Benign Prostatic Hyperplasia (BPH)
(Benign Prostatic Hypertrophy)
Definition:
Benign prostatic hyperplasia is non-malignant enlargement of the prostate. The prostate is a walnut-sized gland located at the neck of the bladder surrounding the urethra. It is part of the male reproductive system.
Causes:
The exact cause of BPH is unknown. It may be related to changes in hormone levels as men age. These changes probably cause the prostate to grow. Eventually, the prostate becomes so enlarged that it puts pressure on the urethra. This causes the urethra to narrow or, in some cases, close completely.
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition. The main risk factor for BPH is being over 50 years old. By age 60, 50% of all men will have some evidence of BPH in their prostates.
Symptoms:
Narrowing of the urethra caused by enlargement of the prostate causes the symptoms of BPH. Symptoms usually increase in severity over time.
Symptoms include:
- Difficulty starting to urinate
- Weak urination stream
- Dribbling at end of urination
- Sensation of incomplete bladder emptying
- Urge to urinate frequently, especially at night
- Deep discomfort in lower abdomen
- Urge incontinence
Diagnosis:
BPH diagnosis is based on:
- Your age
- Symptoms – often quantified using a validated survey know as the IPSS score sheet
- Digital rectal exam – the doctor inserts a gloved finger into the rectum in order to examine the area
Other tests may include:
- Urine flow study
- Cystometrogram (a functional study of the way your bladder fills and empties)
- X-ray of the urinary tract
- Cystoscopic examination
- Transrectal ultrasound
Testing for prostate specific antigen (PSA) is often used to screen for prostate cancer, a malignant condition. However BPH, which is far more common, may cause a lesser elevation in PSA levels, which may raise false concerns about the presence of cancer.
Treatment:
In mild cases of BPH, no treatment is necessary. In many cases, men with BPH eventually request medical intervention.
Treatments include:
Medication
Medications include:
- Finasteride (proscar) – inhibits the production of the specific form of testosterone which is responsible for prostate glandular growth. (In some men, finasteride can shrink the prostate.)
- Dutasteride (avodart) – also inhibits the production of the specific form of testosterone which is responsible for prostate glandular growth. Like proscar, avodart can result in shrinking of the prostate
- Alpha-blockers (flomax, uroxatral, cardura, terazosin)– reduce bladder obstruction and improve urine flow by relaxing the muscles of the prostate and bladder neck.
Men with BPH should not take decongestant drugs containing alpha agonists such as pseudoephedrine. These drugs can worsen the symptoms of BPH.
Minimally Invasive Interventions
These are used when drugs are ineffective but the patient is not ready for surgery. Non-surgical treatments include:
Transurethral Microwave Thermotherapy (TUMT) – uses microwaves to destroy excess prostate tissue
Transurethral Needle Ablation (TUNA) – uses low levels of radio frequency energy to burn away portions of the enlarged prostate
Transurethral Laser Therapy – uses highly focused laser energy to remove prostate tissue
Surgery
Surgical procedures include:
Transurethral Surgical Resection of the Prostate (TURP) – a scope is inserted through the penis to remove the enlarged portion of the prostate.
Transurethral Incision of the Prostate (TUIP) – small cuts are made in the neck of the bladder to widen the urethra. The long-term effectiveness TUIP is not yet clearly established.
Open Surgery – removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area. This is much more invasive then TURP or TUIP.
Alternative Treatments
Preliminary clinical trials suggested positive results with saw palmetto, an herb native to the Southern United States. However recent studies, particularly a carefully conducted randomized double-blind study indicate that the use of saw palmetto is no different than placebo in reducing BPH symptoms, raising questions about the true clinical effectiveness of this product.
Prevention:
Because prostate enlargement occurs naturally with advancing age, there are no specific prevention guidelines.
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