BPH stands for benign prostatic hyperplasia (pronounced "be-NINE
prah-STAT-ik HY-per-PLAY-zha").Benign means "not cancer," and hyperplasia means too much
growth.
The result is that the prostate becomes enlarged. BPH is
not linked to cancer and does not raise your chances of getting
prostate cancer--yet the symptoms for BPH and prostate cancer
can be similar.
BPH Symptoms
BPH symptoms usually start after the age of 50.
They can include:
- Trouble starting a urine stream or making more than a
dribble
- Passing urine often, especially at night
- Feeling that the bladder has not fully emptied
- A strong or sudden urge to pass urine
- Weak or slow urine stream
- Stopping and starting again several times while passing urine
- Pushing or straining to begin passing urine
At its worst, BPH can lead to:
- A weak bladder
- Backflow of urine causing bladder or kidney infections
- Complete block in the flow of urine
- Kidney failure
BPH affects most men as they get older. It can lead to urinary
problems like those with prostatitis. By age 60, many men have
signs of BPH. By age 70, almost all men have some prostate enlargement.
The prostate starts out about the size of a walnut. By the time a
man is 40, it may have grown slightly larger, to the size of an
apricot. By age 60, it may be the size of a lemon.
As a normal part of aging, the prostate enlarges and can press
against the bladder and the urethra. This can slow down or block
urine flow. Some men might find it hard to start a urine stream,
even though they feel the need to go. Once the urine stream has
started, it may be hard to stop. Other men may feel like they need
to pass urine all the time or are awakened during sleep with the
sudden need to pass urine.
Early BPH symptoms take many years to turn into bothersome
problems. These early symptoms are a cue to see your doctor.
How can BPH be treated?
About half the men with BPH eventually have symptoms that are
bothersome enough to need treatment. BPH cannot be cured, but
drugs or surgery can often relieve its symptoms. BPH symptoms
do not always grow worse.
There are three ways to manage BPH:
- Watchful waiting (regular follow-up with your doctor)
- Drug therapy
- Surgery
Talk with your doctor about the best choice for you. Your symptoms may change over time, so be sure to tell your doctor about any new changes
Watchful waiting
Men with mild symptoms of BPH who do not find them bothersome often choose this approach.
Watchful waiting means getting annual checkups. The checkups
can include DREs and other tests. Treatment is
started only if symptoms become too much of a problem.
If you choose to live with symptoms, these simple steps can help:
- Limit drinking in the evening, especially drinks with
alcohol or caffeine.
- Empty the bladder all the way when you pass urine.
- Use the restroom often. Don't wait for long periods
without passing urine.
Some medications can make BPH symptoms worse, so talk with your doctor or pharmacist about any medicines you are taking such as:
- Over-the-counter cold and cough medicines (especially
antihistamines)
- Tranquilizers
-
Antidepressants
- Blood pressure medicine
Drug therapy
Millions of American men with mild-to-moderate BPH symptoms
have chosen prescription drugs over surgery since the early 1990s.
There are two main types of drugs used. One type relaxes muscles
near the prostate while the other type shrinks the prostate gland.
There is evidence that shows that taking both drugs together may
work best to keep BPH symptoms from getting worse.
Alpha-blockers
These drugs help relax muscles near the prostate to relieve pressure
and let urine flow more freely, but they don't shrink the size of the
prostate. For many men, the drug can improve urine flow and
reduce symptoms within days. Possible side effects include
dizziness, headache, and fatigue.
5 alpha-reductase inhibitor
This drug, known as
finasteride, shrinks the prostate. It relieves
symptoms by blocking an
enzyme that acts on the male
hormone, testosterone, to boost organ growth. When the
enzyme is blocked, growth slows down. This helps shrink the prostate,reduce blockage, and limit the need for surgery.
Taking this drug for at least 6 months to 1 year can increase urine
flow and reduce your symptoms. It seems to work best for men
with very large prostates. You must continue to take the drug to
prevent symptoms from coming back.
This drug is also used to treat baldness in men. It can cause these
side effects in a small percentage of men:
- Decreased interest in sex
- Trouble getting or keeping an
erection
- Smaller amount of semen with ejaculation
It's important to note that taking this drug can lower your PSA test levels. There is also evidence that finasteride lowers the risk of
getting prostate cancer, but whether it lowers the risk of dying from prostate cancer is still unclear.
| BPH Medications |
| Category |
Activity |
Generic Name |
Brand Name |
| Alpha-blockers |
Relax muscles
near prostate |
doxazosin
tamsulosin
terazosin
prazosin
|
Cardura
Flomax
Hytrin
Minipres
|
| 5 alphareductase
inhibitor |
Slows prostate growth, shrinks
prostate |
finasteride |
Proscar or
Propecia |
BPH surgery
The number of prostate surgeries has gone down over the years.
But operations for BPH are still one of the most common surgeries
for American men. Surgery is used when symptoms are severe or
drug therapy has not worked well.
Types of surgeries include:
-
TURP (transurethral resection of the prostate) is the most
common surgery for BPH. It accounts for 90 percent of all
BPH surgeries. It takes about 90 minutes. The doctor passes
an instrument through the urethra and trims away extra
prostate tissue. A
spinal block
is used to numb the area.
Tissue is sent to the laboratory to check for prostate cancer.
TURP generally avoids the two main dangers linked to other
prostate surgeries:
- Incontinence (not being able to hold in urine)
- Impotence (not being able to have an erection)
The recovery period for TURP is much shorter as well.
-
TUIP (transurethral incision of the prostate) is similar to
TURP. It is used on slightly enlarged prostate glands. The
surgeon places one or two small cuts in the prostate. This
relieves pressure without trimming away tissue. It has a low
risk of side effects. Like TURP, this treatment helps with urine
flow by widening the urethra.
-
TUNA (transurethral needle ablation) burns away excess
prostate tissue using radio waves. It helps with urine flow,
relieves symptoms, and may have fewer side effects than TURP.
Most men need a
catheter to drain urine for a period of time
after the procedure.
-
TUMT (transurethral microwave thermotherapy) uses
microwaves sent through a catheter to destroy excess prostate
tissue. This can be an option for men who should not have
major surgery because they have other medical problems.
-
TUVP (transurethral electroevaporation of the prostate)
uses electrical current to vaporize prostate tissue.
-
Open prostatectomy means the surgeon removes the prostate
through a cut in the lower abdomen. This is done only in very
rare cases when obstruction is severe, the prostate is very large,
or other procedures can't be done. General or spinal
anesthesia is used and a catheter remains for 3 to 7 days after
the surgery. This surgery carries a higher risk of complications
than medical treatment. Tissue is sent to the laboratory to
check for prostate cancer.
Be sure to discuss options with your doctor and ask about the
potential short- and long-term benefits and risks with each
procedure. For a list of questions to ask, see
Checklist of Questions for Your Doctor.
