protector" -- works quietly in the dark, industrial district of the lower pelvis, between the bladder and rectum. And there it may remain, unnoticed and unsung, for a man's entire life.
Unless, with the onset of age, it swells and starts pressing on the bladder and the urethra. Then we're talking problems with a capital pee.
"All males, as they age, will get some enlargement of the prostate," says Winnipeg urologist Dr. Graham Glezerson. The fancy medical term is benign prostatic hyperplasia (BPH), and the most common symptoms are weak, painful or restricted urine flow, and a frequent or urgent need to urinate, especially at night.
By the age of 60, half of all men will have symptoms related to BPH. After age 80, that number is closer to 80 per cent.
As Glezerson points out, though, there's a difference between having symptoms and being bothered by them.
"You get the businessman who's in his late 50s or 60s who can't leave a meeting every 15 minutes to pee, but for the old guy who's sitting around watching TV, that may not matter."
And while some of his patients may be able to tolerate getting up three times a night to urinate, in extreme cases of BPH, the doctor says, "it can get to the point where they can't pee at all."
The good news is that Manitoba urologists now have a powerful new laser technology with which to treat this non-life-threatening but potentially serious condition. (Left untreated, BPH can lead to infections and bladder and kidney damage.)
Winnipeg's Victoria General Hospital recently became the first facility in the province to acquire the GreenLight XPS Laser System. It's one of 19 medical facilities in Canada now using the non-invasive technology, which promises fewer risks and complications and a shorter recovery period than other treatments.
Up to now, Manitoba men with BPH basically had two treatment options: a lifetime of prescription drugs or an invasive surgical procedure known as transurethral resection of the prostate (TURP).
Medication is not only costly, but can stop working over time. And invasive surgery carries higher risks of infection and complications such as incontinence and impotence, and typically requires multiple days of hospitalization and catheterization and a four- to six-week recovery period.
During a TURP, the gold standard treatment since the late 1930s, an electrical cutting loop is passed down a cystocope through the urethra to carve away the prostate from the inside to create an open channel.
Laser surgery, or "ablation," does essentially the same thing by melting away the prostate tissue to enlarge the urinary channel, Glezerson says, but it's quicker, cleaner and safer.
While he's been using lasers to treat BPH for about 15 years, the GreenLight laser -- so named because the wavelength it emits appears as green light -- has the added advantage of actually disposing of the unwanted tissue.
"With TURP, you're in there and you're cutting away prostate tissue and then you have to wash all that tissue out of the bladder," Glezerson explains.
"This is a very high-energy laser that simultaneously cooks the tissue, coagulates, or seals, the blood vessels, and at the same time vaporizes the prostate tissue so the tissue just disappears."
GreenLight therapy is formally known as photosensitive vaporization of the prostate (PVP). The procedure, which typically takes between 30 and 90 minutes, is done on an outpatient basis under general anesthetic. Patients usually only have to wear a catheter for a day, if that.
"It's very good because it's a quick procedure and there is very little or minimal bleeding," says Glezerson, one of three Winnipeg doctors who use GreenLight laser therapy to treat enlarged prostates. He does the majority of procedures, he says, which number between 12 and 15 a month.
If there's one disadvantage, Glezerson says, it's that the vaporization process means there will be no tissue sample left at the end to screen for prostate cancer. He does point out, however, that there's no correlation between an enlarged prostate and prostate cancer.
"They're two separate issues that happen to be in the same gland," Glezerson says.
As for monitoring that gland, the walnut comparison is only a reference point.
"It's the size of a walnut in a youngster," the urologist says, "but as it grows, it can reach the size of an apricot. If it's really enlarged, it can be the size of an orange."
A better way to think of the prostate might be a tiny donut with a straw through the centre of it -- and the hole is gradually getting smaller.
However, as Richard Bruno, 66, can attest, the onset of BPH symptoms can be sudden and severe.
Last winter, after returning home from a party, the Montreal resident noticed his urine output had decreased significantly. By 5 a.m., he was headed to the emergency room, where he waited in severe back pain to be seen.
"If you can't urinate for almost 18 hours, your bladder gets full, you get an increasing pressure that forces the urine eventually into your kidneys and that's a very painful experience," Bruno says during a phone interview.
The Montrealer, who tried two prostate medications with little success, says he's been symptom-free since receiving GreenLight laser therapy, which removed about two-thirds of his severely enlarged prostate gland.
"It's fantastic," he says of the procedure. "I went in at noon and was home by six."