It may be small, but the walnut-sized prostate gland can create big discomfort for men as they age. The reason: That little gland grows over time, eventually causing benign prostatic hyperplasia, or BPH, the medical term for an enlarged prostate. This is one instance where bigger isn’t better: The larger the prostate, the more likely it will squeeze the urethra, which just happens to travel through the prostate gland. And because the urethra is the tiny channel through which urine and semen pass, what happens next isn’t very much fun.
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If you have BPH, you’re in good company. It’s estimated that by age 60, more than half of men will develop it; by age 85, 90 percent will. “In a sense, BPH is inevitable,” says Dr. Kevin T. McVary, president of the guidelines committee for the American Urological Association.
The good news: “You don’t have to suffer,” says McVary. Here, a look at the condition and what can be done to treat it:
What it is: BPH occurs when there’s an overgrowth of cells inside the prostate gland. The process starts in early adulthood: Once men reach their 30s, cells start to proliferate, and the gland slowly increases in size.
What it isn’t: The word benign is a tip-off: BPH is not cancer. Nor does it raise your risk for prostate cancer, something many men assume. Recently Danish researchers examined data on more than three million men from 1980 through 2006 and reported some scary findings. Men hospitalized for BPH had twice the risk of developing prostate cancer as men in the general population. Men who underwent surgery to treat their BPH had three times the risk. The risk of dying from prostate cancer was twice as high among men hospitalized for BPH and up to eight times as high for men who underwent surgery for the condition. That’s a sobering fact, but men shouldn’t panic, say experts.
While the study is huge, it doesn’t show causation, says Dr. Ketan K. Badani, associate professor of urology at Columbia University Medical Center. The fact that men in the study had been hospitalized for BPH likely means they were undergoing a battery of tests, says Badani. “If you look hard enough for prostate cancer, you will find it,” he says.
According to McVary, prostate cancer and BPH are caused by two different disease processes. “There doesn’t seem to be a relationship between BPH and prostate cancer at all,” he says.
“As it stands now, if a man has BPH, he should not been concerned about an increased risk of prostate cancer,” adds Badani. “That has not been proven yet.” In fact, some studies show that BPH can protect against prostate cancer, he says.
What the symptoms are: When the urethra is blocked, men may have a tough time urinating. “There are seven cardinal symptoms,” says McVary, chair of urology at Southern Illinois University School of Medicine in Springfield. These include a weak or slow urinary stream; frequent urination; urinary urgency; getting up frequently during the night to urinate; straining to urinate; double urination; and the sensation that your bladder isn’t completely empty. However, “symptoms aren’t inevitable, ” he says. Many men never develop symptoms or if they do, aren’t bothered by them, he adds.
What causes it: No one knows. But the older you are, the greater the risk. Having a family history of BPH also raises your risk as does being obese or physically inactive. Also, men who have erectile dysfunction are candidates for developing BPH.
How it’s diagnosed. To make a diagnosis, the urologist will take a medical history and do a digital rectal exam. (Sometimes the doctor can actually feel the enlarged prostate, says McVary.) A post-void residual volume test may be done to measure the amount of urine left in the bladder after peeing. The amount of pressure inside the bladder during urination may be measured and an ultrasound of the prostate or kidney performed. Your urologist will also use the American Urological Association symptom score to gauge the frequency of your symptoms and how much they bother you. Based on the score, the urologist can classify the BPH as mild, moderate or severe. Other tests that may be done to rule out conditions with symptoms that mimic those of BPH include a prostate specific antigen (PSA) test to screen for prostate cancer; urinary cytology to screen for urinary cancer; and a urinalysis to check for glucose in the urine. If glucose is found, it could mean undiagnosed diabetes is triggering frequent urination. The urinalysis can also detect an infection that may be causing BPH-like symptoms.
How it’s treated: A guy who has mild BPH or isn’t bothered by his symptoms is a good candidate for watchful waiting, or active surveillance. But if symptoms develop or worsen over time, medication and/or surgery can help.
Three classes of medications are prescribed. Alpha blockers are “our first line medication for BPH,” says Badani. These drugs relax muscles in the prostate and bladder, improving flow and decreasing resistance, he explains.
Another option: 5-alpha-reductase inhibitors, which shrink the prostate by almost 50 percent. The inhibitors may be prescribed along with alpha blockers if needed, adds Badani. Anticholinergics are used when the problem is not so much blockage as it is an overactive bladder.
Surgery is considered when medications don’t work, or a patient has unwanted or intolerable side effects, says McVary. Options include minimally invasive procedures such as transurethral needle ablation (TUNA), which uses low-level frequency radio waves to reduce the gland’s size, and transurethral microwave thermotherapy (TUMA), in which high-frequency radio waves destroy prostate tissue that’s blocking the flow of urine. The downside of these treatments is that symptoms may reoccur.
Surgical techniques deliver longer lasting benefits. Transurethral resection of the prostate (TURP) “is the gold standard operation for the surgical treatment of BPH,” says Badani, who is also director of robotic and minimally invasive surgery at Columbia University Medical Center. During the procedure, the surgeon opens the channel through which urine flows. “It’s far more effective than minimally invasive surgery,” he says. During an open prostatectomy, the inner portion of the prostate is removed to clear the channel. During laser procedures, surgeons vaporize tissue causing the blockage. Other surgical procedures are also available. Ultimately, you and your doctor should agree on whichever procedure you undergo, says McVary. Just make sure you understand the risks and benefits of each before making a decision.