What is benign prostatic hyperplasia?
It is a common, noncancerous enlargement of the prostate gland. The enlarged prostate may compress the urinary tube (urethra), which courses through the center of the prostate, impeding the flow of urine from the bladder through the urethra to the outside. Abbreviated BPH. If BPH is severe enough, complete blockage can occur. BPH generally begins after age 30, evolves slowly, and causes symptoms only after age 50. Half of men over age 50 develop symptoms of BPH, but only a minority need medical or surgical intervention. Medical therapy includes drugs such as finasteride and terazosin. Prostate surgery has traditionally been seen as offering the most benefits’and the most risks’for BPH. BPH is not a sign of prostate cancer. Also known as benign prostatic hypertrophy and nodular hyperplasia of the prostate.
How common is prostate enlargement?
Prostate enlargement is a common condition associated with ageing. Around 60% of men who are aged 60 or over have some degree of prostate enlargement.
The cause of prostate enlargement is unknown, but most experts agree that it is linked to changes in hormone levels in a man’s body due to ageing (see causes of prostate enlargement for more information).
Prostate gland enlargement varies in severity among men and tends to gradually worsen over time. Prostate gland enlargement symptoms include:
- Weak urine stream
- Difficulty starting urination
- Stopping and starting while urinating
- Dribbling at the end of urination
- Frequent or urgent need to urinate
- Increased frequency of urination at night (nocturia)
- Straining while urinating
- Not being able to completely empty the bladder
- Urinary tract infection
- Formation of stones in the bladder
- Reduced kidney function
The size of your prostate doesn’t necessarily mean your symptoms will be worse. Some men with only slightly enlarged prostates have significant symptoms. On the other hand, some men with very enlarged prostates have only minor urinary symptoms.
Only about half the men with prostate gland enlargement have symptoms that become noticeable or bothersome enough for them to seek medical treatment. In some men, symptoms eventually stabilize and may even improve over time.
When to see a doctor
If you’re having urinary problems, see your doctor to check whether your symptoms are caused by an enlarged prostate and find out what tests or treatment you may need. If you’re unable to pass urine at all, seek immediate medical attention.
If you don’t find urinary symptoms too bothersome and they don’t pose a health threat, you may not need treatment. But you should still have your symptoms checked out by a doctor to make sure they aren’t caused by another problem such as prostate cancer.
The prostate gland is the male organ that produces most of the fluid in semen, the milky-colored fluid that nourishes and transports sperm out of the penis during ejaculation (orgasm). It sits beneath your bladder. The tube that transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. So, when the prostate enlarges, it begins to block (obstruct) urine flow.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate enough to cause urinary symptoms or to significantly block urine flow. Doctors aren’t sure exactly what causes the prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older.
Treatments and drugs
A wide variety of treatments are available for enlarged prostate. They include medications, surgery and minimally invasive surgery. The best treatment choice for you depends on several factors, including how much your symptoms bother you, the size of your prostate, other health conditions you may have, your age and your preference. If your symptoms aren’t too bad, you may decide not to have treatment and wait to see whether your symptoms become more bothersome over time.
Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to relieve symptoms of enlarged prostate include:
- Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral) and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you’ll probably have increased urinary flow and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going back into the bladder rather than out the tip of the penis.
- 5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very enlarged prostates. It may be several weeks or even months before you notice improvement. While you’re taking them, these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire or retrograde ejaculation.
- Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally more effective than taking just one or the other by itself.
- Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can’t be used in combination with alpha blockers. It also can’t be taken with medications called nitrates, such as nitroglycerin.
Your doctor may recommend surgery if medication isn’t effective or if you have severe symptoms. There are several types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an option is based on a number of factors, including the size of your prostate, the severity of your symptoms, and what treatments are available in your area.
Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence (erectile dysfunction). Ask your doctor about the specific risks of each treatment you’re considering.
A prostatic stent is a tiny metal or plastic device that’s inserted into your urethra to keep it open. Tissue grows over the metallic stent to hold it in place. The plastic stent needs to be changed every four to six weeks but keeps you from having to undergo any surgical procedure. In most cases, doctors don’t consider stents a viable long-term treatment because they can cause side effects including painful urination or frequent urinary tract infections. The metal stents can be difficult to remove and are used only in special circumstances, such as for someone who can’t have surgery. Sometimes, plastic stents may be used temporarily before surgery to make sure you’ll be able to urinate after your surgery.