BPH

Benign prostatic hyperplasia is nonmalignant (noncancerous) enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hypertrophy and abbreviated as BPH and as nodular hyperplasia of the prostate.

From birth to young adulthood, the prostate grows from about the size of a pea to about the size of a walnut. Most men experience a second period of prostate growth in their mid- to late 40s. At this time, cells in the central portion of the gland — where the prostate surrounds the urethra — begin to reproduce more rapidly, resulting in prostate gland enlargement. As tissues in the area enlarge, they often compress the urethra and partially block urine flow. Benign prostatic hyperplasia (BPH) is the medical term for prostate gland enlargement.

Prostate gland enlargement affects about half of men in their 60s and up to 90 percent of men in their 70s and 80s. The presence or absence of prostate gland enlargement is not related to the development of prostate cancer .

Treatment of prostate gland enlargement depends on your signs and symptoms and may include medications, surgery or nonsurgical therapies.

Signs and Symptoms

Prostate enlargement varies in severity from man to man, and doesn't always pose a problem. Only about half the men with prostate enlargement experience signs and symptoms that become noticeable or bothersome enough for them to seek medical treatment. These signs and symptoms may include:

• Weak urine stream
• Difficulty starting urination
• Stopping and starting again while urinating
• Dribbling at the end of urination
• Frequent need to urinate
• Increased frequency of urination at night (nocturia)
• Urgent need to urinate
• Not being able to completely empty the bladder
• Blood in the urine (hematuria)
• Urinary tract infection

More about BPH

Nobody knows the basic cause of BPH. Research shows that testosterone, the male hormone, or dihydrotestosterone, a chemical produced when testosterone breaks down in a man's body, may cause the prostate to keep growing. Since it surrounds the urethra, the prostate gland squeezes the urethra as it expands. It is believed that factors linked to aging and the testicles themselves may play a role in the growth of the gland. Men who have had their testicles removed at a young age (for example, as a result of testicular cancer) do not develop BPH.
Some over-the-counter medications for colds or allergies can drastically worsen BPH.

Some facts about prostate enlargement:

• The likelihood of developing an enlarged prostate increases with age.
• BPH is so common that it has been said, "All men will have an enlarged prostate if they live long enough."
• A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80.
• No risk factors have been identified other than having normally functioning testicles

The main risk factor for prostate gland enlargement is aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than 40, but approximately half the men in their 60s experience some signs and symptoms. In addition to age, other risk factors include:

• Ethnic Groups - African American men are at higher risk and Asian men at lower risk for BPH, men of Scandinavian ancestry had a lower chance of developing BPH.
• Family History - A family history of BPH appears to increase a man's chance of developing the condition.
• Medical Conditions - Some evidence has reported a higher incidence of benign prostatic hyperplasia -- particularly fast-growing BPH -- in men with obesity, heart and circulatory diseases, and type 2 diabetes. Diabetes, in any case, worsens urinary tract symptoms in men with BPH. In one study, flow rates were adversely affected by diabetes, although residual urine volumes were not significantly greater.
• Marital status. For unknown reasons, married men are more likely to experience prostate enlargement than are single men. There's no evidence that supports a link between sexual activity and prostate growth.

To diagnose prostate gland enlargement, your doctor will likely begin by asking you about your symptoms, when they developed and how often they occur. Your doctor will also want to know about other health problems, medications you're taking and whether there's a history of prostate problems in your family. Over-the-counter (OTC) drugs, such as aspirin, decongestants and antacids, are considered medications, so tell your doctor about those too. The history of when you start and stop medications also is important for your doctor to know.

In addition, your checkup may include:

• Digital rectal exam.
• Urine test.
• Prostate-specific antigen (PSA) blood test
• Additional tests
  

If the results of these tests suggest prostate enlargement, your doctor may want to perform additional exams. The following can help confirm the diagnosis of prostate enlargement and determine its severity:

• Questionnaire.
• Urinary flow test.
• Postvoid residual volume test.
• Ultrasound.
• Urodynamic studies.
• Cystoscopy
• Intravenous pyelogram

Treatment Approach

Alpha blockers ( alpha 1-adrenergic receptor antagonists) (such as doxazosin, prazosin and tamsulosin) and certain antiandrogens such as the 5 alpha-reductase inhibitors (finasteride and dutasteride) are used, often together, in suppressing the symptoms.

There is also extensive evidence of the efficacy of Serenoa repens (Saw Palmetto) fruit extracts in alleviating mild-to-moderate BPH symptoms. A systematic review of evidence found comparable efficacy to finasteride. Other herbal medicines that have solid research support in systematic reviews include beta-sitosterol from Hypoxis rooperi (African star grass) and Prunus africanum (pygeum) bark, while there is less substantial support for the efficacy of Cucurbita pepo (pumpkin) seed and Urtica dioica (stinging nettle) root. At least one double-blind trial has also supported the efficacy of rye flower pollen.
If medical treatment fails, transurethral resection of prostate (TURP) surgery may need to be performed. This involves removing (part of) the prostate through the urethra. There are also a number of new methods for reducing the size of an enlarged prostate, some of which have not been around long enough to fully establish their safety or side effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what's left. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), TransUrethral Microwave ThermoTherapy (TUMT),TransUrethral Needle Ablation (TUNA), ethanol injection, and others are studied as alternatives.
Newer techniques involving lasers in urology have emerged in the last 5-10 years.

Medications

BPH Medications

• Flomax
• Propecia
• Proscar