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Diseases & Conditions

Benign Prostatic Enlargement (BPH)

Benign (noncancerous) enlargement of the prostate, known as benign prostatic hyperplasia, or BPH, is the most common prostate problem in men. Almost all men will develop some enlargement of the prostate as they age.

Who is affected by prostate enlargement?

Overall, the number of men 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. About half of these men will develop symptoms that require treatment.

Does having BPH increase your risk of developing prostate cancer?

Based on research to date, having BPH does not seem to increase the risk of developing prostate cancer. However, BPH and prostate cancer have similar symptoms, and a man who has BPH may have undetected cancer at the same time.

To help detect prostate cancer in its early stages, the American Urological Association and the American Cancer Society recommend annual screening for men ages 50 to 70. They further recommend that men who are at high risk -- such as African-American men and men with a family history of prostate cancer -- begin screening at about age 40. Tests used to screen 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 gland surrounds the urethra, the tube that carries urine outside the body, it is easy to understand that enlargement of the prostate can lead to blockage of the tube. Therefore, you may develop:

  • Slowness or dribbling of your urinary stream
  • Hesitancy or difficulty starting to urinate
  • Frequent urination
  • Feeling of urgency or sudden need to urinate
  • Need to get up at night to urinate

As symptoms progress, you may develop:

  • Bladder stones
  • Bladder infection
  • Blood in your urine
  • Damage to your kidneys from back pressure caused by retaining large amounts of extra urine in the bladder
  • Sudden blockage of the urinary tube, making urination impossible

How is BPH diagnosed?

After evaluating your medical history and giving you a complete physical, your doctor will perform a digital rectal examination. Because the prostate gland is in front of the rectum, it is relatively easy for the doctor to feel much of the gland. This enables him to estimate the size of the prostate and to detect any hard areas that could be cancer.

Several studies may be performed to help diagnose your condition:

  • A seven-question survey may be completed to evaluate your symptoms.
  • A flow study may be conducted to measure how slow the urinary stream is compared with normal flow.
  • A study may be conducted to detect how much urine is left in the bladder after urination is completed.
  • In addition, the physician may need to look into the bladder. The procedure is called cystoscopy.

How is BPH treated?

Patients with mild symptoms may not require treatment other than continued observation to make sure their condition doesn't worsen. This approach is sometimes called “watchful waiting” or surveillance. There are a number of treatment options available if your symptoms are severe:

Treatments for BPH include:

Medication

Proscar was one of the first drugs used to treat BPH. It works by inhibiting the production of the hormone dihydrotestosterone (DHT), which affects the growth of the prostate gland. Proscar appears to be most beneficial for men with larger prostates. Drugs that relax the muscle in the prostate (to reduce the tension on the urine tube) are more commonly used. These include Hytrin, Cardura, and Flomax. The most common side effects are light-headedness and weakness.

Surgery

A number of surgical procedures have been used to remove the prostate tissue blocking the flow of urine. The most common procedure is called transurethral resection of the prostate, or TURP. It involves removing the tissue blocking the urethra (urine tube) with a special instrument. Although TURP is an effective treatment, there are potential side effects, including bleeding, infection, impotence (inability to maintain an erection suitable for sex) and incontinence (inability to control the flow of urine).

Another, less complicated procedure is transurethral incision of the prostate (TUIP). Instead of removing tissue, as with TURP, this approach involves widening the urethra by making several small cuts in the bladder neck (area where the urethra and bladder join), as well as in the prostate gland itself. This relieves some of the pressure on the urethra and improves urine flow.

Minimally invasive treatments

New treatments have been developed in recent years that can effectively reduce the size of the prostate and relieve urinary obstruction, but are less invasive and damaging to healthy tissue than is surgery. In general, minimally invasive procedures require less time in the hospital, result in fewer side effects, are less costly and allow for quicker recovery. The most common side effects reported with these treatments include urinary frequency and irritation while the prostate is healing. However, many of these techniques are new, and little is known about the long-term effectiveness and complications of these procedures.

Minimally invasive treatments include:

  • Transurethral Microwave Thermotherapy (TUMT): Microwave energy delivers temperatures above 45 degrees C (113 F) to the prostate by way of an antenna positioned in the prostate using a special catheter (tube). Another catheter is used to circulate coolant around the urethra, which helps keep you reasonably comfortable throughout the procedure. The entire procedure is computer-controlled, based on temperature recordings obtained in the urethra and rectum. This technique is performed in your doctor's office and takes approximately 90 minutes. Patients are generally given medicine to prevent pain and relieve anxiety. The most common complaints during the treatment are an urge to urinate and a burning sensation in the penis. There are two programs: "standard treatment" or "high-energy" treatment. High-energy treatment delivers more energy to the prostate, which generally provides better results and improved flow, but patients are likely to experience more side effects in the recovery period.
  • Transurethral Needle Ablation (TUNA): This technique uses low-level radiofrequency energy delivered through two needles to ablate, or burn away, an area of the enlarged prostate.
  • Transurethral Electrovaporization: This technique uses electrical energy applied through an electrode to rapidly heat prostate tissue, turning the tissue cells into steam. This allows the doctor to vaporize an area of the enlarged tissue and relieve urinary obstruction.

In addition to these medical and surgical treatments, use of the herb saw palmetto is showing some promise as a treatment for BPH. Recent studies have found that the extract from saw palmetto berries appears to block the formation of DHT, the hormone responsible for prostate gland growth.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/16/2012...#9100