Benign Prostatic Hyperplasia (BPH)
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The prostate gland is part of the male reproductive system. It is located just below the bladder and surrounds the urethra, the small tube through which urine travels out of the body. As men age, the prostate gland becomes larger. As it enlarges, it may press on the urethra and block the flow of urine out of the bladder. This condition is known as BPH, or benign prostatic hyperplasia. In men with Benign Prostatic Hyperplasia, the partial blockage of the urethra leads to irritation in the bladder, which eventually does not completely empty during voiding. The blockage and partial emptying of the bladder lead to a variety of problems, including a weak, interrupted or hesitant stream of urine, frequent urination (especially at night), a feeling of urgency to urinate, and leaking or dribbling of urine. For some men, these symptoms are simply annoying. Symptoms of prostate enlargement can also signal a more serious condition, such as prostate cancer. If BPH is not treated, it can cause serious problems over time, including urinary tract infections, incontinence (leaking urine), stone formation, and even permanent damage to the bladder or kidneys. It is very important to treat Benign Prostatic Hyperplasia in its early stages to avoid these complications.
Drugs Can Reduce Symptoms
The prostate gland enlarges as a normal process of aging in men, and usually does not cause urinary problems before age 40. This enlargement is considered “benign” because it is not cancerous. More than half of men in their 60s and even more in their 70s and 80s have an enlarged prostate. The cause of this enlargement is not completely understood. It is probably related to hormone levels, or the amount of dihydrotestosterone (DHT) in the prostate. DHT is a derivative of testosterone that may contribute to the growth of prostate gland cells. The urinary problems of BPH result from the narrowed urethra and the slow loss of bladder function, which leaves urine in the bladder even after urinating. The severity of the symptoms is not always related to the size of the prostate, since men with very large prostate glands may have almost no symptoms and those with less-enlarged prostate glands can suffer severe symptoms. Most men begin to feel urinary symptoms when the prostate gland enlarges enough to restrict urine flow. Problems can include a weak or interrupted flow of urine, difficulty in beginning the urinary stream, frequent urination, a feeling of urgency to urinate, or leaking urine. These symptoms can be made worse by some prescription drugs, such as anti-Parkinson agents, that cause urinary retention. Some antihistamine drugs can also worsen Benign Prostatic Hyperplasia symptoms.
How BPH Is Diagnosed: Benign Prostatic Hyperplasia is typically diagnosed from either a patient’s history of urinary symptoms or after a routine physical. A digital rectal exam can give the doctor an idea of the size and shape of the prostate gland. Often a prostate-specific antigen blood test (PSA) is ordered to determine if this protein is elevated. A high PSA level is often found in men with prostate cancer. Other tests such as a rectal ultrasound of the prostate, and urinary tract studies such as a urinalysis, voiding cystourethrogram, post-void residual urine measurement, pyelogram x-ray or examination by cystoscopy can help determine the size of the prostate and whether urinary blockage is present. Although treatment of mild prostatic enlargement may not be necessary since many symptoms of BPH disappear on their own, many men with symptoms of Benign Prostatic Hyperplasia will eventually need either drug or surgical treatment for this condition.
Drug Therapy: Currently, four drugs relieve symptoms of Benign Prostatic Hyperplasia: finasteride, terazosin, doxazosin, and tamsulosin. Finasteride decreases the production of DHT, the hormone involved in prostatic enlargement. Finasteride not only stops the prostate from enlarging, but can actually shrink the prostate in some men, an effect seen after about 3 months of treatment. Unfortunately, finasteride works in less than half of patients. Terazosin, doxazosin, and tamsulosin belong to a class of drugs known as alpha-blockers. These drugs all relax the smooth muscle of the prostate and bladder to help improve urine flow out of the bladder. Alpha-blockers reduce the urinary symptoms of Benign Prostatic Hyperplasia but do not decrease the size of the prostate. These drugs also lower blood pressure, a side effect, and they can be used to treat men with high blood pressure as well as BPH. Other side effects of alpha-blockers are headache, dizziness, and weakness. These can sometimes be avoided by starting with a low dose and slowly increasing it over several weeks. Alpha-blockers are effective in about 70% of patients. Persons who have symptoms of Benign Prostatic Hyperplasia should not ignore these symptoms, but see their doctor for a complete examination.