Benign prostatic hyperplasia (BPH) - symptoms and treatment
What is benign prostatic hyperplasia (BPH)
A noncancerous enlargement, also called benign prostatic hypertrophy, of a man’s PROSTATE GLAND. BPH is common in men over age 60 and is a condition of aging. Though BPH is not cancer, some men who have BPH do develop PROSTATE CANCER. Researchers do not know what causes BPH though believe the changes in HORMONE levels and ratios that naturally occur with aging probably are key.
BPH develops when the number of cells in the prostate gland increases, causing the gland to grow. The prostate gland encircles the URETHRA like a cuff at the neck of the BLADDER. BPH typically constricts the urethra, either by compressing it from the outside or blocking it from the inside if prostate cells invade the urethral walls. The resulting occlusion interferes with URINATION.
Symptoms of Benign Prostatic Hyperplasia and Diagnostic Path
The symptoms of BPH develop gradually over time and may include
- hesitation when urinating (stopping and starting during the flow)
- URINARY URGENCY and URINARY FREQUENCY, especially at night (NOCTURIA)
- dribbling URINE after the man finishes urinating
- HEMATURIA (bloody urine)
- URINARY INCONTINENCE
The diagnostic path includes a BLOOD test to measure the PROSTATE-SPECIFIC ANTIGEN (PSA) level and a DIGITAL RECTAL EXAMINATION (DRE), which allows the doctor to palpate (feel) the prostate gland through the wall of the RECTUM. This examination helps determine whether the enlargement of the prostate gland is likely benign (the gland feels soft to palpation) or suspicious (the gland feels hard or irregular). Further diagnostic procedures may include measurement of postvoiding urine (urine that remains in the bladder after urination), ULTRASOUND of the bladder, and occasionally CYSTOURETHROGRAM to rule out other causes of the symptoms.
Benign Prostatic Hyperplasia Treatment Options and Outlook
Treatment depends on the nature of the prostate gland’s overgrowth, the severity of symptoms, and the man’s preferences. Treatment options include
- MINIMALLY INVASIVE SURGERY to remove excess prostate gland tissue
- transurethral resection of the prostate (TURP), an OPERATION in which the urologist removes portions of the prostate gland using an endoscopic instrument inserted through the urethra
- PROSTATECTOMY, an operation to entirely remove the prostate gland
- alpha blocker medications, which relax smooth MUSCLE tissue to improve the flow of urine
- 5-alpha reductase inhibitor medications such as finasteride and dutasteride, which block the conversion of TESTOSTERONE to dihydrotestosterone (DHT) to slow the growth of prostate gland cells
- herbal remedies such as SAW PALMETTO, stinging nettle extract, SOY protein and soybean products, and flaxseed oil
| MEDICATIONS TO TREAT BENIGN PROSTATIC HYPERPLASIA (BPH) | |
|---|---|
| alfuzosin | doxazosin |
| dutasteride | finasteride |
| prazosin | tamsulosin |
| terazosin | |
Prostatectomy is the only cure for BPH, though it has significant risks and potential complications. Most men are able to achieve long-term relief of symptoms through medication or minimally invasive procedures.
Risk Factors and Preventive Measures
Age is the primary risk factor for BPH. BPH is rare in men under age 50 and nearly always present in men over age 70. There are no known methods for preventing BPH. It is important for men over age 50 to undergo recommended preventive screening and examination for prostate cancer, as the risk for prostate cancer also increases with age and its early symptoms are indistinguishable from those of BPH.
See also AGING, REPRODUCTIVE AND SEXUAL CHANGES THAT OCCUR WITH; BLADDER CANCER; ENDOSCOPY; HORMONE-DRIVEN CANCERS; SURGERY BENEFIT AND RISK ASSESSMENT; URETHRAL STRICTURE.
