A very large proportion of men over the age of sixty suffer from BPH (enlarged prostate gland)- about one in two. The figures for the over 50s is about 33%. Normally the gland is no larger than a walnut and is situated at the neck of the bladder. When it enlarges, the pressure it puts on the urethra (the tube which drains the urine from the bladder) is such that the tube is narrowed and urination becomes difficult.

Because the enlarged prostate acts like a clamp on the urethra, difficulty in urinating is the main symptom together with increased frequency, burning sensation and difficulty in emptying the bladder. The condition is also known in medical circles as BPH which is an acronym for benign prostatic hyperplasia.

The doctor will order a PSA test which is a blood test which reveals the presence of an antigen which is a tumor marker - that tells us whether there are any cancerous cells around. A scan sometimes needs to be done if the results from the PSA are borderline or a more sophisticated blood test (the free PSA) can be carried out.

Secondly, the doctor may do a DRE which is a digital rectal examination. This is a test where the doctor can feel the prostate gland through the rectal wall. He can then tell whether the gland has a smooth surface (this is a positive sign) and can also ascertain how big the gland is.

Thirdly, men need to know about surgical procedures and the risks involved. Laser techniques and other procedure are now common and nerve spring is almost standard in the effort to prevent incontinence or impotence after surgery. The percentage of these problems is very small. The doctor has to assess the overall condition of the patient and make a recommendation.

The fourth question men usually ask is about the medication and what advantages there are. They may also ask about side effects. Most doctors opt for a wait and see policy and prescribe alpha-blockers which help the muscles to relax thus easing the flow of urine and frequency. These drugs are well known names such as Flomax or Cardura. The second type of drug actually reduces the size of the gland which will again relieve some of the symptoms.

The fifth fact concerns diet. Will a change in your diet or lifestyle really make any difference? In the case of mild BPH, it can, and anyway it is always recommended as dietary habits can relieve the symptoms. Tomatoes (which contain lycopene) are highly recommended together with plenty of fruit and vegetables together with a lower intake of alcohol and coffee. Herbal natural supplements are sometimes used. The most common herbal supplements are saw palmetto,beta sitosterol, pumpkin seeds and zinc.

Thankfully surgery is not often an option now but the doctor and patient together can make an informed decision about which treatment is best. Herbal supplements are sometimes used in conjunction with standard medication. They may also be used instead of these medicines. In the final analysis, the patient has to decide what is best for him.