Benign Prostatic Hyperplasia
The prostate gland is a small, round lump of tissue located between the penis and the bladder. Its function is to add fluid to the semen, the liquid that carries the sperm. It tends to grow bigger as men enter middle age, and continues to grow with age. In some men the prostate gland can grow to be more than seven times its original size. This runaway growth is called hyperplasia and results in the condition benign prostatic hyperplasia (BPH).
BPH causes no symptoms or problems in two-thirds of men over the age of 50 years, but the chance of developing symptoms increases with each additional year. The prostate surrounds the top of the urethra, the tube through which we urinate, just where it meets the bladder. If the prostate gets too big, it can squeeze the urethra, partly closing it. This can lead to various urinary tract problems.
Having BPH doesn't increase your chances of getting prostate cancer. The two diseases can have similar symptoms, although prostate cancer often has no symptoms. It's also possible to have BPH and prostate cancer at the same time.
We don't know why the prostate grows larger in older men, but it's believed to be linked to hormonal changes associated with aging.
Symptoms and Complications
At first, you may find you have to strain harder when you are urinating. Over time, this straining can affect the bladder muscles, causing them to become oversensitive. Often, no matter how much you strain, the bladder still contains urine. The urge to urinate comes with increasing frequency. This can be a particular nuisance at night.
Other symptoms you can have include:
- feeling that you must urinate right away (urgency)
- a delay when you start urinating
- weak or interrupted stream of urine
- tendency to dribble after urination
- feeling your bladder isn't empty after urination
A bladder that won't empty properly encourages infection of the urinary tract. A few men get urinary stones, repeated infections, or blood in the urine. Sometimes BPH causes urinary retention, a condition where you cannot empty your bladder completely when urinating. Rarely, it produces complete blockage of the urethra, which is a medical emergency.
Making the Diagnosis
BPH diagnosis is made by taking a medical history that focuses on your urinary symptoms. The size of your prostate does not always predict symptoms: you can have a small but tight prostate causing many symptoms or a large prostate that causes few symptoms. In either case, symptoms are due to the blockage caused by the prostate.
A physical exam includes a digital rectal exam, in which the doctor feels for the prostate with a gloved finger to check its size and texture. There's also a blood test that measures a specific protein that is secreted by the prostate gland (also known as prostate specific antigen, or PSA). PSA can be mildly elevated in BPH or more elevated in men with prostate cancer. There can be overlap in PSA levels between these 2 conditions, and only a prostate biopsy can tell the difference.
Treatment and Prevention
Your doctor may recommend watchful waiting, especially if the symptoms are mild and do not interfere with your daily life. Watchful waiting involves monitoring for signs of worsening symptoms without any treatment.
Medications called alpha-blockers (e.g., terazosin*, alfuzosin, tamsulosin, silodosin) can help relax the bladder outlet, allowing easier passage of urine, especially if the obstruction of the urethra isn't too severe. Other medications (e.g., dutasteride, finasteride) help reduce the size of the prostate.
These medications can remove the need for surgery in many people with BPH. However, surgery is the only way to eliminate the problem completely. The most commonly used technique is called a TURP (transurethral resection of the prostate), which can be used for most cases except those with extremely large prostate glands. A tube equipped with a camera and a loop is inserted into the urethra (the tube that runs the length of the penis and back to the bladder) to remove strips of enlarged prostate. TURP causes fewer postoperative problems than open surgery, which involves an abdominal incision and the risk of blood transfusion.
Other techniques like TUIP (transurethral incision of the prostate), laser prostatectomy, and radiofrequency ablation aim to reduce the size of the prostate, often with fewer side effects than TURP. Only a specialist can decide which technique is most appropriate in each case.