Enlarged Prostate Health Article

Definition

A non-cancerous condition that affects many men past 50 years of age, enlarged prostate makes urinating more difficult by narrowing the urethra, a tube running from the bladder through the prostate gland. It can be effectively treated by surgery and, today, by certain drugs.

Description

The common term for enlarged prostate is BPH, which stands for benign (non-cancerous) prostatic hyperplasia or hypertrophy. Hyperplasia means that the prostate cells are dividing too rapidly, increasing the total number of cells, and, therefore, the size of the organ itself. Hypertrophy simply means "enlargement." BPH is part of the aging process. The actual changes in the prostate may start as early as the 30s but take place very gradually, so that significant enlargement and symptoms usually do not appear until after age 50. Past this age the chances of the prostate enlarging and causing urinary symptoms become progressively greater. More than 40% of men in their 70s have an enlarged prostate. Symptoms generally appear between ages 55–75. About 10% of all men eventually will require treatment for BPH.

BPH has been viewed as a rare condition in African, Chinese and other Asian peoples for reasons that are not clear.

Causes and symptoms

The cause of BPH is a mystery, but age-related changes in the levels of hormones circulating in the blood may be a factor. Whatever the cause, an enlarging prostate gradually narrows the urethra and obstructs the flow of urine. Even though the muscle in the bladder wall becomes stronger in an attempt to push urine through the smaller urethra, in time, the bladder fails to empty completely at each urination. The urine that collects in the bladder can become infected and lead to stone formation. The kidneys themselves may be damaged by infection or by urine constantly "backing up."

When the enlarging prostate gland narrows the urethra, a man will have increasing trouble starting the urine stream. Because some urine remains behind in the bladder, he will have to urinate more often, perhaps two or three times at night (nocturia). The need to urinate can become very urgent and, in time, urine may dribble out to stain a man's clothing. Other symptoms of BPH are a weak and sometimes a split stream and general aching or pain in the perineum (the area between the scrotum and anus). Some men may have considerable enlargement of the prostate before even mild symptoms develop.

If a man must strain hard to force out the urine, small veins in the bladder wall and urethra may rupture,

causing blood to appear in the urine. If the urinary stream becomes totally blocked, the urine collecting in the bladder may cause severe discomfort, a condition called acute urinary retention. Urine that stagnates in the bladder can easily become infected. A burning feeling during urination and fever are clues that infection may have developed. Finally, if urine backs up long enough it may increase pressure in the kidneys, though this rarely causes permanent kidney damage.

Diagnosis

When a man's symptoms point to BPH, the first thing the physician will want to do is a digital rectal examination, inserting a finger into the anus to feel whether—and how much—the prostate is enlarged. A smooth prostate surface suggests BPH, whereas a distinct lump in the gland might mean prostate cancer. The next step is a blood test for a substance called prostate-specific antigen or PSA. Between 30–50% of men with BPH have an elevated PSA level. This does not mean cancer by any means, but other measures are needed to make sure that the prostate enlargement is in fact benign. An ultrasound exam of the prostate, which is entirely safe and delivers no radiation, can show whether it is enlarged and may show that cancer is present.

If digital or ultrasound examination of the prostate raises the suspicion of cancer, most urologists will recommend that a prostatic tissue biopsy be performed. This is usually done using a lance-like instrument that is inserted into the rectum. It pierces the rectal wall and, guided by the physcian's finger, obtains six to eight pieces of prostatic tissue that are sent to the laboratory for microscopic examination. If cancer is present, the prognosis and treatment are changed accordingly.

A catheter placed through the urethra and into the bladder can show how much urine remains in the bladder after the patient urinates—a measure of how severe the obstruction is. Another and very simple test for obstruction is to have the man urinate into a uroflowmeter, which measures the rate of urine flow. A very certain—though invasive—way of confirming obstruction from an enlarged prostate is to pass a special viewing instrument called a cystoscope into the bladder, but this is not often necessary.

It is routine to check a urine sample for an increased number of white blood cells, which may mean there is infection of the bladder or kidneys. The same sample may be cultured to show what type of bacterium is causing the infection, and which antibiotics will work best. The state of the kidneys may be checked in two ways: imaging by either ultrasound or injecting a dye (the intravenous venous urogram, or pyelogram); or a blood test for creatinine, which collects in the blood when the kidneys cannot eliminate it.