Benign Prostate Enlargement, also known as Benign Prostatic Hyperplasia (BPH), is a common condition that affects many men as they age. The prostate is a gland that is part of the male reproductive system and surrounds the urethra, the tube that carries urine from the bladder out of the body. When the prostate gland grows larger than it should, it can cause various symptoms that can impact quality of life.
What are the causes of Benign Prostatic Enlargement?
While the exact cause of BPH is not fully understood, several factors have been identified as potential contributors.
One of the primary factors is hormonal changes that occur as men age. BPH is much more common in men over the age of 50. Specifically, a decrease in testosterone and an increase in oestrogen can lead to an overgrowth of prostate tissue, which can cause the gland to enlarge.
Other potential contributing factors include genetics, as there is evidence to suggest that BPH may run in families. Additionally, lifestyle factors such as diet and exercise can play a role, as can certain medical conditions like obesity and diabetes.
What are the symptoms and warning signs of Benign Prostatic Enlargement?
As men age, their prostate gland can grow, leading to benign prostatic enlargement, potentially causing uncomfortable and sometimes painful symptoms. Here are some of the signs and symptoms of benign prostatic enlargement to look out for:
- Frequent Urination: One of the most common BPH symptoms is urinating frequently, especially at night. This happens because the enlarged prostate gland presses against the urethra, making it difficult for urine to pass through. As a result, the bladder may not be able to hold as much urine as it used to, or not be able to empty as efficiently, leading to more frequent trips to the bathroom.
- Difficulty Urinating: Along with the need to urinate more frequently, BPH can make it harder to start (hesitancy) or cause a weak urine stream. You may also feel like you need to strain or push to empty your bladder, which can be uncomfortable or painful.
- Incomplete Emptying of the Bladder: Even after urinating, you may still feel like you need to go again. This happens because the prostate gland can block the urethra, preventing all the urine from emptying from the bladder.
- Blood in the Urine: In some cases, BPH can cause blood to appear in the urine. This is usually not always a serious issue, but it should be evaluated to rule out other conditions.
- Urinary Tract Infections: When the bladder does not empty completely, it can increase the risk of urinary tract infections (UTIs). UTIs can cause pain and discomfort and, if left untreated, can lead to more serious health problems.
How is Benign Prostatic Enlargement diagnosed?
If you are experiencing any symptoms of BPH, your doctor may recommend some tests to diagnose the condition.
Digital Rectal Exam (DRE): One of the first tests that doctors use to diagnose BPH is a digital rectal exam (DRE). During this exam, the doctor inserts a lubricated, gloved finger into the rectum to feel the prostate gland. The doctor can detect any enlargement, lumps, or other abnormalities in the gland.
Prostate-Specific Antigen (PSA) Test: A PSA test measures the amount of PSA in your blood. PSA is a protein produced by the prostate gland. A high PSA level can indicate prostate cancer or BPH. However, a normal PSA level does not always mean you do not have BPH.
Urine Flow Study: Your doctor may also conduct a urine flow study, which measures how fast urine flows from your bladder. This test helps determine if the prostate gland is obstructing urine flow. During the test, you will be asked to urinate into a special device that measures the rate of urine flow.
Post-Void Residual (PVR) Measurement: A PVR measurement determines the amount of urine left in your bladder after you urinate. This test helps determine if the prostate gland is obstructing the flow of urine out of the bladder. Your doctor may perform this test using ultrasound or a catheter.
Transrectal Ultrasound (TRUS): A transrectal ultrasound (TRUS) is a non-invasive test that uses high-frequency sound waves to create an image of the prostate gland. The doctor inserts a small probe into the rectum, which emits sound waves that bounce off the prostate gland and create an image on a monitor. This test can help determine the size and shape of the prostate gland.
Cystoscopy: A cystoscopy is a procedure in which the doctor inserts a thin, flexible tube with a camera on the end into the urethra to view the inside of the bladder and urethra. This test helps determine if there are any obstructions or abnormalities in the urinary tract.
What are the treatment options for Benign Prostatic Enlargement?
If you have been diagnosed with BPH, there are various treatment options available that can help manage the symptoms and improve your quality of life. In this article, we will discuss the different treatment options for BPH.
Watchful Waiting: For men with mild symptoms of BPH, watchful waiting may be an appropriate treatment option. This approach involves monitoring the symptoms without any active treatment. Your doctor may recommend lifestyle changes such as avoiding caffeine and alcohol, reducing fluid intake before bedtime, and performing pelvic floor exercises.
Medications: There are several medications that can help manage the symptoms of BPH. Alpha-blockers, such as tamsulosin and alfuzosin, relax the prostate and bladder neck muscles, making urination easier. 5-alpha-reductase inhibitors, such as finasteride and dutasteride, reduce the size of the prostate gland. Combination therapy, which involves using both alpha-blockers and 5-alpha-reductase inhibitors, may be more effective in managing symptoms.
Minimally Invasive Procedures: Minimally invasive procedures may be an appropriate treatment option for men with moderate to severe symptoms. These procedures are less invasive than traditional surgery and can be performed on an outpatient basis. They include:
Transurethral Resection of the Prostate (TURP): TURP is a surgical procedure that involves removing a portion of the prostate gland using a special instrument inserted through the urethra. A small camera is also inserted during the procedure to allow the surgeon to see the prostate gland. The instrument then removes the excess tissue, allowing for improved urine flow. TURP is a highly effective procedure that has been used for decades to treat BPH. It is typically recommended for men with larger prostates and severe symptoms.
Greenlight Laser Therapy: Greenlight laser therapy is a minimally invasive surgical procedure that uses laser energy to remove excess prostate tissue. During the procedure, a small camera is inserted through the urethra, and a laser fibre is used to remove the excess tissue. Greenlight laser therapy is a safe and effective procedure that has been shown to significantly improve urinary symptoms in men with BPH. It is typically recommended for men with smaller to moderate-sized prostates.
Holmium Laser Enucleation of the Prostate (HoLEP): HoLEP is a minimally invasive surgical procedure that uses a laser to remove the entire prostate gland. During the procedure, a small camera is inserted through the urethra, and the laser is used to carefully remove the prostate tissue. HoLEP is a highly effective procedure that has been shown to significantly improve urinary symptoms in men with BPH. It is typically recommended for men with larger prostates and severe symptoms.
Transurethral needle ablation (TUNA): A procedure that uses radiofrequency energy to heat and destroy prostate tissue.
Prostate Artery Embolisation (PAE): PAE is a minimally invasive procedure that involves blocking the blood supply to the prostate gland, causing it to shrink. During the procedure, a small catheter is inserted through the groin and threaded into the arteries that supply blood to the prostate gland. Tiny particles are then injected into the arteries, blocking the blood flow and causing the prostate to shrink.
Rezum: Rezum is a minimally invasive procedure that uses steam to shrink the prostate gland. During the procedure, a small device is inserted into the urethra and directed toward the prostate gland. The device then delivers a controlled amount of steam to the prostate tissue, causing it to shrink over time.
Urolift: Urolift is a minimally invasive procedure that involves placing small implants in the prostate gland to hold open the urethra, making it easier to urinate. During the procedure, a small device is inserted through the urethra and directed toward the prostate gland. Small implants are then placed in the prostate tissue to hold the prostate gland away from the urethra, reducing the pressure and allowing for improved urine flow.
Which is the best treatment for BPH?
Several treatment options are available for BPH. The best treatment will depend on the individual’s symptoms, prostate size, overall health, and lifestyle priorities.
For men with mild to moderate symptoms, lifestyle changes such as limiting caffeine and alcohol intake and increasing physical activity may help alleviate symptoms. Medications such as alpha-blockers and 5-alpha-reductase inhibitors may also be prescribed to help relax the prostate gland and reduce its size.
Surgical procedures may be recommended for men with more severe symptoms or larger prostate sizes. Transurethral resection of the prostate (TURP), Greenlight laser therapy, and Holmium laser enucleation of the prostate (HoLEP) are the three most commonly used surgical procedures to treat BPH. These procedures are highly effective, but recovery time can vary.
Newer, minimally invasive procedures such as Prostate Artery Embolisation (PAE), Rezum, and Urolift are also gaining popularity due to their less invasive nature and potentially shorter recovery times but perhaps with less or shorter lasting efficacy.
The best treatment option for BPH depends on the individual’s symptoms, overall health, and lifestyle priorities. Discussing all treatment options and their potential side effects with a urologist is important to determine the best course of action.
Can BPH turn into cancer?
Benign Prostatic Hyperplasia (BPH) is a non-cancerous condition that affects the prostate gland. While BPH itself does not turn into cancer, some symptoms of BPH can mimic those of prostate cancer, leading to concerns about the possibility of cancer.
Prostate cancer is a separate condition from BPH, and having BPH does not increase a man’s risk of developing prostate cancer. However, while BPH itself does not turn into cancer, it is possible for men with BPH to also have prostate cancer. This is because both conditions can cause an increase in prostate-specific antigen (PSA) levels, making it difficult to distinguish between BPH and prostate cancer based on symptoms and PSA levels alone.
It is important for men with BPH to have regular prostate exams and PSA testing to monitor any changes in their prostate gland and to detect any potential prostate cancer. Men with a family history of prostate cancer or other risk factors for prostate cancer should be especially vigilant about monitoring their prostate health.
In conclusion, Benign Prostate Enlargement is a common condition that can impact quality of life for men as they age. Various treatment options are available to alleviate symptoms and improve overall health outcomes. If you are experiencing symptoms of BPH, don’t hesitate to speak with your GP or urologist to discuss potential treatment options.
Author: Mr Neil Haldar MBBS MD FRCS
Consultant Urological Surgeon
The Pelvic Specialists