Prostate Health
PROSTATE ENLARGEMENT (BPH)
WHAT IS BENIGN PROSTATIC HYPERPLASIA?
Benign prostatic hyperplasia is when the prostate gland is enlarged but not cancerous.
As the prostate enlarges, the gland presses against and pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause many of the problems associated with benign prostatic hyperplasia.
THE PROSTATE OR PROSTATE GLAND IS AN IMPORTANT COMPONENT OF THE MALE REPRODUCTIVE SYSTEM. IT IS LOCATED BENEATH THE BLADDER AND IS RESPONSIBLE FOR SECRETING FLUID THAT BECOMES A PART OF SEMEN. THIS FLUID IS SLIGHTLY ALKALINE, WHICH HELPS TO THE LIFESPAN OF SPERM.
Unfortunately, the prostate gland is the site of many clinical problems. Some of the more common clinical problems that are associated with the prostate gland are inflammation (prostatitis), cancer (prostate cancer is one of the most common cancers that affect men that reach old age) and benign prostate enlargement. We will discuss benign prostate enlargement in more detail in this chapter.
Benign Prostate Enlargement
Benign prostate enlargement (BPH) or benign prostatic hyperplasia is an enlargement of the prostate that is non-cancerous1. The cause of BPH is currently unclear; however, many risk factors contribute in a small way to BPH, which include obesity, diabetes, erectile dysfunction and a lack of exercise. Additionally, many scientists and doctors believe that age-related factors contribute to the development of BPH. One such factor is the drop in testosterone that occurs as men age.
Due to the position of the prostate near the bladder, when the prostate becomes enlarged it can interact with the bladder, which can lead to various urinary symptoms. Symptoms of BPH include frequent urination, difficulty initiating urination, inability to completely empty the bladder, increased urination at night and weak urine streams.
Methods for Assessing Benign Prostate Enlargement
Urologists assess and determine BPH based on physical examinations, medical tests and personal/family history. The American Urological Association or AUA has devised a BPH symptom score index, which will rate BPH as mild, moderate or severe. The BPH symptom score is also known as the International Prostate Symptom score or IPSS. The IPSS is an eight-question screening tool that tracks the symptoms and suggests relief for benign prostate hyperplasia2. The questions asked on the IPSS are as follows:
- Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
- Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating?
- Over the past month, how often have you found you stopped and started again several times when you urinated?
- Over the past month, how often have you found it difficult to postpone urination?
- Over the past month, how often have you had a weak urinary stream?
- Over the past month, how often have you had to push or strain to begin urination?
- Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?
Each answer choice has a score that ranges from 0 to 5. Depending on the score, the results will be tallied to yield a mild, moderate or severe BPH.
A score between 0 and 7 is mild. A score between 8 and 19 is moderate. A score between 20 and 35 is severe. Another way to assess BPH is via an ultrasound to take a 3D picture of the prostate and measure the exact volume or size of the prostate.
Urologists can also suggest a Uroflow study. Uroflowmetry is a technique that measures the flow of urine. This technique will track how fast urine flows, how long an individual takes to urinate and how much urine flows out. While a Uroflow measures the flow of urine, a post-void residual urine test will measure how much urine stays in the bladder after urination3. A urologist can conduct a post void residual urine test via the utilization of an ultrasound4. An ultrasound uses sound waves to show how much urine is left in the bladder.
Treatment for Benign Prostate Enlargement
Treatment of BPH depends upon the severity of symptoms. If symptoms are mild, doctors will observe BPH and recommend lifestyle modifications such as diet and exercise. Medications can also be prescribed to treat BPH. For example alpha blockers are used to relax the muscles of the prostate and the bladder to improve urine flow. Alpha blocking medications include flomax, hytrin, cadura and uroxatral. 5-alpha reductase inhibitors are also utilized to treat BPH, due to the ability to block the production of DHT. Studies indicate that DHT buildup can contribute to prostate growth. Some examples of 5-alpha reductase inhibitors are proscar and avodart.
Minimally invasive surgery options for BPH include urolift or prostate urethral lift (PUL)5. With PUL, implants are inserted into the prostate to lift the prostate so that it is not blocking the urethra. A more drastic surgical option for the treatment of BPH is transurethral resection of the prostate or TURP6. TURP is a procedure that will remove tissue from the prostate via dissection or electrocautery. TURP carries the potential risk of erectile dysfunction and retrograde ejaculation.