Benign prostatic hyperplasia
Benign prostatic hyperplasia or BPH is the medical term for an enlarged prostate, which is the growth of the prostate gland to an unhealthy size.
Definition & Facts
The prostate gland is a small gland of the male reproductive system located just below the bladder surrounding the urethra, which is the tube that transports urine from the bladder out of the body. Its primary function is to secrete fluid that comprises part of semen. If the prostate becomes enlarged, a problem may arise due to the prostate pushing against the urethra. A compressed urethra is likely to result in urination problems.
As the name implies, BPH results from a non-malignant or non-cancerous cause. Although prostate cancer may have similar symptoms, BPH is separate and distinct, and there is currently no medical evidence that suggests a link between the two. The chances of BPH increase with age such that:
- Age 31-40: one in 12 men have BPH.
- Age 51-60: about one in two.
- Over age 80: more than eight in 10.
Symptoms & Complaints
When men become aware of potential problems, it typically arises in either the storage of urine in the bladder or elimination from the bladder. Included among the more commonly reported symptoms are:
- Difficulty initiating a urine stream, which can be manifested by straining or hesitation
- Decreased urine stream
- Feeling the need to urinate again shortly after urination
- Inability to completely empty the bladder, which can be manifested by dribbling urine
- A feeling that the bladder is not completely empty
- Pain during urination
If the symptoms are ignored and the condition is allowed to worsen, more advanced symptoms may develop, such as bladder stones, infection, and potentially damage to the kidneys created by a back-flow of urine from the bladder. Symptoms similar to those that may indicate BPH may alternately be a sign of a urinary tract infection, diabetes, or a neurological disorder, in addition to prostate cancer.
Every man has a certain risk of developing BPH by the very nature of having a prostate. The exact reason that triggers the prostate to become enlarged to the extent it creates a health concern is unclear. What is clear, however, is that the prostate undergoes a “normal” growth pattern as a male ages.
For the vast majority of healthy males, the prostate grows very little between birth and puberty. Between puberty and the early to mid-twenties, a typical man’s prostate will increase in weight and double in size. For some men, there will be no significant growth of the prostate after this time; for others, slow growth begins around 40, and for a small percentage of the population, growth may occur in the 30’s or earlier.
Male hormones almost certainly play a role in prostate growth. Testosterone, which is produced in a man’s testes throughout his lifetime, is converted in the prostate to a stronger male hormone known as dihydrotestosterone (DHT). DHT causes rapid cell growth in the lining of the tissues of the prostate during and after puberty. For reasons unknown, DHT may also stimulate tissue growth in older men, as well.
Men who have had their testicles removed at any early age due to health issues do not develop BPH. Another theory involves estrogen that is present to some extent in all men. As the levels of testosterone decrease with age, the relatively higher percentage of estrogen may stimulate prostate growth.
Diagnosis & Tests
As with many potential medical issues, a diagnosis of BPH is considered within the context of multiple sources of information, including:
- A description of symptoms from the patient
- A medical history of the patient and his family
- A physical examination
- Various medical tests
The primary diagnostic test used to detect BPH is the digital rectal examination. The doctor inserts a gloved and lubricated finger into the rectum of the patient allowing the doctor to feel the prostate, which can reveal any abnormalities.
Due to the fact that the existence of BPH and its severity may be difficult to conclusively diagnose and that symptoms similar to those indicating BPH may alternately point to another cause, medical professionals most often run a range of tests designed to eliminate possibilities other than an enlarged prostate. Tests may include a urinalysis, cystoscopy, ultrasound, or tests that measure the speed of urine flow and the extent to which the bladder is void of urine after urination.
A PSA test (prostate-specific antigen test) may also be conducted, whcih measures the level of a prostate-specific antigen in the patient’s blood. This test is widely used to detect prostate cancer, but recent findings have indicated an elevated level of PSA is present with individuals that have BPH, thus reducing its effectiveness in isolating cancer as the cause of the symptoms reported.
Treatment & Therapy
BPH has no known cure. Treatment, therefore, is focused on reducing the symptoms of the patient. This becomes a very individualized matter based on the degree of the enlargement and the ability of the patient to tolerate the symptoms. Many men with mild symptoms adopt a watch and wait strategy entailing regular monitoring and examinations but avoiding medication or surgery.
Mild to moderate cases may be treated with medications such as alpha blockers or antiandrogens. Severe cases may result in surgical removal of part of the prostate. Recent advances have provided some with the option of prostate laser surgery, which involves a laser cutting or melting away tissue that is causing an obstruction in urinary flow.
Prevention & Prophylaxis