Fast Facts: Benign Prostate Hyperplasia (BPH)

As a man ages, his prostate enlarges and when it grows big enough, it can create problems, commonly called benign prostatic hyperplasia. This section provides information regarding the causes, symptoms, diagnostic methods, and treatment of benign prostate hyperplasia.

What does benign prostate hyperplasia mean？

The prostate is a component of the male reproductive system, and its primary function is to produce fluid for semen. Its weight is around an ounce and its size is comparable to a walnut. It is located in front of the rectum and below the bladder. Benign prostatic hyperplasia (BPH) is the medical term for when the prostate and surrounding tissue enlarge.

As a man ages, the prostate increases in size during two major phases – the initial stage of puberty (due to a surge in testosterone levels) and then again around the age of 25, which continues for the majority of a man’s lifetime. The urethra may be squeezed as the gland grows and the bladder wall thickens and the bladder may get weakened and lose its capacity to empty with time.

Does benign prostatic hyperplasia increase the risk of cancer?

Benign means that a condition is non-cancerous. However, BPH and prostate cancer can occur at the same time.

What causes benign prostate hyperplasia？

One theory suggests that your body produces less testosterone as you become older, while oestrogen levels stay the same. The growth of your prostate cells may result from these hormonal changes. Another theory suggests that the hormone dihydrotestosterone(DHT), a more potent form of testosterone, is found in increased amounts in older men and it stimulates the prostate cells to increase in size.

What are the risk factors for benign prostate hyperplasia？

Risk factors mainly include:

Ageing: By the age of 60, roughly one-third of men experience moderate to severe symptoms, and by the age of 80, about half of them experience these symptoms
Family history
Obesity
Diabetes
Heart disease
Beta-blockers

What are the symptoms of benign prostate hyperplasia？

The most common symptom of BPH is a frequent need to urinate. This may occur once or twice an hour, primarily at night.

Other symptoms include:

The sense that your bladder is still full after urinating (indicates incomplete emptying)
Urination is required often, roughly every one to two hours
Intermittence: the requirement to repeatedly stop and start when urinating
Urgency of urination
A weak urine flow
Straining to urinate
Nocturia: Waking up multiple times at night to urinate

You might not be able to pass urine at all if your BPH worsens. This is an emergency situation.

How is benign prostate hyperplasia diagnosed？

There are numerous testing methods. The following exams are performed to identify and monitor BPH:

Digital rectal exam (DRE): You either lie on your side or bend over. To feel the prostate gland’s posterior wall, your doctor slips a gloved, lubricated finger into your rectum and checks for swelling, discomfort, lumps, or hard place

Urine analysis: This examines your urine sample to look for red blood cells, bacteria, glucose, protein, crystals that can help your urologist determine the source of your symptoms. If you notice blood in your urine, discomfort or burning when you pass urine, or difficulty passing urine visit a doctor as soon as possible

Post-void residual volume: The amount of urine still left in the bladder after passing urine is called post-void residual volume (PVR). It is done to identify the degree of obstruction

Uroflowmetry: Your doctor measures your urine flow rate, again to identify the degree of obstruction

Scanning:
These examinations are performed to determine the prostate’s size and shape. BPH scans can include:

Ultrasound detects changes in the prostate’s size and structure, obstructions caused
A cystoscopy is a test that uses a scope to examine the bladder or urethra
More thorough scans include computed tomography (CT) and magnetic resonance imaging (MRI). These are carried out in case where surgery is required

Blood testing: Blood tests may be performed if cancer is suspected. Testing for prostate-specific antigen (PSA) to detect prostate cancer, is carried out. The PSA blood test measures the concentration of PSA, a protein that the prostate gland alone produces. It may increase as a result of prostate inflammation or benign (non-cancerous) enlargement of the prostate gland as well.

Note: Avoid having sexual intercourse a few days before the test since it can artificially raise the PSA reading

What is the treatment of choice for benign prostate hyperplasia?

If your symptoms are minor, you might not need any professional intervention and your doctor might advise a ‘watchful waiting’ strategy, in which you schedule routine appointments to make sure your BPH doesn’t worsen.

Options for treatment include:

Medications

Alpha-blockers
Alpha-blockers are medications that relax the muscles in the bladder and prostate. They do not shrink the prostate, but if there is a blockage, they reduce the blockage and enhance urine flow. Examples: alfuzosin, doxazosin, tamsulosin, terazosin

5-Alpha Reductase Inhibitors
5-alpha reductase inhibitors are medications that work by decreasing dihydrotestosterone (DHT) production, improving urine flow and reducing prostate size. Drugs include dutasteride and finasteride.

Combined Therapy
Alpha-blockers and 5-alpha reductase inhibitors are used concurrently in combination therapy. They prevent the worsening of BPH more effectively, but you run the risk of experiencing more adverse effects as well. Possible drug combinations include:

Finasteride and doxazosin
Dutasteride and tamsulosin
Alpha-blockers and antimuscarinics

Surgery

Your urethra-blocking prostate tissue can be removed surgically using a variety of techniques. These consist of:

Transurethral resection of the prostate (TURP): Resectoscopes are specialised tools that a urologist inserts through your urethra to view and remove prostate tissue.

Transurethral incision of the prostate (TUIP): To enlarge your urethra and increase urine flow, your urologist makes two tiny incisions in your prostate at the point where your bladder and urethra unite (the bladder neck).

Transurethral electrovaporisation: Your urologist warms the tissue in your prostate using an electrode. The tissue cells in the enlarged regions of your prostate are converted into steam as a result.

Minimally invasive procedures

Prostatic urethral lift: Through this treatment, the enlarged prostate lobes are divided, allowing for a broader urethra and easier urination
Water vapour therapy: A tool is inserted into your urethra by your urologist and moved to your prostate. A needle is then injected into your prostate and steam is released from the needle that condenses into water. Your prostate cells are destroyed by the warm energy of the water and your prostate shrinks as your body reabsorbs the dead cells

What distinguishes benign prostatic enlargement from benign prostatic hyperplasia?

The disorder known as BPH is what makes your prostate enlarge. Benign prostatic enlargement (BPE) is a term that healthcare providers use to describe the increased size of your prostate gland due to BPH.

What distinguishes benign prostatic hyperplasia from prostate cancer?

BPH is benign, meaning it is non-cancerous. Prostate cancer on the other hand is the uncontrolled growth of cells in your prostate gland that can spread to other parts of the body. The symptoms of prostate cancer and BPH are comparable; hence, it is important to undergo routine and timely health checkups to distinguish between the two conditions.