'The World's Biggest Prostate' by David Blumenfeld (Non-Fiction)

One of the many delights of being an older male is a phenomenon known as benign prostatic hyperplasia, or BPH, which in plain English is simply an enlarged prostate gland. The normal prostate is a walnut-size gland that surrounds the urethra. When swollen, the prostate constricts the urethra making the passage of urine difficult and presses against the bladder, thus reducing the latter’s holding capacity. Considering its symptoms, I see little benign about BPH, but I suspect that the term is used because BPH is not associated with prostate cancer and isn’t likely to kill you. Notwithstanding the old saw that misery loves company, it is cold comfort to those of us who have BPH to know that almost all men develop it as they get older and that more than ninety-percent of men over eighty have it. Among its most typical symptoms are: a sudden sense of urgency to urinate, especially at night; a gradual increase over time in the number of such occasions; substantial difficulty in actually urinating, or at least in getting started: and, best of all, incontinence. Something to look forward to if you haven’t got BPH already.

A couple of the many urologists I have seen over the years regularly administer a “BPH Quiz,” for the purpose of determining just how severe your symptoms are and whether, or by how much, they have increased over time. One answers questions roughly like these:

“How many times a night do you get up to go to the bathroom?”

“How many seconds does it take to get started?”

“On a scale of 1 – 10, how severe do you consider your condition to be, where 1 is

‘not severe at all’ and 10 is ‘extremely severe’?”

You fill in the numbers and count them toward a final quiz total, which indicates just how bad off you are or roughly how large your prostate is likely to be. Beware recording an answer above 7, as it as an invitation to a choice among several lovely surgical procedures. For further confirmation, there follows a mandatory anal probe in the intimacy of the physician’s office. Many of my male friends of a similar age still dread this exam even after having been probed endlessly over the years, but for some reason I manage to take it in stride, accepting it simply as one more of the many routine and inevitable humiliations of being an older man. To my surprise, my symptoms always score somewhere in the moderate range, even though when I last took the quiz with my previous urologist, I was getting up for a bathroom run six or seven times a night. So, I felt I really deserved a higher (better? worse?) score. But then some fourteen years of post-secondary education and test-taking have no doubt ingrained in me far too great an interest in getting high test scores.

To educate myself about BPH, I consulted various sources. The results were not encouraging. One source had a category called “Risk Factors,” under which there was but a single sentence: “No risk factors have been identified other than having normally functioning testicles.” This, I swear, is a direct quote, which, as far as I can tell, means that you are at risk of getting BPH if and only if you have two normally functioning balls or, as the text went on to explain more precisely, at least one. If you have no balls or if neither of them works, “You’re OK, Jack: No BPH.” A corollary was also humorlessly added: “If the testicles are removed after a man develops BPH, the prostate begins to shrink.” Good to know. Very good to know. But, thank you very much, it’s a trade-off I’d rather not make, even to reduce the number of times I go to the potty at night.

Informed opinion on how best to treat a serious case of BPH is not uniform. Of course, medical diagnosis --- at least when made by a human being rather than a computer program --- is an art rather than a science. One would expect some divergence of opinion, but I consider what occurred in my case to be ridiculous. My urologist at the time, who happened to be a surgeon, determined (after studiously probing the issue) that my symptoms had worsened sufficiently to require “doing something about it.” Doing something about it involved a choice among a number of surgical procedures. One of these was Trans-Urethral Incision of the Prostate or, to use the cheery acronym, TURP. I wasn’t anxious to be TURPED. Another choice was Trans-Urethral Needle Ablation, or TUNA. TUNA, imagine! I didn’t want to be TUNAD either. My favorite was Trans-Urethral Microwave Therapy, TUMT. I’ll spare you the gory details about what each of these involves but my layman’s conception of Trans-Urethral Microwave Therapy was this: You put your dick into a microwave oven, the physician zaps it on high for about a minute and voila, you’re cured. I’ve forgotten which of these --- TURP, TUNA or TUMT --- was my doctor’s preferred alternative but it didn’t matter. They were all unappealing.

Because I was so apprehensive about my physician’s recommendation, I asked whether surgery was absolutely necessary. He replied that it wasn’t absolutely necessary right now but sooner or later would be. I’d be better off having it now, when I was strong and healthy, rather than when I was older, weaker and less able to endure its rigors.

ME: “How difficult is the recovery?”

DR. U: “Not bad at all. A little pain but not much and it disappears in a few days.”

ME: “And the risks?”

DR. U: “Low risk. Very few complications.”

ME: “Are you certain I’m going to have to have surgery sooner or later?”

DR. U: “Definitely. No doubt about it.”

ME: “OK, I’ll think it over. Maybe we can schedule it the next time I come in.”

For the moment we left it at that.

Before my next appointment, I received a letter explaining that my doctor had decided to limit his practice to patients requiring a specialized kind of surgery that had become his new expertise. Since I didn’t qualify for it, I was being transferred to another physician on their staff who would take care of me thereafter. Reassigning me so perfunctorily struck me as abrupt, impersonal and presumptuous but I went along with it.

After my new physician had examined me and asked if I had any questions, I piped up: “So when do you think we should schedule my prostate surgery?” I mentioned here the name of the type of surgery, TUMT, TUNA or whichever it was that his colleague had preferred. My new doctor looked as astonished as if I had asked, “So when do you plan to amputate my penis?”

“Why in the world would you want that?” he asked.

“Well, isn’t it the case that my condition requires it?”

“Not at all. What makes you think it does?”

Not wanting to cause an intra-office dispute, I too kindly let that one pass without a response.

“Well,” I said, “I realize it isn’t absolutely necessary right now but isn’t it inevitable that I will need it sooner or later? Wouldn’t I be better off having it now, when I’m still strong and healthy, rather than later when I’m older and weaker?”

Again, a look of astonishment.

“Absolutely not,” he replied. “You may never need surgery. Your symptoms are only at the high end of moderate and they don’t seem to be increasing very rapidly. Why have surgery and subject yourself to all the risks it involves?

“RISKS?” I asked. “What exactly are the risks?”

He proceeded to tick off a list of common consequences that made my head spin. Among the choicest of these were a lengthy period of painful urination, post-operative bleeding, infection, incontinence, impotence and death.

“Well,” I said, “On second thought, let’s give it a pass.”

Because my wife and I moved recently, I have gotten yet another urologist, whom I like very much. At my last visit he gave me some information that initially distressed me and then, for irrational reasons, pleased me in an oddball sort of way. Apparently, my prostate has become considerably larger. As a result, he explained, “You are retaining a lot of urine.” On one or two occasions I have retained an attorney; a friend once praised me for having retained my cool in a tight spot; and a high school teacher congratulated me on my capacity to retain foreign language vocabulary. Now, it appears, all I can retain is a lot of urine.

To make my condition graphic, the doctor showed me one of those multi-colored plastic models that physicians have in their exam rooms to display the nature and medical condition of their organs of specialty. In an ophthalmologist’s office there’s a big plastic eye peering at you, in an Ear, Nose and Throat doctor’s office there’s a large plastic nose complete with plastic nose hairs, and so on. In every urologist’s office there are at least two such models, one with a plastic penis and the other relevant equipment and another that features two prostates side by side --- a normal, healthy, walnut-size prostate and a very abnormal, absolutely huge and maximally unhealthy one. Pulling the plastic prostate model to his desk, my urologist leaned over, pointed to the replica of the enormous prostate and said, “Yours is like that one. Bigger in fact.” That one struck me as being the size of a large grapefruit. In a Phillip Roth novel whose title I can no longer recall, the main character, an aging man with BPH, claims that his prostate is the size of a potato. At the time, I found that amusing but assumed it was case of literary license, hyperbolic hyperplasia, so to speak. Yet, if my doctor’s report was correct, then unless that potato was really large, my prostate definitely had the Rothian one beat. It also had the impressive trait of being actual rather than fictional.

My urologist continued in a concerned tone,

“Sooner or later, the size of your prostate will require doing something about it.”

“Doing something about it, huh?” That phrase was starting to sound familiar. “What do you have in mind?”

“Oh, don’t worry, we’ve got lots of options to open things up. I did so well with the last guy I worked on, you could drive a truck through his prostate.”

A truck, I asked myself? I hope he’s thinking of a small one: Nothing bigger than a Ranger or a Tacoma. Then came the denouement:

“Your prostate is a monster. It’s the largest one I have ever examined.”

Gadzooks! Considering that my doctor was about sixty years old and had probably been practicing medicine for thirty years or more, during which time he had examined thousands of prostates, I began to feel, despite the obvious downside of my condition, that I was rather distinguished. My prostate was gargantuan. If it was at the top of his very long list, there probably weren’t too many men anywhere whose organ could easily exceed the size of mine. I might be a national or even a world contender. No sooner had he launched me into this state of medical hubris, however, than the good doctor let the air out of my prostatic balloon.

“Come to think of it now,” he mused, “I forgot about one of my other patients. He has a slightly larger one. Yours is second largest.”

Bad luck, I thought, crowned champion for a moment and immediately thrown from glory.

“Fortunately, you have been taking Flomax for years, whereas my other patient has not. If it weren’t for Flomax, your prostate would be as large as his. Maybe larger.”

Flomax? At first, I didn’t know what he was referring to. I hate those pleasant-sounding, euphemistic names that drug companies give to products for unsavory conditions like diarrhea, excessive gas, vaginal fungus and BPH. I had always referred to Flomax as “Magnapiss,” which seemed a more ingenuous designation. At the moment, however, all I really cared about was being top dog in the prostate kennel. If Flomax or Magnapiss or whatever you care to call it was responsible for my prostate’s being smaller than my competitor’s, I briefly considered discontinuing it so I could catch up in size with and eventually overtake my rival. Even in my competitive state of mind, though, I remained sufficiently rational to dismiss this idea and search for other options. The doctor did say that the other guy’s prostate was “slightly larger”; maybe if I just wait mine will grow or his will shrink. Unfortunately, there didn’t seem to be any way to guarantee this.

Later, back at home in the solitude of my study, a strategy occurred to me, which I blurted out loud:

“I’m in good health for my age. All I have to do to overtake him is to outlive him. If I can just stay healthy and outlast him, I’ll eventually have the biggest prostate among the thousands and thousands that my doctor has examined. In fact, if I last long enough, maybe I’ll eventually have the world’s biggest prostate.”

Now there’s something to live for!

Copyright. David Blumenfeld.

David Blumenfeld, professor emeritus of philosophy, has taught at the University of California, Santa Cruz; University of Illinois at Chicago; Southwestern University; and Georgia State, where he was chair of philosophy and associate dean for the humanities. His most recent publications are "Uncle Freddie and Gentleman John Dillinger" in Best New True Crime Stories: Well-Mannered Crooks, Rogues & Criminals and "And Then He Was a Raindrop," (under the pen name, Dean Flowerfield) in Balloons Lit. Journal.