Enlarged Prostate / BPH

 

Benign Prostatic Hyperplasia, commonly known as an enlarged prostate, is a non-cancerous condition where the prostate gland grows larger. The prostate is a small, walnut-sized gland in men, located just below the bladder. It surrounds the urethra, the tube that carries urine from the bladder out of the body. As men age, the prostate often gets bigger. This growth is benign, meaning it is not cancer and does not increase the risk of developing prostate cancer.

 

Causes and Risk Factors

 

The exact cause of BPH is not fully understood, but it is strongly linked to the aging process and hormonal changes in men.

• Age: BPH rarely causes symptoms before age 40, but the risk and prevalence increase significantly with age. By age 60, about half of men have some signs of BPH, and this number rises to about 90% by age 85.

• Hormones: The balance of hormones, such as testosterone and estrogen, changes as men get older. These changes are believed to stimulate the growth of prostate cells.

• Genetics: A family history of BPH can increase a man's risk.

• Lifestyle: Obesity, diabetes, and a lack of physical activity are also linked to a higher risk of developing BPH.

 

Symptoms

 

As the prostate enlarges, it can squeeze and narrow the urethra, blocking the flow of urine. This can lead to a variety of urinary symptoms, often referred to as lower urinary tract symptoms (LUTS). The severity of symptoms does not always correlate with the size of the prostate.

Common symptoms include:

• Frequent or urgent need to urinate: This can be particularly noticeable at night (nocturia).

• Difficulty starting urination (hesitancy): A person may have to strain or push to begin urinating.

• Weak or interrupted urine stream: The flow of urine may stop and start multiple times.

• Feeling of incomplete bladder emptying: A sensation that the bladder is not fully empty, even after urinating.

• Dribbling at the end of urination.

• Urinary retention: Inability to urinate at all, which is a medical emergency.

 

Diagnosis

 

A doctor can diagnose BPH through a physical exam and a review of symptoms. The process may involve:

• Digital Rectal Exam (DRE): A doctor inserts a gloved finger into the rectum to feel the back of the prostate gland for enlargement or abnormalities.

• Symptom Questionnaire: The patient may be asked to complete a questionnaire, such as the International Prostate Symptom Score (IPSS), to rate the severity of their symptoms.

• Urine and Blood Tests: These can help rule out other conditions like infection or kidney problems. A blood test for prostate-specific antigen (PSA) may be done to screen for prostate cancer, as BPH and prostate cancer can have similar symptoms.

• Urine Flow Study: This test measures the strength and volume of the urine stream.

 

Treatment Options

 

The best treatment for BPH depends on the severity of the symptoms, the size of the prostate, and the patient's overall health.

• Watchful Waiting (Active Surveillance): For men with mild symptoms that don't significantly affect their quality of life, a doctor may recommend monitoring the condition with regular check-ups. Lifestyle changes, such as reducing fluid intake before bed and avoiding caffeine and alcohol, can help manage symptoms.

• Medications:

  • Alpha-blockers: These drugs relax the muscles in the bladder neck and prostate, making it easier to urinate.

  • 5-alpha reductase inhibitors: These medications work by shrinking the prostate gland.

  • Combination therapy: Taking a combination of an alpha-blocker and a 5-alpha reductase inhibitor can be more effective for some men.

• Minimally Invasive Procedures and Surgery: These options are typically used for men with moderate to severe symptoms who have not responded to medication. They are designed to relieve the pressure on the urethra.

  • Transurethral Resection of the Prostate (TURP): This is a common surgical procedure where a surgeon removes portions of the prostate that are blocking urine flow using an instrument inserted through the urethra.

  • Laser Therapy: Various laser procedures can be used to destroy or vaporize excess prostate tissue.

  • Other procedures: Newer, less invasive treatments like water vapor therapy (Rezum) or prostatic urethral lift (UroLift) are also available.

Untreated BPH can lead to complications such as urinary tract infections, bladder stones, and even kidney damage. Therefore, it's important for men experiencing symptoms to consult with a healthcare professional.