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Conditions

Prostate Enlargement

BPH stands for benign prostatic hyperplasia.

Benign means "not cancer," and hyperplasia means abnormal cell growth. The result is that the prostate becomes enlarged. BPH is not linked to cancer and does not increase your risk of getting prostate cancer�yet the symptoms for BPH and prostate cancer

BPH affects most men as they get older. It can lead to urinary problems like those with prostatitis. BPH rarely causes symptoms before age 40, but more than half of men in their 60s and most men in their 70s and 80s will have signs of BPH.

The prostate gland is about the size of a walnut when a man is in his 20s. By the time he is 40, it may have grown slightly larger, to the size of an apricot. By age 60, it may be the size of a lemon.

The enlarged prostate can press against the bladder and the urethra. This can slow down or block urine flow. Some men might find it hard to start a urine stream, even though they feel the need to go. Once the urine stream has started, it may be hard to stop. Other men may feel like they need to pass urine all the time, or they are awakened during sleep with the sudden need to pass urine.

Symptoms

BPH symptoms usually start after the age of 50. They can include:

  1. Trouble starting a urine stream or making more than a dribble
  2. Passing urine often, especially at night
  3. Feeling that the bladder has not fully emptied
  4. A strong or sudden urge to pass urine
  5. Weak or slow urine stream
  6. Stopping and starting again several times while passing urine
  7. Pushing or straining to begin passing urine

At its worst, BPH can lead to:
  1. A weak bladder
  2. Backflow of urine causing bladder or kidney infections
  3. Complete block in the flow of urine
  4. Kidney failure

Treatment Options

There are three ways to manage BPH:

  1. Watchful waiting (regular follow-up with your doctor)
  2. Drug therapy
  3. Surgery


Watchful waiting

Men with mild symptoms of BPH who do not find them bothersome often choose this approach.

Watchful waiting means getting annual checkups. The checkups can include DREs and other tests (see "Types of Tests"). Treatment is started only if symptoms become too much of a problem.

If you choose watchful waiting, these simple steps may help lessen your symptoms:
  1. Limit drinking in the evening, especially drinks with alcohol or caffeine.
  2. Empty your bladder all the way when you pass urine.
  3. Use the restroom often. Don't wait for long periods without passing urine.

Drug therapy

Many American men with mild to moderate BPH symptoms have chosen prescription drugs over surgery since the early 1990s. Two main types of drugs are used. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. Some evidence shows that taking both drugs together may work best to keep BPH symptoms from getting worse.

Alpha-blockers

These drugs (see the table on page 14) help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they don't shrink the size of the prostate. For many men, these drugs can improve urine flow and reduce the symptoms of BPH within days. Possible side effects include dizziness, headache, and fatigue.

5 alpha-reductase inhibitor

These drugs (see the table on page 14) help shrink the prostate. They relieve symptoms by blocking the activity of an enzyme known as 5-alpha reductase. This enzyme changes the male hormone testosterone into dihydrotestosterone (DHT), which stimulates prostate growth. When the action of 5-alpha reductase is blocked, DHT production is lowered and prostate growth slows.

Surgery

The number of prostate surgeries has gone down over the years. But operations for BPH are still among the most common surgeries for American men. Surgery is used when symptoms are severe or drug therapy has not worked well.

Types of surgery for BPH include:

TURP (transurethral resection of the prostate). The most common surgery for BPH, TURP accounts for 90 percent of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue. A spinal block (anesthesia) is used to numb the area. Tissue is sent to the laboratory to check for prostate cancer.

TURP generally avoids the two main dangers linked to another type of surgery called open prostatectomy (complete removal of the prostate gland through a cut in the lower abdomen):

  1. Incontinence (not being able to hold in urine)
  2. Impotence (not being able to have an erection)