Is Your Prostate Normal?

A Visual Guide to Enlarged Prostate (BPH)

  

What is an Enlarged Prostate?

An enlarged prostate occurs when a man's prostate gland slowly grows bigger as he ages. More than half of men over age 60 have this condition, also called benign prostatic hyperplasia (BPH). Some men have symptoms and others don't. The exact causes are unknown, but one thing is sure: BPH is not cancer and it does not lead to cancer. The prostate sits below the bladder and produces fluid for semen.

Symptom: Frequent Need to Urinate

Do you have to pee more often these days? Especially at night, when you're trying to sleep? That’s a common symptom of BPH. It happens when the growing prostate presses on the urethra, the tube that carries urine out of your body. The bladder has to contract more strongly to get urine out. As a result, the bladder may start to contract even when it only contains a little urine, which makes you get the urge to go more often.

Symptom: Difficulty Urinating

With an enlarged prostate, it may take you longer to get the flow of urine going, and the flow may be weaker than it used to be. You may dribble urine or feel as if there's still some inside even though you're finished urinating. These symptoms happen because the pressure on the urethra makes it narrow, so your bladder must work harder to pass urine.

Symptom: Inability to Urinate

This can happen when advanced BPH blocks your urethra entirely -- or as a result of a bladder infection. Bladder muscles also may become too weak to force urine out of the body. From any cause, it can lead to permanent kidney damage. You can prevent this by seeing your doctor as soon as you notice symptoms. If you suddenly can't urinate, go to a hospital emergency room immediately.

Who Gets an Enlarged Prostate?

Most men get an enlarged prostate as they age. The prostate gland grows throughout most of a man's life, first at puberty and then from about age 25 on. It usually doesn't cause symptoms before the age of 40. But by age 85, up to 90% of men have symptoms. Only about a third of men with an enlarged prostate are bothered by symptoms.

What Causes the Prostate to Grow?

No one knows for sure. It is believed that different hormones such as testosterone, dihydrotestosterone (DHT), and estrogen may play a role. It is also unclear why some men with BPH will have symptoms while others do not. Vasectomy and sex do not raise the risk of having BPH.

Getting Diagnosed Early

BPH symptoms can be similar to those of other conditions. If you have symptoms, it's important to see your doctor, who can rule out other possible causes, such as an infection or cancer.

Ruling Out Prostate Cancer

Symptoms of BPH can be scary because some of them are the same as those for prostate cancer. But an enlarged prostate is much more common than prostate cancer. And if you have BPH, you are no more likely than other men to develop prostate cancer. Because the two conditions share some symptoms and can occur at the same time, however, your doctor will need to evaluate you.

How Will Your Doctor Diagnose BPH?

Your doctor will ask about your symptoms and may do these tests:

• A digital rectal exam to check for prostate enlargement or irregularities
• Lab tests of urine or blood
• An ultrasound scan and a prostate biopsy
• A urine flow study to measure the strength of your urine stream
• A cytoscopy, in which a thin tube inserted through the penis allows the doctor to view and evaluate the urethra and the bladder 

When Does BPH Need to Be Treated?

Whether you need to treat BPH depends on your symptoms. If you have none or your symptoms are not severe, you probably won't need treatment. But recurring infections, kidney damage, difficulty urinating, or a leaky bladder can really impact your quality of life. In these cases, medications or surgery may help.

Treatment: Watchful Waiting

If your symptoms are mild, you and your doctor may choose to monitor your condition. With this approach, you'll probably need to visit the doctor one or more times a year. And if your symptoms don't get worse, that may be all you ever need to do. Up to a third of all mild cases of BPH have symptoms that clear up on their own.

reatment: Lifestyle Changes

These strategies may help:

• Cut down or cut out alcohol and caffeine.
• Drink small amounts all day rather than large amounts all at once.
• Avoid fluids at bedtime.
• Avoid decongestants and antihistamines.
• Go when you have the urge and when a bathroom is handy.
• Double void: Empty your bladder, wait a moment, then try to empty it again.
• Relax. Stress can trigger the urge to pee.
• Exercise regularly.

reatment: Drugs for Urine Flow

Often prescribed for high blood pressure, alpha blockers help relax the muscles in the prostate gland and bladder. This allows urine to flow more freely. Alpha blockers approved by the FDA to treat BPH include alfuzosin, doxazosin, tamsulosin, and terazosin.

Treatment: Drugs to Slow Prostate Growth

A class of medications known as 5-alpha reductase inhibitors may stop the prostate from growing or even shrink it in some men. They lower the production of DHT, a hormone involved in prostate growth. However, these medications -- which include dutasteride and finasteride -- can also lower sex drive and cause erectile dysfunction. And it can take up to a year to feel the benefits.

Treatment: Medicine Combos

Some men benefit from taking more than one medication for their enlarged prostate. In fact, combining a medicine that relaxes the bladder muscles with one that slows prostate growth may work better than either drug alone. Medicines used to manage an overactive bladder may also be added to standard BPH medications.

Treatment: Complementary Medicine

In some studies, saw palmetto extract has shown promise in treating BPH symptoms. These include frequent urination and trouble starting and maintaining flow. Other studies have found it to be no better than a sugar pill. With no clear benefit yet -- and a risk that herbal treatments may interfere with other drugs -- the American Urological Association does not recommend saw palmetto or other complementary medicines for BPH.

Treatment: Less Invasive Procedures

When medication doesn't do the job, a number of procedures can remove excess tissue from the prostate, easing obstruction of the urethra. These outpatient procedures are less invasive than surgery and may take no more than an hour. Two of them -- transurethral needle ablation (TUNA), also known as radiofrequency ablation, and transurethral microwave therapy (TUMT) -- may require temporary use of a catheter after treatment. Other procedures include the use of laser and stenting.

Treatment: Surgery

The most common surgery is a transurethral resection of the prostate, or TURP, which is done under general anesthesia. An instrument is inserted through the tip of the penis and into the urethra to remove parts of the enlarged prostate, relieving pressure on the urethra.

Will BPH Affect My Sex Life?

There is some evidence that older men with severe BPH symptoms may be more likely to have problems in the bedroom, compared to other men their age. Some of the medications commonly used to treat BPH have been associated with problems getting an erection and ejaculating. If you develop sexual issues, talk to your doctor. A change in medications may be enough to correct them.

Living with BPH

Some men never even know they have BPH. Others are never troubled by it. But if you have bothersome symptoms, there are many options for treating them to help you maintain a high quality of life. The most important thing is to see your doctor as soon as you notice symptoms.