Benign prostatic enlargement, also known as benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy, is a non-cancerous growth of the gland. Approximately half of men will get BPH in their lifetime. As men age, the prostate grows. Because the gland encircles the urethral channel, its growth causes obstruction to the flow of urine from the bladder. The prostate which is typically the size of a walnut, may grow to be as large as a grapefruit. When enlarged, its configuration is much like a plump donut.
Symptoms include difficulty initiating a urinary stream, slow urinary stream, a sense of incomplete voiding, nuisance or prolonged dribbling after voiding, and / or blood in the urine. Some patients develop florid urinary retention and / or bladder stones. Some patients develop irritative voiding symptoms such as urinary urgency, frequency of urination, or waking at night to urinate. Men with BPH are more prone to urinary infection.
The diagnosis is made by history and physical examination, including a digital rectal examination. While BPH is not cancerous, prostate cancer may coexist with BPH. A PSA level is, therefore, typically drawn to help rule out the presence of cancer. If a nodule is appreciated, or if the PSA level is too high (or rate of rise is too quick), a biopsy would be necessary to rule out cancer.
Patients with minimal or no symptoms need only observation, typically with periodic digital rectal examination and PSA checks. For patients with symptoms, treatments range from herbals, to prescription medications, transurethral surgery, to open or robotic “simple” prostatectomy:
- Saw Palmetto
- Alpha Blockers (Flomax, Uroxatral, Cardura)
- 5-Alpha Reductase Inhibitors (Proscar, Avodart)
- Transurethral Heating: Microwave, TUNA
- Transurethral Surgery: TURP (monopolar glycine, and saline bipolar); “Button” TUVP; PVP-GreenLightLaser
- Open Surgery: Simple Suprapubic Prostatectomy, Simple Retropubic Prostatectomy
- Robotic Simple Suprapubic Prostatectomy
Saw Palmetto is one of the few herbal treatments examined scientifically in a randomized and controlled fashion with demonstrable improvement in patients’ symptoms. It is available at most health food stores.
Alpha blockers such as Flomax and Uroxatral are medications which target the muscles at the bladder neck and within the prostate to open the channel and make it more accommodative to the flow of urine.
5-alpha reductase inhibitors such as Proscar and Avodart block the conversion of testosterone to dihyrdotestosterone (DHT, the active form of testosterone in the prostate). Deprivation of this hormone causes shrinkage of the prostate gland over time (several months).
For all men with symptomatic BPH, there is a 1 in 10 chance that they will require a surgical procedure to overcome their symptoms in their lifetime. Men who use an alpha-blocker or a 5-alpha-reductase inhibitor may reduce their chances of surgery to 5%. Men who use both agents may reduce their surgical requirements to less than 2%.