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The Prostate and BPH
The prostate is a walnut-sized gland
that forms part of the male reproductive system. The gland is made of
two lobes, or zones, enclosed by an outer layer of tissue. The
prostate is located in front of the rectum and just below the bladder,
where urine is stored. The prostate also surrounds the urethra, the
canal through which urine passes out of the body.
As a man matures, the prostate goes through two main periods of
growth. The first occurs early in puberty, when the prostate doubles
in size. At around age 25, the gland begins to grow again. This second
growth phase often results, years later, in
BPH. Benign Prostatic Hyperplasia and
Benign Prostatic Hypertrophy are both non-cancerous conditions that
cause a constriction of the urethra, due to the increase in the size
of the prostate. BPH commonly affects middle aged to elderly men.
About 43% of men with BPH are over 65. Although the two conditions are
scientifically quite distinct from each other they are both called BPH
by doctors and have the same methods of diagnosis and treatment.
What is BPH?
Benign
Prostatic Hyperplasia describes the abnormal increase in the number of
non-cancerous cells within the transition zone of the prostate.
Most cancers of the prostate start in
the peripheral zone, while the central zone tends to be free from
changes.
Benign Prostatic Hypertrophy is the
abnormal increase in the size of non-cancerous cells within the
transition zone of the prostate.
What causes BPH?
As men get older, there is a surplus
in the amount of testosterone produced by the testicles. This excess
testosterone is absorbed by the prostate. Testosterone causes an
increase in the growth of prostate cells and how long those cells
live. The result of this is growth of the prostate. Since the prostate
surrounds the urethra this growth slowly begins to strangle the
urethra as it exits the bladder. This can cause obstruction and reduce
the flow of urine from the bladder.
Signs & Symptoms
The degree of symptom
will differ from man to man as will the type of symptoms experienced
and length of time they last. The signs and symptoms experienced are
often referred to by health professionals as Lower Urinary
Tract Symptoms (LUTS).
|
Symptom |
Description |
| Poor stream |
Urine flow is weak and slow |
| Frequency |
urinating more than
10 times a day |
| Urgency |
The sudden almost
uncontrollable need to urinate |
| Hesitancy |
Difficulty and delay
starting to urinate |
| Nocturia |
Waking up more than
twice a night to urinate |
| Dribbling |
Being unable to stop completely
the flow of urine |
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Incomplete emptying of the
bladder |
|
Discomfort |
Burning/pain on urination |
If left unchecked problems
that are more serious can develop:
Some men find that they have a
sudden and painful inability to pass urine. This requires urgent medical treatment by means of
draining the bladder with a urinary catheter and probably a short
period of hospitalization.
Other men find it becomes
increasingly more difficult, though usually painless, to empty the
bladder and they retain more urine than they pass. Chronic retention
of urine will cause an
overstretching of the bladder as it tries to cope with the increase in
capacity and pressure. The increase in pressure can lead to back
pressure which left unchecked can result in kidney failure as the
kidneys become "waterlogged". As the lining and muscles of the bladder
become fatigued through the constant stretch of chronic retention
small tears and pockets may develop and give rise to urinary tract
infections as well as the formation of bladder stones.
Bladder stones are collections of
crystallized urine that form into either semi-soft or hard rock-like
stones. Although not life threatening, bladder stones can be painful
and contribute to a worsening of symptoms.
Watchful Waiting
If there are no complications and
minimal inconvenience from the symptoms it may be more appropriate to
wait and see how your condition develops over a period of time.
You
should have regular checks on your symptoms.
Lifestyle Changes
If you who wish to avoid surgery and
drug therapies relief from symptoms may be increased by some simple
changes to your lifestyle:
- Avoid drinks that are high in
caffeine
- Avoid alcohol or reduce your
alcohol intake
- Decrease the amount you drink in
the evening
- Avoid cold and allergy medicines
such as anti-histamines and decongestants, which can affect the
muscles in the bladder
- Drink Green tea, it contains
flavenoids that may be of benefit to the prostate
- Increase the amount of fiber and
fruit in your diet to avoid constipation
Water
While it is recommended to decrease the amount you drink in the
evening, it is important to drink plenty of water throughout the day. The natural reaction to
urgency and frequency problems is to cut back on fluid intake.
However, this is a mistake. You risk dehydration and the urine becomes
so strong that a bladder infection is more likely. Drinking lots of
fluid keeps the retained urine in the bladder fairly dilute and
reduces the risk of bladder infection and dehydration.
Drug therapy
PROSCAR lowers levels of a key hormone
called DHT (dihydrotestosterone), which is a major cause of prostate
growth. Lowering DHT leads to shrinkage of the enlarged prostate gland
in most men. This may lead to gradual improvement in urine flow and
symptoms over a period of several months. However, each case of BPH is
different; even though the prostate shrinks, there may NOT be an improvement in
urine flow or symptoms.
Herbal Therapy
 Some men
report finding relief from the
symptoms of BPH from herbal therapies. One widely available
alternative therapy is saw palmetto extract. Saw Palmetto is a small,
palm-like plant native to North America. This herb is called the
"plant catheter" due to its therapeutic effect on the neck of the
bladder and the prostate. Like the drug Proscar, it can alter results
of a PSA test and make prostate cancer hard to diagnose. If you take
it, tell your physician.
Recent studies on saw palmetto
Saw palmetto contains
certain phytosterols, substances that seem to curb prostate cell
growth. Its action in the body is probably similar to that of
finasteride (Proscar) and
other drugs. A study in JAMA reviewed
18 clinical trials of saw palmetto, none of them first rate. For
example, some were brief or small or limited in other ways. Only two
used standardized doses. But they were deemed worthy of notice by
these researchers. Compared with a placebo, saw palmetto improved
urinary tract symptoms, including nighttime urination, by about 25%.
Men taking saw palmetto were twice as likely to report improvements as
those taking a placebo. In Germany, other studies have tended to
support the effectiveness of saw palmetto.
Cost considerations: A 90-day supply of
finasteride costs about $150, compared with
$15-$20 for a 90-day supply of saw palmetto. To date, fewer side
effects (such as erectile dysfunction) have been reported with saw
palmetto than with finasteride.
Surgery
For the majority of men with BPH
whose symptoms become unbearable or who develop complications, surgery
is the recommended treatment. There are many modern therapies
available which are too numerous to discuss here. There are potential
advantages and disadvantages with each procedure and these should
thoroughly discussed in advance with the treating physician.
Prostate Specific Antigen
(PSA) Blood Test In order to
rule out cancer as a cause of urinary symptoms, your doctor may recommend
a PSA blood test. PSA, a protein produced by prostate cells. PSA is frequently
present at elevated levels in the blood of men who have prostate cancer.
The U.S. Food and Drug Administration has approved a PSA test for use in
conjunction with a digital rectal exam to help detect prostate cancer in
men age 50 or older and for monitoring prostate cancer patients after
treatment. However, much remains unknown about the interpretation of PSA
levels, the test's ability to discriminate cancer from benign prostate
conditions and the best course of action following a finding of elevated
PSA.
Treatment options - A final word
The type of treatment you require
will be based upon the severity of your symptoms, the presence of any
complications and your general health. All treatments have advantages
and disadvantages. You should discuss the most appropriate treatment
with your doctor.
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SOURCES: |
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| 1. The Mayo Clinic |
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| 2. The Prostate Cancer Charity |
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| 3. University of California Davis
Health System |
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