IF YOU'RE a male above 50 years and have been taking a much longer time than usual urinating, you might think it's just your organs 'slowing down' with age.

You've a 50 per cent chance of it being more serious than that however, as you could be suffering from an enlarged prostate - a condition called benign prostatic hyperplasia (BPH). Men's prostates tend to grow larger as they get older and could squeeze the urethra which then results in them having difficulty urinating or with urine retention.

While doctors lament about the way ageing men are reluctant to have their prostate health checked out - surely one of the reasons must be the fact that the treatment options are somewhat limited. So they'll hold on until the situation becomes unbearable.

A new treatment - using laser energy - is now available to make prostate 'reduction' less uncomfortable; while even the gold-standard treatment for prostate enlargement - known as trans-urethral resection of the prostate (TURP) - has been modified to have fewer side effects.

The newest treatment here for an enlarged prostate is the Greenlight laser photoselective vaporisation of the prostate (PVP), which was made available in Singapore just a month or so ago.

'The good thing about PVP is that it can be done on an outpatient basis - although for now, we require the patient to stay one night at the hospital,' says Dr Li Man Kay of Li Man Kay Urology Associates.

PVP has been in use for more than five years, pioneered in the United States. The method is somewhat similar to TURP - but uses laser light to 'vaporise' excess prostate tissue instead of employing electrical current to carve away tissue.

During the operation, when the patient is under general anaesthesia, a thin, tube-like telescope (otherwise known as a cystoscope) is inserted through the penis and into the bladder, to show the urethra interior on a computer monitor.

Once the scope is in place, a thin fibre is inserted through it which delivers tissue-vaporising energy. When a powerful green light is sent through the fibre, it is selectively absorbed by the red prostate tissue which is then vaporised into small particles which are then washed out.

At the same time as it removes tissue, the laser also seals blood vessels - creating a widened urethral 'pipeline' for urine. 'There is minimal bleeding associated with this technique and it has less potential for damage,' says Dr Li.

'Re-treatment within five years is usually not necessary, and PVP also preserves sexual function,' he adds. However, patients will tend to have 'dry climax' or retrograde ejaculation thereafter, which also happens in TURP. Under half of PVP patients experience this.

A muscle which lies under the prostate at the bladder neck - which contracts during ejaculation so that semen is expelled from the penis instead of taking a 'shortcut' into the bladder - is sometimes cut for a better outcome during PVP or TURP surgery. Retrograde ejaculation is when the semen flows into the bladder.

As for improvements in TURP, surgeons like Christopher Cheng, head of the Department of Urology at Singapore General Hospital, are now testing out Bipolar TURP. 'The technique is the same as TURP, just that instead of the electricity returning through the body, the current goes through the electrical loop and comes directly back to the sheath. The irrigating solution is also saline, instead of water, which makes it safer,' explains Dr Cheng.

Going for surgery - PVP or Bipolar TURP - is usually the later option for those diagnosed with enlarged prostates, say doctors. The possible negative side effects of such operations is impotence, incontinence and reduced fertility. PVP treatment costs about $8,000 while TURP costs about $7,000.

The first line of defence, especially with early detection of an enlarged prostate, is watchful waiting, then medication can be prescribed. 'BPH in the mild and moderate stages can be easily treated. This will save affected men a lot of needless worry, interrupted sleep and silent suffering,' says Dr Cheng. Medication includes 5-alpha reductase inhibitors and/or alpha blockers which relax muscles and shrink the prostate gland.

BPH isn't a form of prostate cancer however, and will not lead to prostate cancer either, assures Dr Cheng.

But while many men can live with some minor inconveniences like frequent urination, or longer urination times, especially when they first start experiencing it, they shouldn't close an eye to it either because avoiding the issue could result in a complete inability to urinate, urinary tract infection, kidney stones or bladder infections.

About 200 general practitioners (GPs) and hospitals islandwide are giving men aged 50-75 years subsidised prostate check-ups until April 30, during Prostate Awareness Month. For appointments at Tan Tock Seng Hospital, Singapore General Hospital, National University Hospital, Changi General Hospital and Raffles Hospital, call the Singapore Cancer Society until April 13, at Tel: 6221 9578 or 6421 5833, from 8.30am to 5.30pm.

For the list of participating GPs, check out www.singaporecancersociety.org.sg, or the Singapore Urological Association's website at www.sua.org.sg.