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BPH

Benign prostatic hyperplasia (BPH) is an enlarged prostate. The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during most of a man’s life. As you age, your prostate may get larger. Benign prostatic hyperplasia often occurs with the second growth phase.

Normal and Enlarged Prostate
Normal and Enlarged Prostate
Alan Hoofring (Illustrator), National Cancer Institute

As the prostate enlarges, it can then squeeze down on your urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some urine in the bladder. The narrowing of the urethra and urinary retention–the inability to empty the bladder completely–cause many of the problems associated with benign prostatic hyperplasia. BPH is benign. This means it is not cancer. It does not cause nor lead to cancer. But BPH and cancer can happen at the same time.

BPH is common in aging men. About half of all men between the ages of 51 and 60 have BPH. Up to 90% of men over age 80 have BPH.

The Prostate

Male Reproductive Organs
Medical Illustration Copyright © 2015 Nucleus Medical Media, All rights reserved

The prostate is part of the male reproductive system. It is about the size of a walnut and weighs about an ounce. The prostate is below the bladder and in front of the rectum. The prostate goes all the way around a tube called the urethra. The urethra carries urine from the bladder out through the penis. The main job of the prostate is to make fluid for semen. During ejaculation, sperm made in the testicles moves to the urethra. At the same time, fluid from the prostate and the seminal vesicles also moves into the urethra. This mixture-semen-goes through the urethra and out the penis.

What Are The Symptoms of BPH?

With BPH, the prostate gets larger. When it is enlarged, it can irritate or block the bladder. A common symptom of BPH is the need to urinate often. This can be every one to two hours, especially at night.

Other symptoms include:

  • Feeling that the bladder is full, even right after urinating
  • Feeling that urinating “can’t wait”
  • Weak urine flow
  • Dribbling of urine
  • The need to stop and start urinating several times
  • Trouble starting to urinate
  • The need to push or strain to urinate

In severe cases, you might not be able to urinate at all. This is an emergency. It must be treated right away.

How Can BPH Affect Your Life?

In most men, BPH gets worse as you age. It can lead to bladder damage and infection. It can cause blood in the urine. It can even cause kidney damage. Men with BPH should get treated.

What Causes BPH?

The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers believe factors related to aging and the testicles may cause benign prostatic hyperplasia.

Throughout their lives, men produce testosterone, a male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of estrogen within the prostate increases the activity of substances that promote prostate cell growth.

Another theory focuses on dihydrotestosterone (DHT), a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.

What Are The Risk Factors For BPH?

Risk factors include aging and a family history of BPH. Other risk factors are obesity, lack of physical activity, and erectile dysfunction (ED).

Can BPH be Prevented?

There is no sure way to prevent BPH. Because excess body fat may affect hormone levels and cell growth, diet may play a role. Losing weight and eating a healthy diet, with fruits and vegetables, may help prevent BPH. Staying active also helps weight and hormone levels.

How is BPH Diagnosed?

The American Urological Association (AUA) developed a BPH Symptom Score Index. It asks how often urinary symptoms happen. The score rates BPH as mild to severe. Take the test and talk with your healthcare provider about your results.

Your health care provider will review your Symptom Score and take a medical history. There will be a physical exam with a digital rectal exam (DRE). You may also have:

  • Urinalysis (urine test)
  • PSA blood test to screen for prostate cancer
  • Urinary blood test to screen for bladder cancer
  • Post-void residual volume (PVR) to measure urine left in the bladder after urinating
  • Uroflowmetry to measure how fast urine flows
  • Cystoscopy to look at the urethra or bladder with a scope
  • Urodynamic pressure to test pressure in the bladder during urinating
  • Ultrasound of the prostate

You should see your health care provider if you have symptoms. See your health care provider right away if you have blood in your urine , pain or burning when you urinate, or you cannot urinate.

PSA Test

The prostate-specific antigen (PSA) blood test, tests the level of prostate-specific antigen (PSA) in the blood. PSA is a protein made only by the prostate gland. The PSA test can be done in a lab, hospital or health care provider’s office. There is no special preparation. The PSA test should come before the health care provider does a DRE. Ejaculation can raise the PSA level for 24 to 48 hours. So the patient should not ejaculate for two days before a PSA test.

Very little PSA is found in the blood of a man with a healthy prostate. A low PSA is better for prostate health. A rapid rise in PSA may be a sign that something is wrong. One possible cause of a high PSA level is benign (non-cancer) enlargement of the prostate . Inflammation of the prostate, called prostatitis is one more common cause of high PSA levels.

Digital Rectal Exam of the Prostate
Digital Rectal Exam of the Prostate
Alan Hoofring (Illustrator), National Cancer Institute

DRE

The digital rectal examination (DRE) is done with the man bending over or lying curled on his side. The health care provider puts a lubricated gloved finger into the rectum. The health care provider will feel the prostate. They will be looking for abnormal shape or thickness in the prostate, The DRE can help your health care provider find prostate problems.

Adopted from Urology care foundation