Enlarged Prostate (BPH)
You can -- and should -- manage an enlarged prostate
Prostate enlargement affects more than half of all men over age 50. It happens when a growth develops on the prostate gland, partly blocking your bladder and disturbing urinary function.
An enlarged prostate means only that the gland has grown larger than normal; it is not cancer and does not cause cancer. It might not even cause you problems. But if you feel symptoms when urinating -- such as difficulty in starting to urinate or a feeling that urination is incomplete -- tell your doctor. Untreated, prostate enlargement can lead to bladder thickening, bladder stones, and kidney damage.
Though no one knows the exact causes of prostate enlargement, or a cure, your doctor can usually manage your symptoms with medication, surgical procedures, or both. Alternative medication, self-care measures, and dietary options are important considerations when creating a treatment plan. Many experts believe that changes in hormonal balance that come with aging prompt changes in the prostate.
Synonyms
- Benign prostatic hyperplasia (BPH)
- Prostatic hypertrophy
Detailed Description
The prostate gland, which makes about a third of the semen that carries sperm, is located at the base of the bladder. It surrounds the urethra, and often becomes enlarged in men over age 50. Prostate enlargement (also called benign prostatic hyperplasia, or BPH) is the condition caused by a noncancerous overgrowth of prostate tissue. As the gland size increases, it presses on the urethra and blocks the flow of urine -- starting the first symptoms.
You may have a hard time starting to urinate or a feeling that urination is incomplete. You may have to get up often at night to urinate, because the bladder doesn't empty completely each time. While the need may feel more pressing, the force and volume of your urinary flow may become smaller, with a weaker stream and dribbling at the end. The bladder response may eventually cause urinary incontinence.
Prostate growth can lead to serious complications if untreated. Eventually, your decreasing ability to empty your bladder will result in serious conditions. As the condition worsens, you may develop urinary tract infections. Without treatment, you will lose the ability to void urine, and increased bladder pressure will cause damage to your kidneys and related organs.
Treatment, primarily through medication or surgery, can help control symptoms but does not offer a cure. Certain drugs shrink prostate glandular tissue, and if they don't work, currently available surgical procedures are safe and very effective.
How Common Is Prostate Enlargement?
Prostate enlargement is relatively uncommon in men under age 40, but begins to show up more frequently with age. It is common in men over age 50. More than half of men over age 60 -- and 80% of men over age 70 -- have enlarged prostates.
Established Causes
No one knows what causes prostate enlargement, but it seems to be hormonally related.
Theoretical Causes
Prostate enlargement may arise from a hormonal alteration in the body that happens with age.
Risk Factors
The main risk factors for prostate enlargement are increasing age and the presence of male hormones (androgens). Potential associated risk factors may include smoking and alcoholism. It may run in families, as well. If your father had a problem, you may have a higher risk.
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
As men age, hormonal changes will enlarge the prostate and thus narrow the urethra. One of the earliest signs that prostate enlargement has begun is difficulty in urinating. Though the correlation between symptoms and prostate enlargement diagnosis is poor, you may have one or more of these symptoms:
- Frequent urination
- Increased urinary urgency (especially at night, known as nocturia)
- Weak stream
- Posturination dribbling
- Urinary incontinence (due to constant bladder overfill)
- Urinary burning
- Feeling of incomplete emptying
- Inability to voluntarily stop urine stream
- Urinary urgency
- Hesitancy
- Urine retention
- Enlarged prostate (about the size of a kiwi fruit)
- Swelled bladder
- Impotence (sometimes)
- Abdominal pain (rarely)
How Prostate Enlargement Is Diagnosed
Your doctor will take your medical history; examine your prostate by inserting a gloved, lubricated finger into your rectum; check for other medical problems; and may order additional tests, such as a pressure-flow study (to measure pressure in your bladder as you urinate) or cystoscopy (to look directly at your prostate and bladder).
Laboratory Work
Laboratory work can test for blockage of the urethra or chronic leftover urine. Though they help suggest a diagnosis, these tests are not designed to definitively diagnose prostate enlargement:
- Urinalysis
- Urine cultures
- Measurement of serum creatine and complete blood count (CBC)
- Measurement of PSA (prostate-specific antigen)
Specific Tests
Doctors use these office procedures to help diagnose prostate enlargement:
- Urine flow rate measurement
- Post-void urine volume measurement by catheter or ultrasound
- Transrectal prostate ultrasound (to determine gland enlargement)
Imaging
The following imaging techniques can help determine the extent of prostate enlargement, as well as the amount of leftover urine:
- Pelvic computed tomography (CT) or magnetic resonance imaging (MRI) scan
- Ultrasound
About PSA Screening
Prostate-specific antigen (PSA) screening is a blood test that can help find prostate cancer. An increase in PSA levels can suggest an abnormal proliferation of cells -- a characteristic of prostate cancer. PSA levels can also indicate whether cancer treatments are working and if cancer has returned -- even before it can be felt in a manual examination. Keep in mind that an enlarged prostate does not cause cancer, but a man can have both at the same time.
More information about PSA screening is available in the Prostate Cancer: Symptoms & Diagnosis.
Goals of Treatment
There is currently no cure, but proven medications and effective surgery are available and can successfully treat the urinary obstruction that prostate enlargement causes. Some specific goals of treatment include:
- Stopping and reversing the process that enlarges the prostate tissue.
- Relieving symptoms caused by compression of the urethra.
- Preventing the complications of urinary obstruction.
- Reducing the risk of requiring surgical treatment.
Treatment Overview
If you have an enlarged prostate with no urinary symptoms, your doctor can manage the condition with observation and no treatment. If your symptoms are mild and you don't want treatment, your doctor may consider "watchful waiting," with reassessment about once a year. Prostate enlargement sometimes progresses very slowly over many years, or not at all.
For most men with moderate prostate enlargement, a trial of drug therapy is an appropriate alternative to immediate surgery. Drug therapy is suitable for early development of the condition, before surgery is possible, or as a temporary solution until surgery becomes feasible. If you and your doctor closely monitor the course of the condition, it's possible that you will never need surgery.
One criticism of drug therapy for early treatment is that there is no opportunity to detect early stages of cancer by surgically removing tissue for examination. To help reduce the risk of overlooking pathological tissue, your doctor should order the following procedures during drug therapy and evaluate suspicious findings:
- Thorough finger (digital) rectal examination
- Transrectal ultrasound imaging of the prostate gland
- Measurement of the prostate-specific antigen (PSA) blood level
Surgery is currently the best treatment, but it does involve risks. Transurethral resection is the most common form of surgery. You'll have to stay in the hospital for resection surgery.
Drug Therapy
Drugs most commonly prescribed
- Alpha-blockers like Hytrin (terazosin), Flomax (tamsulosin), and Cardura (doxazosin) relax the bladder and relieve symptoms
- Anti-androgen drugs such as Proscar (finasteride) help shrink the prostate
Surgery
There are three types of surgery currently approved and being practiced:
- Minimally invasive thermal therapy
- Microwave (TUMT)
- Radiofrequency needles (TUNA)
- Interstitial laser
- Indirect and contact laser destruction
- Resection of prostate growth
- TURP (may include high energy vaporization)
- Open enucleation (removal without cutting) for very large glands
A new injectable technique using alcohol injections represents another relatively noninvasive method.
Healthcare Professionals Who May Be Involved in Treatment
- Urologists
- Family medicine physicians
- Internists
- Geriatricians
Diet Recommendations
Avoiding pesticides, increasing intake of zinc and essential fatty acids, and keeping cholesterol levels below 200 mg/dL (milligrams per deciliter) may help maintain the health of the prostate gland.
Some medical professionals have speculated that a diet high in protein may help treat prostate enlargement. The reasoning is that in lower protein states, the body converts the hormone testosterone to DHT (dihydrotestosterone), which favors prostate enlargement.
In addition, avoid drugs with anticholinergic activities (especially cold medications with pseudoephedrine or phenylpropanolamine). They can worsen the symptoms.
Monitoring the Condition
Due to the constant enlargement of the prostate as age progresses, you and your doctor should regularly monitor your condition. Recommended follow-up may include these procedures:
- Urodynamics, every six months
- PSA, annually
- Digital rectal exam, annually
- Symptom index (AUA Symptom Index), every two to six months
Possible Complications
Your doctor will watch for:
- Development of bladder stones
- Kidney failure
- Development of prostatitis
- Occurrence of occult retention
Considerations for Older Men
An enlarged prostate is part of the aging process and all men who live long enough will experience this condition. Surgery is always more risky at an older age and surgical choices should take into consideration the health and age of each person on an individual basis.
You should also consider that prostate enlargement sometimes progresses so slowly that an elderly man will usually live out his normal life span before the condition requires surgery.
Supplements
- Zinc: If you don't eat zinc-rich foods, try supplementing with 30 to 50 mg/day.
Herbs
- Saw palmetto: a small palm tree native to Florida. An extract of its berry helps shrink enlarged prostates. Commission E, the panel of German doctors, pharmacists, and herbalists that judges the safety and effectiveness of herbs for the German government, endorses saw palmetto for treatment of prostate enlargement, based on several studies that show that it works. For example, European researchers gave 1,098 men with prostate enlargement either saw palmetto or the drug Proscar. Six months later, both treatments were deemed equally effective. This study used a dose of 160 mg of saw palmetto twice a day. [1]
- Pygeum: another helpful herb; use 50 mg/day. [2]
- Nettle: may also be helpful; try 120 mg/day. [3]
1 Carraro, J.C., et al. "Comparison of the Phytotherapy Permixon with Finasteride in Treatment of prostate enlargement: A Randomized International Study of 1,098 Patients," The Prostate 29:231, 1996.
2, 3 Hartmann, R.W., et al. "Inhibition of 5-A-Reductase and Aromatase by Pygeum Africanum and Urtica Dioica," Phytomedicine 3:121, 1996.
Preventing Prostate Enlargement
Because prostate enlargement is not completely understood, no one knows how to prevent it.
Secondary Prevention
In general, an environment that is sensitive to the dietary needs of people with prostate enlargement will help relieve symptoms. Maintaining an active sex life, reducing your use of alcohol and nonprescription medications, reduction of stress, and limited exposure to the cold all can help decrease the stress and symptoms of prostate enlargement.
Many over-the-counter and prescription drugs, such as those for head colds, cough, and allergies, can affect bladder functions. Some antihistamines can inhibit contraction of the urinary bladder and some decongestants can tighten the bladder neck. The effect of these processes is significant impairment of urination, and can enhance the symptoms of prostate enlargement.
Self-Care Measures
- Reduce cholesterol levels in your diet. Cholesterol damaged by free radicals may be harmful to the prostate.
- An essential fatty acids complex, administered regularly, has resulted in improvement for many men who suffer from prostate enlargement. Some experts question the connection.
- Avoid spicy foods and pepper, which can irritate the urethra.
- Do not drink fluids at bedtime.
- Hydrotherapy may temporarily relieve the symptoms of prostate enlargement. Warm sitz baths taken for three to 10 minutes, in water at temperatures between 105F and 115F, are ideal for full therapeutic effect.
- If traveling for long periods of time, make sure that restrooms are regularly available. Avoid situations that prevent opportunities for urination as soon as the urge is felt.
- Frequent ejaculation is recommended for men with prostate enlargement, but avoid sexual stimulation and arousal without ejaculation.
Websites & Organizations
Department of Urology, Northwestern University Medical School
303 East Chicago Avenue
Chicago, IL 60611
Phone: 312-908-8145
Health Answers
American Medical Association
AMA Health Insight
Intellihealth.com Topic:
Benign Prostatic Hypertrophy
National Kidney and Urologic Diseases Information Clearinghouse
Box NKUDIC
Bethesda, MD 20892
Phone: 301-468-6345
Prostate Health Council
American Foundation for Urologic Disease, Inc.
300 West Pratt Street
Baltimore, MD 21201
Phone: 800-242-2383
Prostate Information
Toll-free hotline: 800-543-9632
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