Enlarged Prostate Benign Prostatic Hyperplasia

Benign prostatic hyperplasia, or BPH for short, is the enlargement of theprostate gland. It is caused by excess growth of cells in the prostate. This condition isnot the same as prostate cancer.

What is going on in the body?

The prostate is a walnut-sized gland that is part of the male reproductivesystem. This gland surrounds the urethra, the tube that carries urine from the bladderout of the body. The job of the prostate is to squeeze fluid into semen to help withfertility. The prostate responds to testosterone, the main male hormone. After puberty,it doubles in size. Around age 25, it grows again and continues to grow slowlythroughout a man’s life. This enlargement does not usually cause problems until later inlife. BPH rarely causes symptoms before age 40. But more than half of men in their60s and up to 90% in their 70s have some symptoms of BPH. In somemen, the enlarged prostate can cause a blockage of the bladder outlet known asprostatism. Although the actual causes are more complex, it is helpful to think of BPHas a blockage of urine flow by an enlarging prostate.

What are the causes and risks of the condition?

The cause of BPH is not well understood. Some experts think that factorsrelated to aging and changing hormone levels may spur the development of BPH.

The primary risk of BPH is that urine flow may be blocked. This cansometimes cause kidney damage, bladder stones, and urinary tract infections.

What are the signs and symptoms of the condition?

Symptoms may range from mild to severe, and the most common onesinvolve changes or problems with urination, such as:

Some men have no symptoms at all before suddenly finding themselvestotally unable to urinate. This condition is called acute urinary retention and may betriggered by over-the-counter cold or allergy medicines that contain decongestants.

How is the condition diagnosed?

BPH is commonly diagnosed when its symptoms begin to interfere withdaily life, but the doctor may also find an enlarged prostate during a routine checkup.The symptoms of BPH can be very much like those caused by prostate cancer and other seriousconditions. So,further testing may be needed. A doctor can use a gloved finger in the rectum to checkthe prostate size and for small, hard lumps that might suggest prostate cancer.The doctor may also order a prostate-specific antigen,also known as a PSA, blood test. If this value is abnormal, the doctor may next order abiopsy sample of the prostate to look for prostate cancer.

Other tests may be done in certain cases. These may include measuringthe rate of urine flow and checking with a catheter or special X-ray test to see howmuch urine is left in the bladder after voiding. A pressure-flow study combinesmeasuring the urine flow and the pressure in the bladder during voiding.Cystoscopyis a procedure that uses a tiny telescope to look inside the urethra, prostate, and bladder forthe amount of blockage. Ultrasound, a type of X-ray test, may be used to measure the exactsize of the prostate. This can be important in making choices about therapy. A symptomquestionnaire can help to measure both the symptoms and the response to treatment.Although some of the symptoms of BPH and prostate cancer are the same, BPH does notincrease the chance of prostate cancer.

What can be done to prevent the condition?

There are no widely accepted ways to prevent BPH.

What are the long-term effects of the condition?

Long-term effects are generally due to chronic, incomplete emptying of thebladder and may include:

What are the risks to others?

BPH is not contagious.

What are the treatments for the condition?

Prostatism is usually treated first with medicines called alpha blockers,such as doxazosinor terazosin.These drugs were first used to treat high blood pressure. Tamsulosin is the first alphablocker developed specifically for BPH. These drugs relax the muscle in the prostateand at the bladder neck, which allows better urine flow.

The FDA has approved a fourth drug, finasteride,to treat BPH, but its action is different. It works to suppress testosterone, which can shrinkthe size of the prostate and improve symptoms. Some studies suggest thatfinasteridecan shrink the prostate by about 30%. This may take several months, andoften the improvement is not as dramatic as that seen with alpha blockers. But finasteridehas been shown to reduce the long-term risk of a complete inability to urinate. And thatcan result in less need for surgery.

If medicine does not work, or cannot be taken, surgery is an option. Themost common operation has been transurethral resection of the prostate,also called TURP. This involves passing a special tiny telescope, called an endoscope, throughthe urethra. The endoscope has an electrified loop, which is passed into the area of theprostate that surrounds the bladder neck. Under anesthesia, the electrified loop is usedto scoop out tissue from the prostate and free the flow of urine. This surgery has asuccess rate of about 85%.

Because TURPis costly, inconvenient, and invasive, there has been great effort to find other ways thatwill relieve BPH symptoms. A variety of energy sources have been tried, includinghigh-intensity sound waves, lasers, heat, and radio waves. Sometimes tubes calledstents are placed in the urethra to hold it open. Some of these procedures require asmall amount of anesthesia, and others require none at all. In general, these proceduresare less risky than TURP but do not work as well. Many of these techniques are stillbeing perfected.

What are the side effects of the treatments?

Medicines used to treat BPH may all cause side effects, such asdizziness, low blood pressure, and impotence. Specific side effects depend on the drugused.

Dangerous complications after TURP are unusual. The most common sideeffect of TURP, which occurs in about 4% to 6% of people who have the procedure, is aneed to place a urinary catheter for a short time after the operation. Some bleeding isnormal after surgery, but it should clear up by the time the person goes home from thehospital. Drinking a lot of water will help flush out the bladder and speed healing. Aswith any surgery, there may be some temporary discomfort for a few weeks. This willdecrease as time goes on.

What happens after treatment for the condition?

Those treated with medicines often need treatment for life or untilsymptoms get bad enough to require surgery. Most people recover from TURP quickly.Blood in the urine gradually disappears over the first week or so. Symptoms of bladderblockage are usually relieved right away. The degree and speed of return to normal bladderfunction is often related to the severity of the condition and how long it existed beforetreatment began. In some cases, a second TURP or other prostate surgery may beneeded later.

How is the condition monitored?

Those treated with medicines can often monitor their own symptoms athome. After TURP or prostate surgery, the person is seen from time to time by thehealthcare provider and watched for a return of symptoms. Any new orworsening symptoms should be reported to the doctor right away.