Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia is non-malignant enlargement of the prostate. The prostate is a walnut-sized gland located at the neck of the bladder surrounding the urethra. It is part of the male reproductive system.

The exact cause of BPH is unknown. It may be related to changes in hormone levels as men age. These changes probably cause the prostate to grow. Eventually, the prostate becomes over-enlarged, and puts pressure on the urethra. This causes the urethra to narrow or, in some cases, close completely.

A risk factor is something that increases your chance of getting a disease or condition.

• Age: over 50 years old

(By age 60, 50% of all men will have BPH. By age 80, 90% of men will have BPH.)

Narrowing of the urethra caused by enlargement of the prostate causes the symptoms of BPH. Symptoms usually increase in severity over time.

Symptoms include:

• Difficulty starting to urinate
• Weak urination stream
• Dribbling at end of urination
• Sensation of incomplete bladder emptying
• Urge to urinate frequently, especially at night
• Deep discomfort in lower abdomen
• Incontinence

BPH diagnosis is based on:

• Your age
• Symptoms
• Digital rectal exam – examination of the rectum with the doctor's gloved finger inserted into your rectum

Other tests may include:

• Urine flow study
• X-ray of the urinary tract
• Cystoscopic examination
• Transrectal ultrasound

Testing for prostate specific antigen (PSA) is often used to screen for prostate cancer, a malignant condition. However BPH, which is far more common, causes an elevation in PSA levels, which raises false concerns regarding the presence of cancer.

In mild cases of BPH, no treatment is necessary. In many cases, men with BPH eventually request medical intervention.

Treatments include:

Medication

Medications include:

• Finasteride (Proscar) – inhibits the production of the hormone involved in prostate enlargement (In some men, finasteride can shrink the prostate.)
• Alpha-blockers – reduce bladder obstruction and improve urine flow by relaxing the muscles of the prostate and bladder

Men with BPH should not take drugs containing decongestants. These drugs can worsen the symptoms of BPH.

Minimally Invasive Interventions

These are used when drugs are ineffective but the patient is not ready for surgery. Non-surgical treatments include:

Transurethral Microwave Thermotherapy (TUMT) – uses microwaves to destroy excess prostate tissue

Transurethral Needle Ablation (TUNA) – uses low levels of radiofrequency energy to burn away portions of the enlarged prostate

Transurethral Laser Therapy – uses highly focused laser energy to remove prostate tissue

Balloon Dilation – uses an expandable balloon to widen the urethra

Surgery

Surgical procedures include:

Transurethral Surgical Resection of the Prostate (TURP) – a scope inserted through the penis to remove the enlarged portion of the prostate

Transurethral Incision of the Prostate (TUIP) – small cuts made in the neck of the bladder to widen the urethra (Long-term effectiveness is not yet clearly established.)

Open Surgery – removal of the enlarged portion of the prostate through an incision, usually in the lower abdominal area (much more invasive then TURP or TUIP)

Alternative Treatments

Several clinical trials have shown positive results with saw palmetto, an herb native to the Southern United States. These studies have shown significant improvements in BPH symptoms.

Because prostate enlargement occurs naturally with advancing age, there are no specific prevention guidelines.