One of the main functions of the prostate
is to produce an important liquefying component of semen, which allows the
sperm to move freely. The gland is divided into three zones, peripheral,
transitional and central. With BPH, it is the central part where overgrowth of
cells takes place.
BPH is very common, affecting about one
third of men over 50. Although it is not prostate cancer, the symptoms of BPH
are similar to those of prostate cancer so you should see your doctor if you start
to experience problems passing urine. A separate BUPA factsheet on prostate
cancer covers that topic in more detail.
Location of the prostate gland
Symptoms
You should seek medical advice if you
notice any of the following symptoms:
hesitancy (difficulty in
starting to pass urine,
a weak stream,
the need to strain to pass
urine,
the feeling that your bladder
isn't empty after urination,
the need to pass urine
urgently,
frequent trips to the toilet,
including having to get up several times in the night,
feeling a burning sensation or pain when passing urine.
Diagnosis
Your doctor will ask you questions about
your symptoms and your general health. You may be asked to fill in a urination questionnaire to help work out the severity of
your symptoms.
A digital rectal examination (
Your doctor will also feel your abdomen
to find out if the bladder is distended. A distended bladder may indicate that
you are not completely emptying it (chronic urinary retention, which is
painless).
Other tests will be carried out to make
sure that your urinary problems are due to BPH and not other conditions. A
urine test will be done to check for infection or blood. Blood tests, including
a prostate specific antigen (PSA) test may be carried out. This measures the
amount of an enzyme produced by the prostate. High levels of the enzyme can
indicate prostate cancer. Other blood tests include one to assess your kidney
function and another for blood sugar to check for diabetes. Both of these
problems can cause urinary symptoms.
Other tests
Less common tests may include: urine flow
tests; ultrasound to measure urine left in the bladder and to check for bladder
stones; urodynamic measurements using a catheter inserted into the bladder to
measure the pressure of urine there; and transrectal ultrasonography (TRUS)
where an ultrasound probe is passed into the rectum to give a view of the
prostate.
A biopsy (samples of the prostate) may be
collected using a needle to check for cancerous cells.
Treatment
The mainstays of treatment for BPH are
drugs and surgery. However, as any treatment can have unwanted effects, some
men with mild symptoms opt for "watchful waiting", where no treatment
is undertaken. Instead the situation is monitored closely with routine
check-ups. If symptoms deteriorate, it is then possible to opt for treatment.
Drug treatment
There are two main classes of drugs that
are prescribed for BPH: alpha-blockers and 5-alpha-reductase inhibitors.
Alpha-blockers
Work by relaxing the muscles at
the neck of the bladder and in the prostate. In this way they reduce the
pressure on the urethra and so help increase the flow of urine. They do not
cure BPH but help to alleviate some of the symptoms.
Around 60% of men find symptoms
improve significantly within the first 2-3 weeks of treatment with an
alpha-blocker. There are several different alpha blockers. Currently, these are
alfuzosin (Xatral), doxazosin (Cardura), indoramin (Doralese), prazosin
(Hypovase), terazosin (Hytrin BPH), and tamsulosin (Flomax MR). Some of these
drugs can also be used to treat high blood pressure. The most common
side-effects of alpha-blockers are tiredness, dizziness and headaches.
5-alpha-reductase inhibitors
These drugs work by inhibiting the
production of a hormone called DHT, which contributes to prostate enlargement.
Finasteride (Proscar) is the most commonly used drug of this type for BPH.
Unlike alpha blockers, 5-alpha- reductase inhibitors are able to reverse BPH to
some extent and so may delay your need for surgery.
Potential side-effects of
finasteride include a reduced sex drive and difficulty in maintaining an
erection. Several months of treatment may be needed before the benefit is
noticed.
Plant extracts
A number of plant extracts are
popularly used to alleviate BPH, although formal evidence that they are
effective is often scanty. However, there is some scientific evidence that an
extract of saw palmetto (called Serenoa repens) can be beneficial. If you
decide to try a plant remedy, it's always best to discuss this first with your
doctor or pharmacist as interactions with conventional medicines are possible.
Surgery
There are three main surgical options for
BPH:
TURP
Transurethral resection of the
prostate (TURP) is the most common operation for BPH. The procedure is usually
done under a general anaesthetic. A long thin instrument called a resectoscope
is passed into the urethra. With a light source and lens on the end it acts as
a telescope, allowing the surgeon to view the prostate either directly or on a
video monitor. A precisely controlled electric current, applied by a loop of
wire at the end of the resectoscope, is used to shave off sections of the
enlarged prostate. See the separate BUPA fact sheet on TURP for further
details.
TURP is an effective procedure
with over 90% of men reporting an improvement after the operation. However, as
with any surgical procedure there is a risk of side-effects and complications.
A common side-effect of this procedure is retrograde ejaculation - where semen
passes into the bladder during orgasm instead of out of the penis. This is sometimes
called a "dry orgasm". Retrograde ejaculation is usually not a
problem, although it may reduce fertility. Complications of the operation can
include urinary incontinence or damage to the urethra, resulting in a
"stricture" that can itself cause difficulty passing urine.
TUIP
Transurethral incision of the
prostate (TUIP) may be appropriate for men who have a less enlarged prostate.
It is a quicker operation than a TURP and involves removing less tissue. It is
performed under general or spinal anaesthetic. As with a TURP an instrument is
passed up through the penis, but instead of removing a portion of the prostate,
small cuts are made in the neck of the bladder and the prostate. This reduces
the obstruction of the flow of urine.
Open prostatectomy
Open prostatectomy is only
recommended for men whose prostate is very large. It is a major operation and
carried out under a general anaesthetic. An incision is made in the lower
abdomen in order to remove the central part of the prostate.
Other treatments
Laser therapy (using a laser probe to cut
away prostate tissue) and transurethral microwave thermotherapy (using heat to
remove some of the prostate tissue via a probe) are becoming more common in the
treatment of BPH.
Prevention
Although it is not known why only some men develop BPH, it is clear that advancing age is the prime risk factor. Eating a diet that is low in fat and rich in fruit and vegetables (five portions per day) may well help to reduce the risk of prostate cancer and has been proven to bring other health benefits. You should visit your doctor promptly if you develop urinary problems as early treatment is likely to be more simple.
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