The prostate is part of the male reproductive system about the size of a walnut located below the bladder and in front of the rectum. The prostate surrounds the urethra, the tube that carries urine from the bladder out of the body, and its function is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra at the same time as fluid from the prostate and the seminal vesicles, mixing and creating semen.

The prostate goes through two main growth periods during a man’s life. The first occurs early in puberty when the prostate doubles in size. The second growth phase begins around age 25 and continues for much of the remainder of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase.

BPH Overview:

How common is benign prostate enlargement?

Benign (noncancerous) enlargement of the prostate, known as benign prostatic hyperplasia, or BPH, is the most common prostate issue affecting men. As men age, almost all will develop some degree of enlargement to their prostate.

Who is affected by prostate enlargement?

The number of men afflicted with BPH increases progressively with age. By age 60, 50% of men will have some signs of BPH. By age 85, 90% of men will have signs of the condition and about half of those men will have symptoms that require treatment.

Does having BPH increase your risk for prostate cancer?

Based on current research, having BPH does not appear to increase the risk of developing prostate cancer. That said, BPH and prostate cancer share similar symptoms and a man who has BPH could unknowingly develop cancer at the same time.

The American Urological Association and the American Cancer Society recommend an annual prostate screening for men between ages 50 and 70 in an effort to detect cancer in its early stages. They further recommend that men who are at high-risk, such as African-American men and those with a family history of prostate cancer, begin screening at about age 40. Screening tests for prostate cancer include a blood test for a substance called prostate-specific antigen (PSA) and the digital rectal exam (DRE).

What are the symptoms of BPH?

Since the prostate surrounds the urethra, the direct result of enlargement is blockage of the tube. Therefore, symptoms include:

• Slowness or dribbling of urine
• Hesitancy or difficulty urinating
• Frequent urination
• A feeling of a sudden need to urinate
• Need to get up at night to urinate

As symptoms progress, you could develop:

• Bladder stones
• Bladder infection
• Blood in urine
• Kidney damage from increased pressure caused by retaining extra urine
• Sudden blockage of the urinary tube, making urination impossible

Diagnosis and Tests:

How is BPH diagnosed?

In order to properly diagnosis BPH, you will need to schedule an appointment with your physician. At this appointment, your doctor can review your medical history, any symptoms, and perform a detailed physical exam. As part of the physical, your doctor will conduct a digital rectal examination (DRE) by inserting a gloved, lubricated finger into your rectum to feel the prostate. The prostate gland is located in front of the rectum and is relatively easy for the doctor to feel a large portion of the gland. This test allows your doctor to estimate the size of the prostate and detect any hard areas that could be cancer.

In addition to the physical exam, several studies may be performed:

• A seven-question survey to evaluate your symptoms
• A flow study to measure how slow the urinary stream is
• A study may be conducted to detect how much urine is left in the bladder after urination
• A cystoscopy (a procedure to look into the bladder)

Management and Treatment:

How is BPH treated?

Patients with mild BPH symptoms may not require any treatment other than continued observation to make sure their condition doesn’t get worse. This is sometimes called “watchful waiting” or simply “surveillance.”

There are a number of treatment options if symptoms become severe:

Medication

Proscar was one of the first drugs used to treat BPH and works by slowing the hormone production that affects the growth of the prostate gland.

Drugs that relax the muscle in the prostate are more commonly used. These include Hytrin®, Cardura®, and Flomax®. The most common side effects of these medications are light-headedness and weakness.

Surgery

A number of surgical procedures exist to remove prostate tissue that is blocking urine flow.

• Transurethral resection of the prostate (TURP): Involves removing the tissue blocking the urethra with a special instrument. Although TURP is an effective treatment, the side effects include bleeding, infection, impotence (inability to maintain an erection) and incontinence (inability to control the flow of urine).
• Transurethral electrovaporization: This technique uses electrical energy to rapidly heat prostate tissue, vaporizing areas of the enlarged prostate to relieve the urinary blockage.
• The Greenlight laser: This is commonly used to treat BPH and is associated with less bleeding after the procedure.
• Transurethral incision of the prostate (TUIP): Instead of removing tissue, TUIP involves widening the urethra by making several small cuts in the bladder neck (the area where the urethra and bladder join), as well as in the prostate gland itself to relieve pressure and improve urine flow.

Minimally invasive treatments

These treatments can effectively reduce the size of the prostate and relieve urinary blockage with a less invasive approach to reduce damage to healthy tissue. In general, minimally invasive procedures require less time in the hospital, result in fewer side effects, cost less, and require less recovery time. However, many of these techniques are new and the long-term effectiveness and complications are still being considered.

Minimally invasive treatments include:

• Transurethral microwave thermotherapy (TUMT): Microwave energy delivers high temperatures to the prostate by way of an antenna positioned in the prostate using a special catheter. A second catheter is used to circulate coolant around the urethra to keep you comfortable. The entire procedure is computer-controlled and takes approximately 90 minutes. Patients are generally given medicine to prevent pain and relieve anxiety and the most common complaints during the treatment are an urge to urinate and a burning sensation in the penis.
• Transurethral needle ablation (TUNA): This technique uses low-level radiofrequency energy delivered through two needles to burn away an area of the enlarged prostate.

References:

• National Institute of Diabetes and Digestive and Kidney Diseases: What I need to know about prostate problems
• National Institute of Diabetes and Digestive and Kidney Diseases: Medical tests for prostate problems
• Urology Care Foundation: What is Benign Prostatic Hyperplasia (BPH)?