Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate, is a non-cancerous increase in prostate gland size. The prostate gland is located just below the bladder in men and surrounds the urethra, the tube that carries urine from the bladder out of the body. As the prostate enlarges, it can press on the urethra, causing various urinary symptoms. BPH is a very common condition, especially as men age, and it’s not associated with an increased risk of prostate cancer, although the two conditions can coexist.
Causes:
The exact cause of BPH is not fully understood, but it is primarily linked to aging and hormonal changes in men. The prostate gland typically grows throughout a man’s life, and this growth can lead to BPH.
- Aging: BPH rarely causes symptoms before age 40, but more than half of men in their 60s and up to 90% in their 70s and 80s have some symptoms of BPH.
- Hormonal Changes:
- Dihydrotestosterone (DHT): A powerful male hormone that stimulates prostate growth. Even with declining testosterone levels as men age, DHT levels remain high or even increase in the prostate, contributing to its enlargement.
- Estrogen: As men age, the proportion of estrogen relative to testosterone increases, which may also play a role in prostate cell growth.
- Family History: Having a close relative (father or brother) with BPH increases your risk.
- Testicular Function: Men who have had their testicles removed at a young age (before puberty) do not develop BPH, suggesting a role for testicular hormones.
- Chronic Medical Conditions: Conditions like heart disease, circulatory disease, and diabetes may be associated with an increased risk, though the link is not fully clear.
- Obesity: Some studies suggest a correlation between obesity and an increased risk of BPH.
Symptoms:
The symptoms of BPH are related to the pressure the enlarged prostate puts on the urethra and bladder, affecting urination. The severity of symptoms can vary, and prostate size doesn’t always correlate with symptom severity.
- Frequent or Urgent Need to Urinate: Especially at night (nocturia).
- Difficulty Starting Urination: Hesitancy.
- Weak Urine Stream: Or a stream that stops and starts.
- Dribbling at the End of Urination.
- Inability to Completely Empty the Bladder: Leading to residual urine.
- Straining During Urination.
- Painful Urination (Dysuria): Less common, but can occur with complications like infection.
- Blood in the Urine (Hematuria): Also less common, but can be a sign of complications.
- Urinary Tract Infections (UTIs): Due to incomplete bladder emptying.
- Acute Urinary Retention: A sudden inability to urinate, which is a medical emergency.
Diagnosis:
Diagnosing BPH involves a thorough medical history, physical examination, and various tests to assess prostate health and urinary function.
- Medical History: The doctor will ask about your urinary symptoms, their severity, duration, and impact on your quality of life. They will also inquire about any other medical conditions or medications.
- Digital Rectal Exam (DRE): The doctor inserts a gloved, lubricated finger into the rectum to feel the prostate gland. This allows them to assess its size, shape, and consistency, and check for any abnormal areas.
- Urine Test (Urinalysis): To check for infection, blood, or other abnormalities in the urine.
- Blood Test (Prostate-Specific Antigen – PSA): PSA is a protein produced by prostate cells. Elevated PSA levels can indicate BPH, prostate cancer, prostatitis, or other prostate conditions. While not diagnostic for cancer, it’s used as a screening tool.
- Urinary Flow Test (Uroflowmetry): You urinate into a special device that measures the speed and volume of your urine flow. A reduced flow rate can indicate an obstruction.
- Post-Void Residual (PVR) Volume Test: Measures the amount of urine remaining in your bladder after you urinate, usually with an ultrasound or catheter. High residual volume suggests incomplete emptying.
- Urodynamic Studies: A series of tests that evaluate bladder and urethra function, often used for more complex cases.
- Cystoscopy: A thin, flexible scope is inserted into the urethra and bladder to visualize the urinary tract and prostate.
- Prostate Biopsy: If there are concerns about prostate cancer (e.g., very high PSA or abnormal DRE), a biopsy may be performed to obtain tissue samples for microscopic examination.
Treatment:
Treatment for BPH depends on the severity of symptoms, their impact on quality of life, and the presence of complications. Options range from watchful waiting to medications and surgical procedures.
- Watchful Waiting: For mild symptoms that are not bothersome. Involves regular check-ups and monitoring of symptoms without immediate intervention.
- Lifestyle Changes:
- Reduce fluid intake: Especially before bedtime or going out.
- Avoid caffeine and alcohol: These can irritate the bladder and increase urine production.
- Avoid decongestants and antihistamines: Can worsen urinary symptoms by constricting the urethra.
- Timed voiding: Urinate on a schedule, even if you don’t feel the urge.
- Double voiding: Urinate, wait a few minutes, then try to urinate again to fully empty the bladder.
- Exercise regularly: Can help manage symptoms.
- Medications:
- Alpha-Blockers: Relax muscles in the prostate and bladder neck, making it easier to urinate. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura).
- 5-alpha Reductase Inhibitors: Shrink the prostate gland by blocking the production of DHT. Examples include finasteride (Proscar) and dutasteride (Avodart). These take longer to work (up to 6 months) and are often used for larger prostates.
- Combination Therapy: Often, alpha-blockers and 5-alpha reductase inhibitors are used together for better symptom relief and to reduce BPH progression.
- PDE5 Inhibitors: Tadalafil (Cialis) is approved to treat BPH symptoms and erectile dysfunction.
- Minimally Invasive Procedures:
- Transurethral Microwave Therapy (TUMT): Uses microwave heat to destroy excess prostate tissue.
- Transurethral Needle Ablation (TUNA): Uses low-level radiofrequency energy delivered by needles to burn away prostate tissue.
- Prostatic Urethral Lift (PUL or UroLift): Implants are used to hold open the enlarged prostate lobes, relieving compression on the urethra.
- Water Vapor Thermal Therapy (Rezum): Uses steam to destroy obstructive prostate tissue.
- Prostate Artery Embolization (PAE): Blocks blood flow to the prostate, causing it to shrink.
- Surgical Procedures:
- Transurethral Resection of the Prostate (TURP): The most common surgical procedure for BPH. A scope is inserted into the urethra, and excess prostate tissue is removed piece by piece.
- Transurethral Incision of the Prostate (TUIP): Small incisions are made in the prostate gland and bladder neck to widen the urethra.
- Laser Surgery: Uses various types of lasers (e.g., HoLEP, PVP, GreenLight) to vaporize or remove obstructive prostate tissue.
- Open Prostatectomy (Simple Prostatectomy): For very large prostates, involves an incision in the abdomen to remove the inner part of the prostate.
Regular monitoring by a healthcare provider is essential for men with BPH to manage symptoms, prevent complications, and determine the most appropriate course of treatment.
