Benign Prostatic Hypertrophy

Thomas Edison State College

Men face many health risks as they age. It is important for men to have regular check-ups with their primary care physician. One area men should pay close attention to is the prostate. The prostate is a male reproductive gland that produces the fluid that carries sperm during ejaculation. It surrounds the urethra, the tube through which urine passes out of the body. As men age, past the age of fifty, it is common for the prostate to become enlarged, a condition known as BPH. BPH stands for benign (non-cancerous) prostatic hyperplasia or hypertrophy. It is a condition where the prostate becomes enlarged making urination more difficult by narrowing the urethra. BPH can be effectively treated by surgery and certain medications. The cause of BPH still remains a mystery. However, there is some research that suggests it is possible that the condition is associated with hormonal changes that occur as men age. The testes produce the hormone called testosterone. Testosterone is converted to DHT and estrogen in certain tissues. High levels of DHT, a testosterone derivative that is involved in prostate growth may accumulate and cause hyperplasia. The problem that remains is how and why the levels of DHT increase. (Medline Plus) Another reason they feel hormones play a role is because if the testicles are removed after the development of BPH, the prostate begins to shrink in size. Whatever the cause, an enlarging prostate gradually narrows the urethra and obstructs the flow of urine. BPH is part of the aging process. Actual changes in the prostate may start as early as the 30s but take place very gradually. Changes are so gradual that significant enlargement and symptoms usually do not appear until after age 50. A small amount of prostate enlargement is present in men over the age of 40. After the age of 50, the chances of the prostate enlarging and causing urinary symptoms become progressively greater. Men over the age of 80 have a 90% chance of displaying BPH symptoms. Having a blood relative such as a father or brother with prostate problems means you’re more likely to have the problems as well. Prostate enlargement is also found to be more common in white and black men. It is a rare condition in African, Chinese and other Asian populations for reasons that are unknown. BPH is so common it has been claimed that the annual cost in caring for men with BPH was more than 4 billion dollars. There are many ways to treat BPH there are medications and surgical options available. Some of the medications available are known as alpha-adrenergic blockers. They work to relax the muscle tissue surrounding the bladder outlet and lining the wall of the urethra to permit urine to flow more freely. These medications help improve obstructive symptoms. They do not stop the prostate from enlarging. Medications such as Finasteride and dutasteride do shrink the prostate and may delay the need for surgery. Finasteride and dutasteride lower the levels of hormones produced by the prostate and thus reducing the size of the prostate gland. It typically takes 3-6 months before you notice much improvement with finasteride and dutasteride. The other medication that remains controversial is the use of antibiotics. Antibiotics are prescribed to treat chronic prostatitis which may accompany BPH. Some patients have noted relief of the BPH symptoms after a course of antibiotics. When drugs have failed to control the symptoms of BPH other options are still available. Other options for BPH include intermediate treatments or less invasive procedures. These treatments are used when the physician does not feel that conventional surgery is yet needed. These treatments use different forms of heat to destroy prostate tissue, including: radiofrequency energy- transurethral needle ablation (TUNA), microwave energy – transurethral microwave thermotherapy (TUMT), electrical current – transurethral electrovaporization (TUVP), hot water – water –induced thermotherapy (WIT) and laser – interstitial laser coagulation (ILC) and holmium laser enucleation of the prostate (HoLEP). Surgery may be recommended if you have incontinence, recurrent blood in the urine, urinary retention, recurrent UTI’s, kidney failure or bladder stones. There are a few surgical options for BPH. The type of procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland. The first procedure is called a transurethral resection of the prostate also known as TURP. This is the most common and most proven treatment for BPH. A TURP is performed by inserting a scope through the penis and removing the prostate piece by piece. The next surgical option is known as transurethral incision of the prostate also known as TUIP. The procedure is similar to a TURP, but is usually performed to men who have a smaller prostate. This procedure does not usually require a hospital stay. Similar to a TURP, a scope is inserted through the penis until the prostate is reached. Then a small incision is made in the prostate tissue to enlarge the opening of the urethra and bladder outlet. Finally, the last type most invasive surgery is known as a simple prostatectomy and is performed under general anesthesia and requires a hospital stay of 5-10 days. An incision is made through the abdomen or perineum and the inner part of the gland is removed and the outer portion is left behind. Robot guided prostatectomy is a newer technique but the technology is not widely available. Surgery is typically considered the cure for BPH. Alternative treatments such as Saw Palmetto a herbal supplement has been shown to stop or decrease the hyperplasia of the prostate. Symptoms of BPH are said to have improved after taking the herb for two months, but continued use is recommended. This herb has been used by millions of men to ease BPH symptoms and is often recommended as an alternative to medication. There is no evidence that this popular herb is actually effective more studies are needed. People who use this herb should consult their doctor for continued use. According to Review in Urology,
“BPH is the fifth most prevalent non-cancer related disorder among men aged 50 years and older, and accounts for the seventh highest 1 year disease-specific medical costs. Approximately 1 in 5 men with BPH will have a significant clinical event (i.e., an episode of prostate-related acute urinary retention or prostate surgery) within 1 year of initiating treatment for the condition. It is estimated that the direct costs of medical services provided at hospital inpatient and outpatient settings, emergency departments and physician’s offices for BPH management in the US exceed 1.1 billion annually. The per-person incremental cost for a primary diagnosis of BPH was determined to be $2,577. With doctors increasingly prescribing medical therapy, BPH has become a chronic condition requiring ongoing medication and medical care, with significant economic consequences. Long term cost data call into question the appropriateness of medical therapy as the initial treatment approach for all men with moderate to severe BPH symptoms. The urologic community has begun to reconsider the possibility that for many patients’ initial surgery, rather than medical treatment, might be economically wiser in the long term. As a result, there has been renewed interest in novel surgical techniques and minimally invasive surgical therapies.” According to medline-plus, an article on enlarged prostate, they state “whether or not BPH is caused by hormonal changes in gaining men, there is no known way of preventing it.” However it is always suggested that proper diet and exercise and well regular follow up exams at your doctors are very important. If BPH is caught before the prostate has become grossly enlarged, the risk of complications is minimal. According to the Urology Channel, The best protection against prostate problems is to have regular medical check-ups that include a careful prostate exam. They also advise that regular check-ups are important even for men who have had surgery for BPH. Surgery does not protect against prostate cancer because typically only part of the prostate is removed. In all seneros, the sooner the problem is detected the sooner treatment can begin and the better the outcome.

For more information on the health problem refer to the following websites:
Medline. (2009). Enlarged Prostate. Retrieved November 29, 2010, from http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm#Definition

Urology Channel. (1998). BPH Overview, Anatomy of the Prostate. Retrieved November 30, 2010, from http://www.urologychannel.com/prostate/bph/index.shtml

References
Hollingsworth, John MD., Wei, John, MD. (2006). Reviews in Urology Economic Impact of Surgical Intervention in the Treatment of Benign Prostatic Hyperplasia. VOL 8, SUPPL 3

Mayo Clinic. (2009). Prostate Gland Enlargement. Retrieved November 29, 2010, from http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027

Medicinenet. BPH. Retrieved, November 28, 2010, from http://www.medicinenet.com/benign_prostatic_hyperplasia/article.htm

Medicinenet. ( 2006). Health Tips for Healthy Living. Retrieved, November 28, 2010, from http://www.medicinenet.com/healthy_living/article.htm