Summary
- Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, common in older men.
- Symptoms include urinary frequency, weak stream, and difficulty emptying the bladder.
- Treatment options include medications, lifestyle changes, and minimally invasive surgical procedures.
Introduction
Benign Prostatic Hyperplasia (BPH), or enlarged prostate, is a frequent issue in men, mostly as they get older. This condition involves the non-cancerous growth of the prostate, which surrounds the urethra and causes urinary issues.
BPH is not the same as prostate cancer, as it does not include cancerous cells, but it can affect daily life by blocking urine flow and causing pain.
When the prostate grows, it can squeeze the urethra and bladder, leading to urinary issues like needing to urinate often, feeling an urgent need to urinate, difficulty starting to urinate, and not fully emptying the bladder.
BPH is widespread, with research showing that about 50% of men aged 50 to 60 have some prostate enlargement, with more cases as age increases.
While BPH is usually not dangerous, it can cause problems such as inability to urinate, bladder stones, urinary tract infections (UTIs), and kidney issues if not treated.
Causes
The exact reason for BPH is not completely known, but several factors play a role in its development. Main causes and factors include:
- Aging: Age is the biggest risk factor for BPH. The prostate often gets larger as men get older, especially after 40. The enlargement is believed to relate to hormonal changes, mainly an imbalance between testosterone and estrogen, affecting prostate cell growth.
- Hormonal Changes: As men age, testosterone levels slowly drop, while estrogen levels stay stable. This hormonal imbalance may help trigger prostate cell growth. The presence of dihydrotestosterone (DHT), a form of testosterone, is also linked to BPH. DHT might encourage prostate growth, with higher levels possibly leading to larger prostate size.
- Genetic Factors: Family history is a key factor in BPH development. Men with relatives, especially fathers or brothers, who have BPH are at a higher risk. Certain genetic markers tied to hormone balance and prostate growth might influence this family tendency.
- Metabolic Factors: Obesity, especially around the belly, is associated with a higher chance of BPH. Fat cells make estrogen, which might lead to prostate cell growth, worsening the condition. Additionally, conditions like metabolic syndrome, diabetes, and high blood pressure relate to higher BPH rates.
- Chronic Inflammation: Long-lasting inflammation of the prostate might contribute to BPH. Inflammation can stem from infections, urinary retention, or other issues, possibly causing changes in prostate cells and leading to growth.
- Lifestyle Factors: Some studies indicate that lifestyle habits such as eating a high-fat diet, not exercising, and smoking may increase BPH risk, although the exact reasons are not entirely clear.
Symptoms
BPH symptoms stem from the prostate’s enlargement, which compresses the urethra and disrupts normal urination. Symptoms vary in severity and may affect urinary health in various ways. Common symptoms include:
- Frequent Urination: One major symptom of BPH is needing to urinate more often, especially during the night (nocturia). This happens due to extra pressure on the bladder and lower bladder capacity.
- Urgency: Men with BPH often feel a strong, urgent need to urinate that can be tough to manage. This sensation may be especially noticeable. during the night.
- Trouble Starting Urination: Men with BPH may find it hard to start urination or may have a slow beginning. This can be annoying and might involve a weak stream of urine.
- Weak or Stopping Urine Flow: As the prostate gets bigger, urine flow may become weak or stop and start. The urine stream may break several times during urination.
- Feeling of Bladder Not Empty: Another common symptom is feeling like the bladder is not empty after urination. This could lead to needing to go to the bathroom often.
- Straining to Urinate: Men with BPH may feel it hard to fully empty the bladder, resulting in straining or pushing when urinating.
- Discomfort or Pain: Some men may feel pain or discomfort while urinating, especially if the bladder doesn’t empty well. Pain could also mean other issues, like a urinary tract infection (UTI).
- Blood in Urine: Though it is less common, blood in urine (hematuria) may happen from bladder irritation or other issues related to BPH.
Risk Factors
There are several risk factors that make it more likely to have BPH:
- Age: The chance of having BPH goes up as men age. Mild prostate enlargement is usual in men over 40, but more serious symptoms usually show after age 60.
- Family History: If family members have BPH or prostate issues, the risk for developing it increases. Men with a father or brother having BPH are likely to get it too.
- Obesity and Diet: Being overweight, particularly in the belly area, is linked to more BPH risk. A diet that is high in fats and low in fruits and vegetables might add to BPH risk as certain food factors can affect hormone levels and prostate growth.
- Diabetes and High Blood Pressure: Men with diabetes or high blood pressure are at a greater risk of having BPH. These conditions are believed to influence prostate growth through hormones and metabolism.
- Hormonal Change: As men get older, the balance of testosterone and estrogen changes, often resulting in higher levels of estrogen and dihydrotestosterone (DHT), which can lead to prostate growth.
- Low Activity Level: Not being active may raise the risk of BPH. Exercise can help balance hormones, lower inflammation, and aid overall prostate health.
Differential Diagnosis
There are other conditions that can look like BPH or create similar urinary issues.
It is crucial to identify BPH from other possible causes of urinary problems, such as:
Investigation
To diagnose BPH, a mix of clinical evaluation, imaging tests, and lab tests are used. The following diagnostic methods are commonly used:
- Digital Rectal Exam (DRE): The DRE is a test where the doctor puts a gloved finger in the rectum to feel the prostate. If the prostate is big, it can usually be felt.
- Prostate-Specific Antigen (PSA) Test: PSA is a protein from the prostate, and high levels may show BPH, prostate cancer, or prostatitis. High PSA levels are not only from BPH but can help rule out issues like prostate cancer.
- Urinary Flow Test: This test looks at how fast urine flows when you go to the bathroom. A slow flow might mean a blockage due to BPH.
- Post-Void Residual Volume (PVR): This test measures how much urine is left in the bladder after going to the bathroom. High PVR can mean the bladder isn’t emptying completely, a common issue with BPH.
- Transrectal Ultrasound: This ultrasound gives clear images of the prostate to check its size and shape.
- Urodynamic Testing: Sometimes, urodynamic tests are done to look at how well the bladder works, including how it stores and releases urine.
- Cystoscopy: This is a procedure where a small camera goes through the urethra to look at the bladder and prostate. It is used when there is confusion in diagnosis or possible other issues.
Treatment
The BPH treatment depends on how bad the symptoms are, how big the prostate is, and the patient’s general health. Treatment options include:
1. Lifestyle Changes:
For mild BPH, lifestyle changes might help ease symptoms, such as drinking less fluid before bed, avoiding caffeine and alcohol, and doing pelvic floor exercises to strengthen bladder control.
2. Medications:
Alpha-Blockers: Drugs like tamsulosin and alfuzosin help relax the prostate and bladder neck muscles, improving urine flow and easing symptoms.
5-Alpha-Reductase Inhibitors: Medications such as finasteride and dutasteride stop testosterone from becoming dihydrotestosterone (DHT), which can shrink the prostate over time and help with symptoms.
Combination Therapy: Sometimes, both alpha-blockers and 5-alpha-reductase inhibitors are used together for better relief.
3. Minimally Invasive Treatments:
Transurethral Microwave Therapy (TUMT): This method uses microwave energy to heat and shrink prostate tissue, helping with blockage.
Transurethral Needle Ablation (TUNA): TUNA uses radiofrequency energy to take away extra prostate tissue.
Laser Therapy: This therapy helps remove or vaporize blocking prostate tissue, relieving symptoms with little bleeding.
4. Surgical Treatments:
Transurethral Resection of the Prostate (TURP): TURP is the main surgical treatment for BPH. It involves removing extra prostate tissue through the urethra.
Prostatectomy: In serious cases, a prostatectomy might be needed to take out the whole prostate gland.
Watchful Waiting: If symptoms are mild, some doctors may suggest a watchful waiting method, where symptoms and prostate size are checked regularly.
Conclusion
Benign Prostatic Hyperplasia is a common issue that greatly affects many men’s lives as they get older. The reasons for BPH mainly involve hormones and genetics, with symptoms varying from slight discomfort to serious urinary blockage.
Timely diagnosis and treatment are crucial for managing this condition well, with various options available including lifestyle changes, medications, and surgery.
By knowing the causes, symptoms, and treatments for BPH, individuals can make better choices regarding their health and well-being.
- Roehrborn, C. G. (2008). “Benign Prostatic Hyperplasia: An Overview.” Reviews in Urology, 10(4), 61-70.
- American Urological Association (AUA). (2018). Benign Prostatic Hyperplasia: Clinical Guidelines. Available at: https://www.auanet.org
- Parsons, J. K. (2014). “Benign Prostatic Hyperplasia: Epidemiology and Risk Factors.” Clinical Geriatrics, 22(7), 43-49.
- Nickel, J. C., & Shoskes, D. A. (2017). “Medical Management of Benign Prostatic Hyperplasia.” Canadian Urological Association Journal, 11(3-4), 95-102.