Benign Prostate Hypertrophy

Dear DR. Z.,

My doctor recently told me that my prostate is enlarged. What does this mean, and should I be worried about prostate cancer?

Benign prostate hypertrophy known as BPH is a noncancerous condition that is defined as enlargement of the prostate gland. The prostate gland is part of the male reproductive system. This gland sits directly below the bladder and it hugs the urethra (the tube that drains urine from the bladder). The prostate’s function is to produce semen, which nourishes and transports sperm during ejaculation.

Once a male completes puberty the prostate gland is about the size of a walnut, however the gland may start growing again when a man reaches 40 or 50 years of age. This growth is the source of the symptoms associated with BPH. As the prostate grows it can trigger the urethra to “spasm” making it difficult for urine to flow through smoothly. Prostate growth can also squeeze the urethra, narrowing or obstructing the urine flow. The symptoms of BPH include urgency,inability to empty the bladder all at once, a weaker urinary stream, and hesitancy while urinating. The prostate over growth and the amount of compression it causes can vary from person to person. Some patients may experience blood in the urine due to obstruction or frequent urinary tract infections. Typically symptoms will start mild and may worsen with time depending on prostate growth and each individual’s anatomy.

BPH is uncommon in males younger than 40, it occurs in 50% of men older than 50, and in 80% of men older than 70. The causes of BPH are not completely clear. The current theory is that as a man ages, his testosterone level changes as does the prostate gland cells response to the testosterone. It is known that the testosterone triggers the prostate growth. Family history may play a role, but overall age is the only known risk factor.

There are complications that can occur with BPH. If urine is consistently sitting in the bladder, the bladder will frequently contract in attempt to empty it. This can damage the muscle of the bladder wall leading to the inability to contract. Acute urinary retention can occur which is when the male suddenly is unable to urinate despite the extreme urgency to do so. In this situation the male will have to be catheterized to drain the urine. Bladder stones and kidney damage can occur as well. It is important to note that BPH does not put a person at risk for prostate cancer.

It is important to seek medical care when BPH symptoms begin. There are medications that can help improve symptoms and prevent complications. The provider will want to rule out a urinary tract infection, prostatitis (prostate infection), kidney involvement or prostate cancer. The provider will typically do a urine analysis, obtain a PSA (blood test), and do a digital rectal exam. The PSA stands for prostate specific antigen, which is normally in the blood but the level of this antigen will help guide the provider on the etiology behind the urinary symptoms. Yearly PSA levels should be drawn in men starting at age 40. Tracking the PSA values will help detect and determine when prostate cancer is present versus BPH. A portion of the prostate can be felt via the rectum; allowing the provider to examine for enlargement or masses.
There are many other diagnostic studies available to help diagnose and treat BPH symptoms. The medical provider and patient will determine which tests need to be done based on symptoms, complications and the results of the standard exams mentioned previously.
The most common and simple method of treatment for BPH consists of two different types of oral medications. Surgery is an available option as a last resort when the oral medications fail. These are better left to discuss with your medical provider since each patients symptoms and underlying state of health determine the best treatment method. If you have any further questions or concerns, please don’t hesitate to visit your local “Medical Home” for further evaluation.
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