Benign Postatic Hyperplasia (BPH) : Overview | Causes | Symptoms | Diagnosis | Treatment

Benign Prostatic Hyperplasia (BPH)

Overview

• BPH is the most common benign (non cancerous) tumor in men
• Occurs more often in western than eastern countries(Japan, China, etc.)
• Has a strong genetic link from one male generation to the next
• Symptoms related to BPH are present in about one of four men by age 55, and in half of men by age 75
• Treatment is only necessary if symptoms become bothersome (see Consumer Quiz)
• Main treatment options: Watchful waiting, phytotherapy, medication, surgery, and minimally invasive therapy

Causes

• Enlargement of the glandular tissue and the tightening of smooth muscles surrounding the urethra (this may obstruct the urethra)
• Testosterone (male sex hormone) is essential for the development of BPH
• Aging in males
• Studies suggest that the female sex hormone estrogen may play a role
• Occurs when an increase in the number of prostate cells produces discrete nodules in the prostate

Symptoms

• Difficulty in starting to urinate
• A weak stream
• Urgency (sudden strong desire to urinate)
• Urinary frequency
• Nocturia (urinating at night)
• Sensation that bladder is not empty after urination
• Lack of bladder control
• Blood in the urine(hematuria) can be a sign in some men with BPH—most men do not have this sign

Diagnosis

• Medical history- used to give clues of conditions that can mimic BPH (urethral stricture, bladder cancer or stones, or abnormal bladder function)
• Physical examination:
  1. examine lower abdomen—check for mass
  2. digital exam- to assess size, shape, and consistency of prostate. Look for hard or firm areas—can be cancer
• Laboratory Tests:
  1. urinalysis- looking for UTI (urinary tract infection)
  2. blood creatinie, BUN(blood urea nitrogen), and hemoglobin measured to rule out kidney damage
  3. PSA (prostate specific antigen) measured if digital exam suggests cancer. PSA is best way to determine how rapidly prostrate will increase over time. Better predictor than age or prostate volume of future prostate growth.

Treatment

Special Considerations

• Course of BPH not predictable in any individual
• In Mayo Clinic study, urinary symptoms did not worsen over a 3 ½ -year period in 73% of men with mi ld BPH
• Progressive decrease in size and force of urinary stream and feeling of incomplete emptying of the bladder are symptoms most correlated with eventual need for treatment
• Urethral obstruction left untreated can lead to thickened, irritable bladder, and therefore reduced capacity to store urine, infected urine or bladder stones, and a backup of pressure that damages the kidneys

Basis of Decisions Regarding Treatment:

• Severity of symptoms (as assessed by the International Prostate Symptom Score)
• The extent of urinary damage
• Man’s overall health and age

**note that no treatment is necessary if only a few symptoms and not bothered by them

Treatment and Main Treatment Options for BPH

• Watchful waiting (no immediate treatment—best for those with minimal symptoms that are not bothersome)
• Phytotherapy
• Medication
• Surgery
• Minimally Invasive Therapy (see your doctor)

Phytotherapy for BPH

• Definition - the use of herbs and botanicals to treat the symptoms of BPH
• First documented treatment of BPH with saw palmetto occurred in Egypt in the 15th century B.C.
• American Indians in Florida use berries from saw palmetto plant to relieve swelling and inflammation of the prostate since 1700s
• Saw Palmetto has been widely used in European countries for years to treat BPH and is currently the number one most prescribed product for that condition.
• The use of saw palmetto for the treatment of BPH has experienced rapid growth in the U.S. due to studies demonstrating that it may be as effective and safer as some prescription products. In addition, many consumers are looking for natural alternatives.

Current Rx Medications Used to Treat BPH

1. Alpha-1 adrenergic blockers
   • Cardura (doxazosin)
   • Hytrin (terazosin)
   • Flomax (tamsulosin)
   Work by blocking alpha-1-adrenergic receptors, causing relaxation of the muscle tissue in the prostate, bladder neck, and prostate capsule. The result is increased urinary flow and fewer urinary symptoms.
2. 5-alpha-reductase inhibitors
   • Proscar (finasteride)
   Works by blocking the enzyme 5-alpha-reductase, which converts testosterone into dihydrotestosterone (a hormone responsible for prostate growth). The drug causes the prostate to shrink, and it is most effective when prostate is enlarged.

Surgical Candidates with Prostate Problems:

• Inadequate bladder emptying resulting in damage to the kidneys
• Complete inability to urinate after relief of acute urinary retention
• Incontinence due to overfilling of increased sensitivity of the bladder
• Bladder stones
• Infected residual urine
• Recurrent blood in the urine not responsive to medical therapy
• Symptoms that trouble the patient enough to diminish his quality of life