Enlarged Prostate (BPH) Symptoms, Diagnosis, Treatment

The prostate gland is located below the bladder in men and produces fluid components of semen. Over half of men ages 60 and above have enlargement of the prostate gland. This condition is sometimes called benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). It is not known exactly why this enlargement occurs. However, BPH is not cancer and does not cause cancer. Some men have BPH symptoms while others do not.

The most common symptom of BPH includes having to urinate more, often at night. The reason is that the enlarged prostate gland presses on the urethra, which carries urine out of the body. Because of this pressure, the bladder muscles have to work harder to excrete urine. The bladder eventually may start to contract even when only a small amount of urine is present, creating the urge to urinate more often.

Pressure on the urethra from the enlarged gland and the additional work required of the bladder muscles lead to other symptoms of BPH as well. These include taking longer to initiate a urine stream and urinating with a weaker flow than before. Urine may dribble, or you may feel that there is still urine inside the bladder even after you have finished urinating.

If BPH completely blocks the urethra, inability to urinate may result. This can also happen as a result of infections or if the bladder muscles become excessively weak. The inability to urinate is a serious condition that can permanently damage the kidneys or bladder. If this comes on suddenly, go to a hospital emergency department. If you start to have symptoms of BPH, see your doctor right away in order to prevent worsening of the symptoms.

The prostate gland grows throughout a man's life, starting at puberty and again from age 25 onward. Typically, there are no symptoms from an enlarged prostate before age 40. Up to 90% of men have symptoms of BPH by age 85, but only about one-third of men with BPH symptoms are bothered by the symptoms.

No one knows why the prostate continues to enlarge throughout a man's life. Hormones like testosterone, dihydrotestosterone (DHT), and estrogen may be involved in regulating the growth of the prostate. Having a vasectomy and sexual activity do not increase the risk of getting BPH. It is also not understood why some men have symptoms with BPH while others do not.

The symptoms of BPH may mimic symptoms of other conditions, including tumors and infections. A digital rectal exam can detect BPH in many patients. If you have symptoms, you should see your doctor to rule out other possible causes of the symptoms.

Some of the symptoms of BPH are the same as those of prostate cancer, so many men are fearful of the symptoms. However, BPH is far more common than prostate cancer. Men with BPH are no more likely than other men to develop prostate cancer. However, it's important to have your doctor perform a thorough examination because the two conditions share symptoms and can even coexist.

A presumptive diagnosis of BPH is based upon taking a history of your symptoms; other tests may be used to confirm the diagnosis.

BPH Enlarged Prostate Tests

• A rectal examination to assess the size and shape of the prostate
• Ultrasound examination
• Biopsy of the prostate
• Urine flow studies
• Cystoscopy, in which the doctor can see and evaluate the inside of the bladder

Whether or not BPH must be treated depends on the symptoms and their severity. Recurrent infections, problems urinating, leakage of urine, and kidney damage can all significantly impact your quality of life. Medications or surgical treatments may help if you are having severe symptoms.

Your doctor may suggest watching the condition if you have only mild symptoms. You may need to visit the doctor for a checkup once a year or more often. You may never need treatment if the symptoms do not worsen. In fact, symptoms tend to resolve on their own in up to one-third of mild cases of BPH.

Some lifestyle changes may be able to help with symptom relief.

Lifestyle Changes to Relieve BPH Symptoms

• Avoid alcohol and caffeine
• Avoid drinking fluids at bedtime, and drinking smaller amounts throughout the day
• Avoid taking decongestant and antihistamine medications
• Get regular exercise
• Make a habit of going to the bathroom when you have the urge
• Practice double voiding (empty the bladder, wait a moment, then try again)
• Practice stress management and relaxation techniques

Alpha blockers, drugs often prescribed to treat high blood pressure, can help relax the muscles in the bladder and prostate, allowing urine to flow more freely. Alpha blockers that are FDA-approved to treat BPH include silodosin, alfuzosin, tamsulosin, doxazosin, and terazosin. A common side effect of these medications is decreased or lack of ejaculation.

5-alpha reductase inhibitors are drugs that can stop growth of the prostate or even shrink its size. They work by lowering the production of the hormone DHT. Examples of these medications are dutasteride and finasteride. The downside of these drugs is that they can lower sex drive and can cause erectile dysfunction. It can also take up to a year to see benefits with these drugs.

Saw palmetto is a supplement that showed benefit in some studies in managing BPH symptoms. In other studies, this effect was not seen. Because there is no clear benefit and a risk that supplements may interfere with the action of other drugs, the American Urological Association does not recommend saw palmetto or other herbal supplements for BPH.

Patients are urged to discuss the use of any complementary, herbal and/or home remedies for BPH with their doctors before use.

When medicines are not effective for symptom relief, procedures to remove excess prostate tissue can be considered. Two procedures can usually be done in a urologist’s office: transurethral needle ablation (TUNA), also known as radiofrequency ablation, and transurethral microwave therapy (TUMT). These procedures are less invasive than surgery and can be done in less than one hour.

Common BPH Surgeries

1. Transurethral Resection of the Prostate (TURP)
   TURP is a surgical procedure for relief of BPH. In this procedure an instrument is inserted through the penis and into the urethra to remove some of the prostate tissue.

2. Transurethral Laser Surgery
   Transurethral laser surgery is more commonly performed now than TURP. There are three different laser procedures.

3. Photoselective Vaporization of the Prostate (PVP)
   In this procedure, a laser is used to melt away (vaporize) excess prostate tissue to open the urinary channel.

4. Holmium Laser Ablation of the Prostate (HoLAP)
   This is a similar procedure to PVP, except that a different type of laser is used to melt away (vaporize) the excess prostate tissue.

5. Holmium Laser Enucleation of the Prostate (HoLEP)
   In HoLEP surgery, the laser is used to cut and remove the excess tissue that is blocking the urethra. Another instrument, called a morcellator, is then used to chop the prostate tissue into small pieces that are easily removed.

The prostate is an important part of the male sexual anatomy. Prostates produce semen, and stimulation of the prostate can bring about orgasm.

Some evidence suggests that older men with BPH may have more sexual problems than other men their age, and some drugs used to treat BPH can cause problems with erection and ejaculation. You should talk to your doctor if you develop these problems, since a change in medications may relieve them.

Many men never know they have BPH, and others are never bothered by its symptoms. But for those who do have troubling symptoms, there are many treatment options available. See your doctor as soon as you notice any symptoms.