WHAT IS THE PROSTATE?
The prostate is a small gland that is part of the male reproductive system. A normal, healthy prostate is about the size and shape of a walnut.
Its position in the body is just between the bladder and the base of the penis. The urethra—the tube that carries urine from the bladder and semen
out through the penis—runs through the center of the prostate. The function of the prostate is to produce some of the seminal fluid that nourishes
and carries sperm from the testicles and out of the penis during ejaculation. Because of its position, an enlarged prostate can squeeze the urethra,
causing urinary problems.
Its position in the body is just between the bladder and the base of the penis. The urethra—the tube that carries urine from the bladder and semen
out through the penis—runs through the center of the prostate. The function of the prostate is to produce some of the seminal fluid that nourishes
and carries sperm from the testicles and out of the penis during ejaculation. Because of its position, an enlarged prostate can squeeze the urethra,
causing urinary problems.
WHY ARE PROSTATE CHECK-UPS IMPORTANT?
As a man gets older, especially after age 50, it is important to be screened to identify any abnormalities. Signs of prostate problems can include difficulties urinating, sexual problems or pain. If a man has symptoms that are bothersome, he should talk to his doctor.
WHAT IS BPH?
BPH is a noncancerous (benign) growth of the cells within the prostate gland. BPH is common in older men. By age 60, more than half of men have BPH. By age 85, about 90 percent of men have BPH, but only 30 percent of men will be bothered by their symptoms. BPH affects the inside part of the prostate first. Enlargement frequently causes a gradual squeezing of the urethra where it runs through the prostate. Sometimes this causes difficulty in urinating or other urinary problems. BPH generally does not interfere with sexual functioning.BPH is not cancer nor does it lead to cancer. However, it is possible for a man to have both BPH and prostate cancer.
WHAT ARE THE SYMPTOMS OF BPH?
Many men with BPH may have no significant symptoms. However, symptoms begin by interfering with urinary function. Some characteristic
symptoms can include:
• a weak or slower urinary stream
• a sense your bladder is not empty
• a delay in starting urination
• frequent urination
• urinary urgency
• awakening frequently at night to urinate
• a urinary stream that starts and stops
• the need to strain to urinate
These symptoms are caused by the way in which BPH affects the urethra and, later on, the bladder. In the early phase of prostate enlargement, the bladder muscle is able to force urine through the narrowed urethra by contracting more forcefully. Over time, the bladder muscle gradually becomes stronger, thicker and overly sensitive, causing a need to urinate frequently.In some cases, as prostate enlargement progresses and the urethra is squeezed more tightly, the bladder cannot overcome the problems created by the greatly narrowed urethra. When this happens, the bladder cannot empty completely. If a urinary tract infection develops, there may also be burning or pain during urination. In a small percentage of men, blockage from BPH may lead to repeated urinary tract infections, sudden and complete inability to urinate at all (acute urinary retention), or gradual bladder and/or kidney damage. Fortunately, kidney damage from BPH is quite rare.
symptoms can include:
• a weak or slower urinary stream
• a sense your bladder is not empty
• a delay in starting urination
• frequent urination
• urinary urgency
• awakening frequently at night to urinate
• a urinary stream that starts and stops
• the need to strain to urinate
These symptoms are caused by the way in which BPH affects the urethra and, later on, the bladder. In the early phase of prostate enlargement, the bladder muscle is able to force urine through the narrowed urethra by contracting more forcefully. Over time, the bladder muscle gradually becomes stronger, thicker and overly sensitive, causing a need to urinate frequently.In some cases, as prostate enlargement progresses and the urethra is squeezed more tightly, the bladder cannot overcome the problems created by the greatly narrowed urethra. When this happens, the bladder cannot empty completely. If a urinary tract infection develops, there may also be burning or pain during urination. In a small percentage of men, blockage from BPH may lead to repeated urinary tract infections, sudden and complete inability to urinate at all (acute urinary retention), or gradual bladder and/or kidney damage. Fortunately, kidney damage from BPH is quite rare.
HOW IS BPH DIAGNOSED?
Your doctor will ask you questions (or have you fill out a questionnaire) about your medical history and about any symptoms you are having,
particularly problems with urination. The description you provide of your symptoms is one of the most important parts of the evaluation for BPH.
Your urine will be examined under a microscope to detect blood in the urine or an infection in your urinary tract or prostate. The doctor will then perform a physical examination. The prostate is an internal organ so the physician cannot look at it directly. Because the prostate lies in front of the rectum, however, the doctor can feel it by inserting a gloved, lubricated finger into the rectum. This simple procedure is called a digital rectal examination (DRE). This examination allows your doctor to estimate whether your prostate is enlarged or has lumps or other areas of abnormal texture. While this examination may produce some brief discomfort for you, it should cause neither damage nor significant pain. Because only the central core of the prostate tissue may be enlarged in BPH, patients can be bothered by BPH symptoms even when the prostate does not feel enlarged. Many men who have an enlarged prostate have no symptoms. The digital rectal examination can detect not only BPH but also prostate cancer, one of the leading causes of cancer death in American men. For this reason, the American Urological Association recommends a yearly prostate screening for all men over age 50 who are expected to live at least 10 more years. This includes a DRE and a blood test for prostate-specific antigen (PSA). For men at higher risk for prostate cancer, African American men or men with a family history of prostate cancer, the tests should begin starting at age 45. Yearly checkups can help you avoid the potentially serious results of prostate disease.
particularly problems with urination. The description you provide of your symptoms is one of the most important parts of the evaluation for BPH.
Your urine will be examined under a microscope to detect blood in the urine or an infection in your urinary tract or prostate. The doctor will then perform a physical examination. The prostate is an internal organ so the physician cannot look at it directly. Because the prostate lies in front of the rectum, however, the doctor can feel it by inserting a gloved, lubricated finger into the rectum. This simple procedure is called a digital rectal examination (DRE). This examination allows your doctor to estimate whether your prostate is enlarged or has lumps or other areas of abnormal texture. While this examination may produce some brief discomfort for you, it should cause neither damage nor significant pain. Because only the central core of the prostate tissue may be enlarged in BPH, patients can be bothered by BPH symptoms even when the prostate does not feel enlarged. Many men who have an enlarged prostate have no symptoms. The digital rectal examination can detect not only BPH but also prostate cancer, one of the leading causes of cancer death in American men. For this reason, the American Urological Association recommends a yearly prostate screening for all men over age 50 who are expected to live at least 10 more years. This includes a DRE and a blood test for prostate-specific antigen (PSA). For men at higher risk for prostate cancer, African American men or men with a family history of prostate cancer, the tests should begin starting at age 45. Yearly checkups can help you avoid the potentially serious results of prostate disease.
WHEN TO SEE A SPECIALIST
Your doctor may treat your initial BPH symptoms. However, if your symptoms become more bothersome or if you have blood in your urine,
neurologic disease, recurring urinary infections, bladder stones or the complete inability to urinate, you and your doctor may decide that your BPH
symptoms should be treated by a urologist. A urologist is a doctor who specializes in diseases of the male and female urinary tracts and the male
reproductive system. You should also be referred to a urologist if your symptoms do not respond to drug therapy or if your symptoms become more severe. The urologist will review the severity of your symptoms by asking you questions about your medical history. You will also probably have
another urinalysis and DRE screening.
neurologic disease, recurring urinary infections, bladder stones or the complete inability to urinate, you and your doctor may decide that your BPH
symptoms should be treated by a urologist. A urologist is a doctor who specializes in diseases of the male and female urinary tracts and the male
reproductive system. You should also be referred to a urologist if your symptoms do not respond to drug therapy or if your symptoms become more severe. The urologist will review the severity of your symptoms by asking you questions about your medical history. You will also probably have
another urinalysis and DRE screening.
WHEN SHOULD BPH BE TREATED?
BPH commonly requires treatment if the symptoms are severe enough to be bothersome or if the function of the urinary tract is seriously affected. An enlarged prostate alone is not sufficient reason to consider treatment. A man and his doctor should talk about the benefits and risks of treatment and whether some of the treatment options are limited by other medical conditions. when a diagnosis of BPH is determined. Adopting a healthy lifestyle and diet can be helpful in reducing symptoms in some men. Some modifications include decreasing total fluid intake, decreasing alcohol and caffeine, and emptying your bladder on a scheduled plan.If you have BPH but your symptoms are not bothersome, you and your doctor may decide on a course of “watchful waiting.” This means that you will be examined one or more times a year to make certain that you are not developing complications from BPH. Watchful waiting is not active treatment. In some cases, symptoms lessen without active treatment. If however, your symptoms become more bothersome over time, talk to your doctor to discuss other treatments.
WILL BPH AFFECT MY LIFESTYLE?
The good news is that you need not suffer from bothersome BPH symptoms. Such symptoms are not a necessary part of getting older. They can
be treated, and the number of treatment choices is increasing every year. If you are bothered by urinary symptoms, see your doctor for a prostate
checkup. Most importantly: If you are over age 50 (45 for African Americans or men with a family history of prostate cancer), you should see your doctor for a yearly prostate checkup whether or not you have symptoms. Prostate cancer, the most serious prostate disease, is often symptomless in the early stages when it is most treatable.
be treated, and the number of treatment choices is increasing every year. If you are bothered by urinary symptoms, see your doctor for a prostate
checkup. Most importantly: If you are over age 50 (45 for African Americans or men with a family history of prostate cancer), you should see your doctor for a yearly prostate checkup whether or not you have symptoms. Prostate cancer, the most serious prostate disease, is often symptomless in the early stages when it is most treatable.
BPH Treatments
The treatment you choose will be based on how bad your symptoms are and how much they bother you. Your doctor will also take into account other medical problems you may have. Treatment options include "watchful waiting," lifestyle changes, medicines, or surgery.
If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better. If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.
SELF-CARE
For mild symptoms:
MEDICINES
Alpha 1-blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha 1-blockers notice improvement in their symptoms. .
Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.
Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.
SURGERY
Prostate surgery may be recommended if you have:
Transurethral resection of the prostate(TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.
Simple prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion is left behind. This is a long procedure. Most people need to stay in the hospital for 5 to 10 days. This treatment is most often done on men who have very large prostate glands.
Most men who have prostate surgery have improvement in urine flow rates and symptoms.
Other, less-invasive procedures use heat to destroy prostate tissue. None have been proven to be better than TURP. Patients who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:
If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better. If you have BPH, you should have a yearly exam to monitor your symptoms and see if you need changes in treatment.
SELF-CARE
For mild symptoms:
- Urinate when you first get the urge. Also, go to the bathroom when you have the chance, even if you don't feel a need to urinate.
- Avoid alcohol and caffeine, especially after dinner.
- Don't drink a lot of fluid all at once. Spread out fluids during the day. Avoid drinking fluids within 2 hours of bedtime.
- Try NOT to take over-the-counter cold and sinus medicines that contain decongestants or antihistamines. These drugs can increase BPH symptoms.
- Keep warm and exercise regularly. Cold weather and lack of physical activity may worsen symptoms.
- Learn and perform Kegel exercises (pelvic strengthening exercises).
- Reduce stress. Nervousness and tension can lead to more frequent urination.
MEDICINES
Alpha 1-blockers are a class of drugs that are also used to treat high blood pressure. These medicines relax the muscles of the bladder neck and prostate. This allows easier urination. Most people who take alpha 1-blockers notice improvement in their symptoms. .
Finasteride and dutasteride lower levels of hormones produced by the prostate. These drugs also reduce the size of the gland, increase urine flow rate, and decrease symptoms of BPH. You may need to take these medicines for 3 to 6 months before you notice symptoms getting better. Possible side effects include decreased sex drive and impotence.
Antibiotics may be prescribed to treat chronic prostatitis (inflammation of the prostate), which may occur with BPH. BPH symptoms improve in some men after a course of antibiotics.
SURGERY
Prostate surgery may be recommended if you have:
- Incontinence
- Recurrent blood in the urine
- Inability to fully empty the bladder (urinary retention)
- Recurrent urinary tract infections
- Decreasing kidney function
- Bladder stones
Transurethral resection of the prostate(TURP): This is the most common and most proven surgical treatment for BPH. TURP is performed by inserting a scope through the penis and removing the prostate piece by piece.
Simple prostatectomy: An open prostatectomy is usually performed using general or spinal anesthesia. An incision is made through the abdomen or perineum (the area behind the scrotum). Only the inner part of the prostate gland is removed. The outer portion is left behind. This is a long procedure. Most people need to stay in the hospital for 5 to 10 days. This treatment is most often done on men who have very large prostate glands.
Most men who have prostate surgery have improvement in urine flow rates and symptoms.
Other, less-invasive procedures use heat to destroy prostate tissue. None have been proven to be better than TURP. Patients who receive these procedures are more likely to need surgery again after 5 or 10 years. However, these procedures may be a choice for:
- Younger men (many of the less-invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk with TURP is not very high)
- Elderly patients
- Patients with severe medical conditions, including uncontrolled diabetes, cirrhosis, alcoholism,psychosis, and serious lung, kidney, or heart disease
- Men who are taking blood-thinning drugs