BPH or Benign Prostatic Hyperplasia
What is benign prostatic hyperplasia (BPH)?
BPH or Benign Prostatic Hyperplasia is a non-cancerous uniform growth of the prostate gland. The prostate gland is an organ found only in men located inside the body, just in front of the rectum and below the bladder. It looks like a plum (the prostate gland) with a straw (the urethra) in the middle of it. Its main job is to add fluid to semen to help keep sperm healthier and to help the fluid in the vagina to not be too acidic for sperm to survive long enough to fertilize an egg.
Key points:
1. BPH is a benign growth of the prostate.
2. The prostate gland is only found in men.
3. The prostate gland secretions help maintain a healthy environment for sperm.
What are the symptoms?
Sometimes the prostate gland can be enlarged without symptoms and may be an incidental finding on a rectal exam. Other times, the prostate gland becomes enlarged and may become symptomatic. Commonly, it can interfere [Symptoms can include difficulty] with urination by decreasing the flow of urine and increasing the [and increased] frequency of urination, especially at night. but with a smaller amount voided. This is due to retention of urine which can cause the bladder to stretch and a stretched bladder becomes irritable and signals the need to urinate more often. Chronic constipation may also be present .because the prostate gland is located in front of the rectum and when it is enlarged can make it difficult for stool to pass without straining.
Suspicion that [A]ny of the above symptoms are present should [be reported to] prompt a call to make an appointment with your healthcare provider for a thorough history and evaluation. The healthcare provider may want to perform a rectal examination and check a PSA if it is age appropriate to determine if there is a possibility of prostate cancer. For some men (particularly those younger than age 50), prostatitis (infection of the prostate) or a urinary tract infection may mimic the symptoms of BPH. Other tests such as a urinalysis or screening for sexually transmitted infections may be helpful in determining the cause of symptoms.
Key points:
1. Symptoms include increased night urination (nocturia) and less urine voided, with a feeling of incomplete emptying.
2. Chronic constipation can also be present.
Risk Factors
Risk factors are age and male gender. BPH is usually not seen in men younger than 40. The risk of developing BPH increases [in men over 40, and in African American men] with advancing age. There are no screening guidelines for BPH because it is not cancerous. Screening for prostate cancer is typically recommended starting at age 50 (or even earlier in select groups of patients) and this is when many asymptomatic cases of BPH are discovered. There is no known increased risk of prostate cancer if you are diagnosed with BPH.
Key points:
1. BPH only affects those of male gender.
2. It is a condition usually only seen above age 40, and is more common in African American men
3. There is no risk association between BPH and prostate cancer.
How is it diagnosed?
The rectal examination is the most common and least invasive test used to diagnose BPH. This is an examination usually performed in the office by a healthcare provider that involves insertion of one gloved and lubricated finger inside of the rectum. The healthcare provider [examines] is examining the size and firmness of the prostate during the exam. The normal prostate has two distinct lobes and is firm like a ripe plum and a [A] prostate gland affected by BPH is usually a large, soft and feels like a wet sponge and the lobes are ill-defined.
The primary healthcare provider may also want to have a[A] blood test done called a PSA to give more information about why the prostate gland may be enlarged. The PSA is a screening tool for prostate cancer [and may be recommended] but the level may or may not be elevated above normal range for a man’s age with BPH as well as prostate cancer. It was thought in the past that the rectal examination may cause an elevation of the PSA but many urologists (physicians who specialize in male reproductive health) do not believe that most exams will be rigorous enough to cause an elevation.
Another option for evaluation of the prostate gland for BPH is ultrasonography. This is usually done by a urologist. This is a study that is done by an urologist usually. The primary healthcare provider can request a consultation to an urologist who may determine whether or not this is a necessary test.
Key points:
1. Rectal examination is often adequate for diagnosis of BPH.
2. PSA may be utilized as a cancer screening tool.
3. Consultation by a urologist may be considered in some cases.
Treatment
It is helpful when treating BPH to use the treatments that have the fewest side effects first and if symptoms do not improve choose more aggressive therapies. [To relieve symptoms,] it may be helpful to urinate more often during the day and drink fewer liquids at night. A diet high in fiber may help keep the stool softer and easier to pass if constipation is present. This may help decrease symptoms initially. If symptoms persist the healthcare provider may want to start medication to decrease the size of the prostate. Currently, there are two types of medications used to treat BPH: Alpha blockers and 5alpha-reductase inhibitors. Alpha blockers may cause smooth muscles in the prostate gland and in the urethra to relax promoting better voiding of urine. Commonly prescribed alpha blockers include tamsulosin (Flomax“), alfuzosin (Uroxatral“), doxazosin (Cardura“), prazosin (Minipress“), terazosin (Hytrin“), and phentolamine (Rogitine). 5 alpha-reductase inhibitors prevent testosterone from being converted to DHT (dihydrotestosterone). DHT, which a normal hormone, can cause growth of the prostate. There are currently only two 5 alpha-reductase inhibitors that are approved for use in the US; finasteride (Proscar“) and dutasteride (Avodart“). [BE AWARE THAT USE OF THIS TYPE OF MEDICINE CAN FALSELY LOWER PSA VALUES BY AN AVERAGE OF 50%. PSA IS A SCREEN FOR PROSATE CANCER)
Minimally invasive and invasive Procedures such as ultrasound therapy, laser therapy, water-induced heat therapy and surgery [may be needed] are considerations after medications have been tried and are unsuccessful. These therapies are designed to decrease the size of the prostate gland.
Key points:
1. Conservative measures include urinating more often, avoiding liquids at night and keeping stools soft with a high fiber diet.
2. Medications utilized: Alpha blockers and 5 alpha-reductase inhibitors.
3. Minimally invasive and invasive procedures are also options to decrease the size of the prostate gland.
Are there any complications?
BPH can become a chronic cause of urine retained in the bladder leading to an increased [increase the] risk of recurrent infections of the lower urinary tract (bladder). It may also cause backflow or reflux of urine into the ureters (the tubes that allow urine to flow from the kidneys to the bladder) which may lead to recurrent infections of the upper urinary tract (kidneys) and may also increase the risk of developing kidney stones.
FAST FACTS:
1. BPH is a benign (non-cancerous) growth of the prostate that occurs in men over 40 years of age.
2. Symptoms include frequent urination (especially at night) and difficulty urinating. Chronic constipation may also occur.
3. BPH is diagnosed by an examination of the prostate. A PSA test to rule out prostate cancer may also be recommended.
4. Treatment includes urinating more often, avoiding liquids at night and keeping stools soft with a high fiber diet.
5. Medications utilized: Alpha blockers and 5 alpha-reductase inhibitors.
6. When medications do not work, ultrasound therapy, water-induced heat therapy, and surgery may be recommended.
7. See your doctor if you experience symptoms of BPH.
BPH or Benign Prostatic Hyperplasia is a non-cancerous uniform growth of the prostate gland. The prostate gland is an organ found only in men located inside the body, just in front of the rectum and below the bladder. It looks like a plum (the prostate gland) with a straw (the urethra) in the middle of it. Its main job is to add fluid to semen to help keep sperm healthier and to help the fluid in the vagina to not be too acidic for sperm to survive long enough to fertilize an egg.
Key points:
1. BPH is a benign growth of the prostate.
2. The prostate gland is only found in men.
3. The prostate gland secretions help maintain a healthy environment for sperm.
What are the symptoms?
Sometimes the prostate gland can be enlarged without symptoms and may be an incidental finding on a rectal exam. Other times, the prostate gland becomes enlarged and may become symptomatic. Commonly, it can interfere [Symptoms can include difficulty] with urination by decreasing the flow of urine and increasing the [and increased] frequency of urination, especially at night. but with a smaller amount voided. This is due to retention of urine which can cause the bladder to stretch and a stretched bladder becomes irritable and signals the need to urinate more often. Chronic constipation may also be present .because the prostate gland is located in front of the rectum and when it is enlarged can make it difficult for stool to pass without straining.
Suspicion that [A]ny of the above symptoms are present should [be reported to] prompt a call to make an appointment with your healthcare provider for a thorough history and evaluation. The healthcare provider may want to perform a rectal examination and check a PSA if it is age appropriate to determine if there is a possibility of prostate cancer. For some men (particularly those younger than age 50), prostatitis (infection of the prostate) or a urinary tract infection may mimic the symptoms of BPH. Other tests such as a urinalysis or screening for sexually transmitted infections may be helpful in determining the cause of symptoms.
Key points:
1. Symptoms include increased night urination (nocturia) and less urine voided, with a feeling of incomplete emptying.
2. Chronic constipation can also be present.
Risk Factors
Risk factors are age and male gender. BPH is usually not seen in men younger than 40. The risk of developing BPH increases [in men over 40, and in African American men] with advancing age. There are no screening guidelines for BPH because it is not cancerous. Screening for prostate cancer is typically recommended starting at age 50 (or even earlier in select groups of patients) and this is when many asymptomatic cases of BPH are discovered. There is no known increased risk of prostate cancer if you are diagnosed with BPH.
Key points:
1. BPH only affects those of male gender.
2. It is a condition usually only seen above age 40, and is more common in African American men
3. There is no risk association between BPH and prostate cancer.
How is it diagnosed?
The rectal examination is the most common and least invasive test used to diagnose BPH. This is an examination usually performed in the office by a healthcare provider that involves insertion of one gloved and lubricated finger inside of the rectum. The healthcare provider [examines] is examining the size and firmness of the prostate during the exam. The normal prostate has two distinct lobes and is firm like a ripe plum and a [A] prostate gland affected by BPH is usually a large, soft and feels like a wet sponge and the lobes are ill-defined.
The primary healthcare provider may also want to have a[A] blood test done called a PSA to give more information about why the prostate gland may be enlarged. The PSA is a screening tool for prostate cancer [and may be recommended] but the level may or may not be elevated above normal range for a man’s age with BPH as well as prostate cancer. It was thought in the past that the rectal examination may cause an elevation of the PSA but many urologists (physicians who specialize in male reproductive health) do not believe that most exams will be rigorous enough to cause an elevation.
Another option for evaluation of the prostate gland for BPH is ultrasonography. This is usually done by a urologist. This is a study that is done by an urologist usually. The primary healthcare provider can request a consultation to an urologist who may determine whether or not this is a necessary test.
Key points:
1. Rectal examination is often adequate for diagnosis of BPH.
2. PSA may be utilized as a cancer screening tool.
3. Consultation by a urologist may be considered in some cases.
Treatment
It is helpful when treating BPH to use the treatments that have the fewest side effects first and if symptoms do not improve choose more aggressive therapies. [To relieve symptoms,] it may be helpful to urinate more often during the day and drink fewer liquids at night. A diet high in fiber may help keep the stool softer and easier to pass if constipation is present. This may help decrease symptoms initially. If symptoms persist the healthcare provider may want to start medication to decrease the size of the prostate. Currently, there are two types of medications used to treat BPH: Alpha blockers and 5alpha-reductase inhibitors. Alpha blockers may cause smooth muscles in the prostate gland and in the urethra to relax promoting better voiding of urine. Commonly prescribed alpha blockers include tamsulosin (Flomax“), alfuzosin (Uroxatral“), doxazosin (Cardura“), prazosin (Minipress“), terazosin (Hytrin“), and phentolamine (Rogitine). 5 alpha-reductase inhibitors prevent testosterone from being converted to DHT (dihydrotestosterone). DHT, which a normal hormone, can cause growth of the prostate. There are currently only two 5 alpha-reductase inhibitors that are approved for use in the US; finasteride (Proscar“) and dutasteride (Avodart“). [BE AWARE THAT USE OF THIS TYPE OF MEDICINE CAN FALSELY LOWER PSA VALUES BY AN AVERAGE OF 50%. PSA IS A SCREEN FOR PROSATE CANCER)
Minimally invasive and invasive Procedures such as ultrasound therapy, laser therapy, water-induced heat therapy and surgery [may be needed] are considerations after medications have been tried and are unsuccessful. These therapies are designed to decrease the size of the prostate gland.
Key points:
1. Conservative measures include urinating more often, avoiding liquids at night and keeping stools soft with a high fiber diet.
2. Medications utilized: Alpha blockers and 5 alpha-reductase inhibitors.
3. Minimally invasive and invasive procedures are also options to decrease the size of the prostate gland.
Are there any complications?
BPH can become a chronic cause of urine retained in the bladder leading to an increased [increase the] risk of recurrent infections of the lower urinary tract (bladder). It may also cause backflow or reflux of urine into the ureters (the tubes that allow urine to flow from the kidneys to the bladder) which may lead to recurrent infections of the upper urinary tract (kidneys) and may also increase the risk of developing kidney stones.
FAST FACTS:
1. BPH is a benign (non-cancerous) growth of the prostate that occurs in men over 40 years of age.
2. Symptoms include frequent urination (especially at night) and difficulty urinating. Chronic constipation may also occur.
3. BPH is diagnosed by an examination of the prostate. A PSA test to rule out prostate cancer may also be recommended.
4. Treatment includes urinating more often, avoiding liquids at night and keeping stools soft with a high fiber diet.
5. Medications utilized: Alpha blockers and 5 alpha-reductase inhibitors.
6. When medications do not work, ultrasound therapy, water-induced heat therapy, and surgery may be recommended.
7. See your doctor if you experience symptoms of BPH.
Flomax“ is a registered trademark of Boehringer Ingelheim; Uroxatral“ is a registered trademark of Sanofi Aventis; Cardura“ and Minipress“ are registered trademarks of Pfizer, Inc; Hytrin“ is a registered trademark of Abbott Laboratorie;, Rogitine“ is a registered trademark of Novartis Pharmaceuticals; Proscar“ is a registered trademark of Merck and Co; Avodart“ is a registered trademark of GlaxoSmithKline.
References:
NIH Publication No. 06–3012
June 2006
Copyright 2008-9, MD Kiosk
