Enlarged Prostate (Prostatic Hyperplasia, Benign)

Basic Information

When most men reach the age of 50, the prostate begins to enlarge after at least 20 years of dormancy because usually the prostate has reached its full size by the time a man reaches 30. This new growth (or benign adenoma) which begins to grow at different speeds in each male is called benign prostatic hyperplasia or BPH. The growth is usually quite gradual and symptoms such as frequent urination or the weakening of the urine stream may not be recognized or acknowledged because these changes just become accepted as part of daily or nightly routine. For the majority of men significant problems are not associated with this gradual growth but nearly one-third of men will have problems for which they need to seek treatment.

Because the benign adenoma grows in the section of the prostate adjacent to the urethra, as it grows, gradually pushing on the urethra and over time making urinating a more difficult undertaking, what is really happening is that the bladder is unable to be completely emptied so that a number of men experience unusual or uncomfortable symptoms associated with it.

The cause of BPH is unknown but it is thought to be caused by hormonal changes during the natural aging process. But a man must have one functioning testicle to have BPH. And since the adenoma is benign, treatment is not often indicated for men who remain asymptomatic or unless the man himself is bothered by symptoms. In a number of cases symptoms can become severe and treatment is essential.

Symptoms

With BPH the following symptoms (mild to moderate) may occur:

feeling that the bladder never empties no matter how often or much you urinate
weak or sluggish urinary stream
nocturia -- waking in the middle of the night to urinate
straining to urinate
increased urinary frequency
increased urinary urgency
impotence (occasional)
burning sensation when urinating
abnormally colored urine

Problems associated with severe BPH can include:

kidney damage due to the backup of urine
chronic urinary tract infections
an inability to urinate due to prostatic constriction of the urethra -- this is very painful and an emergency situation that calls for immediate catheterization
lost bladder muscle tones
excess urea in the blood

Diagnosis/Treatment

Diagnostic tests among others include:

digital rectal exam (a check for prostate cancer is indicated for men over 50)
urinary flow rate with post-voidal residue
ultrasound of the bladder

Treatment has made strides during the last decade. Now two types of medications that provide different functions are available and usually successful in improving the flow of urine, quite an improvement over surgical intervention which was one of the only options available before the 1990s.

Your health care provider may prescribe:

alpha adrenergic antagonists or alpha blockers which relax muscles in the prostatic adenoma, allowing an improved flow of urine
5-alpha reductase inhibitors in which testosterone is unable to stimulate prostate growth -- its active form is blocked, allowing the shrinking of the prostate (though this may take months)
both medications improve the flow of urine and may be given in combination, especially since results from the alpha adrenergic antagonists are experienced more rapidly

If you have been diagnosed with BPH and do not respond well to the medications, other methods of treatment or surgical intervention may be indicated. They include:

transurethral needle ablation (TUNA) in which the prostate is heated next to the urethra and dead tissue falls off, allowing a better urine flow
lasers (both YAG or INDIGO) again heats the prostate immediately adjacent to the urethra
balloon dilatation of the prostatic urethra -- fewer complications than those associated with surgery, yet less symptomatic relief
transurethral prostatectomy (TURP) -- the most common surgical procedure for BPH (over 400,000 men have this procedure annually in the U.S.) in which enough of the prostate is cut away to open the urethra
for very enlarged prostates, an open prostatectomy in which the whole prostate is removed has an almost 100 percent rate of improving urinary flow yet there are side effects such as impotence and retrograde ejaculation that may occur

BPH is benign and cannot spread or become cancerous yet up to 13 percent of males with BPH have also been found to have clinically undetected prostate cancer. In treating you, your health care provider will be able to discuss treatment options and the mode of treatment will usually be based on the severity of your BPH. Fortunately symptoms improve in over 70% of patients undergoing treatment.

If you have symptoms of BPH please see your health care provider promptly.