Benign Prostatic Hyperplasia (BPH)

Overview

The prostate is composed of glands and muscle. With increasing age these tissues grow, resulting in enlargement of the prostate (BPH). BPH is rare before age 40, but is present in about 80% of men by age 80. About half of these men will have symptoms from the enlarged prostate.  We do not know what causes BPH but it appears to be related to subtle changes in hormone production, which occur with aging and, possibly, as a result of environmental factors such as diet.

BPH is not a cancer. BPH causes problems because as the prostate enlarges, it compresses the urethra and blocks the passage of urine from the bladder. This can prevent the bladder from emptying, sometimes causing damage to the bladder and kidneys, or the inability to pass urine. These serious effects are relatively uncommon; the more usual result of BPH is bothersome symptoms while urinating.

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Benign Prostatic Hyperplasia (BPH) Overview / Symptoms

Symptoms

Symptoms of BPH Include:

  • Frequent urination
  • Unable to postpone urination
  • Delay in starting to urinate
  • Weak urinary stream – straining
  • Intermittent stream – stopping and starting
  • Incontinence (loss of urinary control)
  • Painful urination
  • Blood in urine
  • Inability to empty bladder (acute urinary retention)

Other diseases such as prostate cancer, prostatitis, bladder cancer, bladder stones, etc. can cause some of these symptoms. Your doctor will usually refer you to a urologist for further evaluation.

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Benign Prostatic Hyperplasia (BPH) Overview / Diagnosis

Diagnosis

How Do I Know If I Have BPH And Not Prostate Cancer?

Prostate cancer may present with symptoms similar to BPH, although in the early stages there are no symptoms. To determine if prostate cancer is present your Doctor will perform tests.

  • The main test is the digital rectal examination (DRE). This is a simple examination in which the doctor will pass a lubricated, gloved finger into the rectum. Because the prostate is located just in front of the rectum, it can be easily palpated. Enlargement can be detected as well as any lumps or firm areas, which can suggest the presence of prostate cancer.
  • Your doctor may also do other tests including checking your prostate specific antigen (PSA). PSA is a substance produced by the prostate, which can be measured by a blood test. Prostate cancer often releases more PSA into the blood than a normal prostate. Elevated levels of PSA suggest the presence of prostate cancer, although BPH and prostatitis may also cause elevated levels. Your physician may use the estimated size of your prostate and/or your PSA level to determine your risk of future progression and problems.
  • If there is a suspicion of prostate cancer following the digital rectal examination, e.g. a nodule or firm area, and/or an abnormal PSA test, then a biopsy will usually be done. This causes minimal discomfort and is usually performed by inserting a needle into the prostate through the rectum. The needle is usually guided by the use of transrectal ultrasound (TRUS). TRUS involves the insertion of a probe, slightly larger than the index finger, into the rectum. TRUS displays an image of the prostate on a screen, permitting accurate placement of the biopsy needle into selected areas of the prostate. Occasionally, the doctor may use a finger in the rectum to guide the biopsy. The majority of men presenting with symptoms of BPH do NOT have prostate cancer, and will not require biopsy.

What Other Tests Will Be Required To Diagnose BPH?

A urine specimen will be examined to detect the presence of blood or infection. Depending upon your symptoms, other tests may be performed such as:

  • Blood Test
    This will check the kidney function.
  • Abdominal Ultrasound
    This painless test involves placing a probe on the abdomen to visualize the kidneys and bladder.
  • Intravenous Urography
    This is an x-ray where an injection is given into the blood stream to visualize the kidneys and bladder.
  • Cystoscopy
    A small telescope is passed through the urethra into the bladder, permitting examination of the urethra, prostate and bladder. Local anesthetic is placed in the urethra, and the procedure causes only minimal discomfort.
  • Urine Flow Study
    You will urinate in your usual manner into a special container, which measures the strength of the flow, and can help determine the severity of the blockage.
  • Residual Urine
    This test, done either by abdominal ultrasound or passing a catheter into the bladder, measures how well you empty your bladder.
  • Urodynamics
    This test measures urine flow, residual urine and bladder volumes and pressures, and involves a small catheter being inserted through the urethra into the bladder.

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Benign Prostatic Hyperplasia (BPH) Overview / Treatments

Treatments

Do I Need Treatment?

If there is evidence of kidney damage, or if you are totally unable to empty your bladder, then surgical treatment will be required. Otherwise, treatment will depend upon how troublesome your symptoms are. If they bother you a lot then you will benefit from treatment, but if your symptoms are minimal, you may wish to defer treatment. Your doctor will continue to monitor your symptoms and check for any evidence of complications. This is called “watchful waiting”.

Symptoms do not necessarily worsen and may stay the same or even improve. A urologist should be able to predict (based on your age, the size of your prostate, and your PSA level) your personal risk for future deterioration of symptoms, having an episode of acute urinary retention, or eventually requiring surgery.

Your urologist will discuss with you the advantages and disadvantages of treatment versus watchful waiting, but the decision regarding treatment will be yours. You should also discuss your risk of developing prostate cancer and what you can do to prevent it. Treatment of BPH may affect your risk of developing prostate cancer, but your urologist can advise you on that risk, and what measures might help prevent it.

Treatment Options For BPH

In addition to watchful waiting , there are a number of treatment options available including drug therapy, surgical approach and minimally invasive procedures. Some of these are considered standard treatment because they are effective and the benefit is lasting. Some newer treatments continue to be evaluated and may not be generally available. You should discuss these options with your doctor prior to deciding which treatment is best for you.

Which Option Should I Choose?

Many patients with mild to moderate symptoms of BPH do not require treatment and will be managed by “watchful waiting”. The decision regarding treatment will depend upon a variety of factors such as severity and rate of progression of your symptoms, age, general health, prostate size, PSA and current availability of some of these treatment options, as well as your own preferences. The advantages and disadvantages and availability of these options should be discussed with your doctor.

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