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Benign prostatic hyperplasia (BPH): when your prostate gland is enlarged

By Geri K. Metzger, Staff Writer, myOptumHealth

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What is benign prostate hyperplasia or BPH?

Benign prostatic hyperplasia is a noncancerous enlarged prostate gland. It is also called benign prostatic hypertrophy, or BPH. It occurs to some degree in almost all men as they age.

Why is BPH a Problem?

An enlarged prostate can press on and sometimes block urine flow through the urethra. The urethra is the tube that carries urine out of the body. So, BPH can cause problems with urination. In BPH, the urine stream is delayed or stops too early before the bladder completely empties. Dribbling may occur after urination. There may be a frequent need to urinate, especially at night.

BPH is benign, or noncancerous. There is no evidence that BPH leads to cancer. Prostate cancer often begins in the outer area of the prostate, closer to the rectum. BPH usually starts near the center of the prostate, around the urethra. Both prostate cancer and BPH have similar symptoms, though. So it is important that any symptoms be checked out thoroughly.

Diagnosing BPH

The symptoms of BPH vary a great deal from person to person. One man may not notice any trouble, while another may have ongoing urinary problems.

Doctors usually detect an enlarged prostate gland when they perform a digital rectal exam (DRE). The DRE, though, does not uncover the cause of the enlargement. The next step is to find the cause.

Depending on your age, medical history and other factors, you may have a prostate specific antigen test (PSA) to help screen for prostate cancer. However, the PSA is sometimes high in conditions other than prostate cancer.

If the PSA is high or if there is any other reason to think the enlargement may be due to something other than BPH, the doctor may want to do a prostate biopsy.

You may also have urine flow tests. For example, your doctor may measure the speed of urine flow, pressures around your bladder and whether any urine stays in the bladder after urination.

Another test, called transrectal ultrasound, may be used to view the rectum and prostate. If your doctor sees any areas that look abnormal, he or she may take a tissue sample (or biopsy) to examine the tissue under the microscope.

Treatments for BPH

If symptoms are not severe, your doctor may advise you to come back for another checkup before taking any further steps with medication or surgery. Your doctor will tell you to come back sooner if symptoms get worse. If symptoms are bad enough to affect your quality of life, medication or surgery may be needed.

Medications

For some men with BPH, medications may be used to control symptoms.

• Alpha-blockers. Some generic names are doxazosin, terazosin and tamsulosin. These drugs relax the bladder and urethra so urine can flow freely and the bladder empties easier. Some of these medications also tend to lower blood pressure, and may do so too rapidly. This can cause lightheadedness if you stand up too quickly.
• 5 alpha-reductase inhibitors. These include Proscar (finasteride) or Avodart (dutasteride). These drugs affect how the hormone testosterone is used by the body. They can help stop prostate enlargement and in some cases even shrink prostate tissue. But it may take as long as 6 months to start to see improved urine flow and a reduction in symptoms. Side effects include decreased sex drive and sexual dysfunction in some men.

For some men, medications don't treat symptoms effectively, and treatments to remove enlarged prostate tissue are considered.

Minimally invasive procedures

These procedures use some form of energy (such as microwaves, radio waves or heat) to destroy prostate tissue instead of cutting it out. They often cause minimal pain and may not require anesthesia.

One example is transurethral microwave thermotherapy (TUMT). Here, computer-guided microwave energy heats only the problem areas of the prostate, while the urinary tract is protected with a water-cooling system. The TUMT and some other minimally invasive procedures are often done as an outpatient. You can usually go home the same day.

Other techniques use radio waves or heated water to destroy the problem portions of the prostate gland.

Surgery

There are three main surgical techniques for removing the prostate (prostatectomy). Each involves cutting out the prostate tissue. For this reason, there is a risk of bleeding and infection. The transurethral procedures are the least invasive of the surgical methods. They cause less bleeding and less risk for sexual dysfunction.

• Transurethral resection of the prostate (TURP). In this procedure, a resectoscope is passed through the penis into the urethra (urine tube). Using a light and electrical device, prostate tissue is removed while bleeding is controlled.
• Transurethral incision of the prostate (TUIP). This is used for men with a smaller prostate gland but who still have significant urinary tract symptoms. Here, tiny incisions widen the urethra (urine tube) to help relieve symptoms. More studies are needed to see the long-term effects of this method.

Open resection of the prostate. When the prostate is severely enlarged due to BPH, it may need to be removed through an abdominal incision.

View the original Benign prostatic hyperplasia (bph): when your prostate gland is enlarged article on myOptumHealth.com 

SOURCES:

• National Kidney and Urologic Diseases Information Clearinghouse. Prostate enlargement: benign prostatic hyperplasia. Accessed: 08/07/2008

• American Urological Association. Diagnosis of BPH. Accessed: 08/07/2008