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    Benign Prostatic Hyperplasia (BPH)

    Overview
    Risk Factors
    Diagnosis
    Treatment
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by SGH Urology Centre

    Overview


    Benign prostatic hyperplasia (also called BPH) is a condition that affects the prostate gland in men. The prostate is a gland found between the bladder (where urine is stored) and the urethra (the tube urine passes through).

    As men age, the prostate gland slowly grows bigger (or enlarges). As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful.

    Most symptoms of BPH start gradually.

    Symptoms include:

    • the need to get up more often at night to urinate
    • the need to empty the bladder often during the day
    • difficulty in starting the urine flow and dribbling after urination ends
    • the size and strength of the urine stream may decrease

    These symptoms can be caused by other things besides BPH. Tell your doctor if you have any of these symptoms, so he or she can decide on the tests to find the possible cause.

    Risk Factors

    BPH is extremely common. Half of all men over 50 develop symptoms of BPH, but only 10 percent need medical or surgical intervention.

    Is BPH a type of cancer?

    No. BPH is completely benign. It is not a precursor (a forerunner) to prostate cancer.

    Diagnosis

    After taking a history of your symptoms, a rectal exam is the next step. In a rectal exam, your doctor checks your prostate by putting a gloved, lubricated finger into your rectum to feel the back of your prostate gland. This allows him to feel the size of the prostate gland and especially assess for hard lumps which may indicate cancer.

    To make sure that your prostate problem is benign and not cancer, your doctor may do a blood test called PSA or prostatic specific antigen.

    What are the consequences of BPH?

    Mild cases usually have no consequence to life. If the enlargement gets moderate, symptoms related to difficult urination become troublesome. In severe cases, a sudden inability to urinate may require an immediate visit to a doctor to insert a urine tube or catheter into the urethra to drain out the urine.

    Even if BPH sufferers manage to pass urine, some amount of urine may be left behind, which easily gets infected, making moderate to severe BPH sufferers prone to urine infections.

    Treatment

    Sometimes mild symptoms get better on their own. Many people believe that a healthy lifestyle and diet with less processed foods rich in fibre, fruit, vegetables will cause the prostate to enlarge less, by decreasing oestrogens and increasing testosterone levels both of which affect prostate size. Some herbal products like saw palmetto are even available commercially. In any case, it is always good to adopt a healthy lifestyle whether these measures make a noticeable difference or not.

    If your symptoms get worse, your doctor may suggest drug treatment.

    Finasteride and dutasteride block conversion of testosterone to dihydrotestosterone, which makes the prostate enlarge.

    The side effects of finasteride are rare and mild and usually affect sexual function. The side effects cease when the medication is stopped. The prostate may enlarge again when the medicine is stopped, so your doctor may suggest another treatment.

    Another kind of medicine, called alpha-blockers, can also help relieve the symptoms of BPH. Alpha-blockers have been used for a long time to treat high blood pressure, but they can also help the symptoms of BPH, even in men with normal blood pressure. Some of these drugs are terazosin, doxazosin, tamsulosin and alfuzosin.

    The side effects of alpha-blockers include dizziness, fatigue and lightheadedness due to lowered blood pressure. Doctors therefore start with a low dose first.

    How can a Urologist help me in further treatment of BPH?

    A referral to a urologist (a surgeon of the urinary-genital system) may be neccessary to explore surgical treatment options.

    A urologist will perform an ultrasound exam of the prostate by inserting a well-lubricated probe into the anus. This will measure the size of the prostate gland, check for cancer if suspected and assess the need for surgery. Biopsy of the prostate is done though the rectum if cancer is suspected.

    A urologist can also perform an ultrasound of the bladder to see how much urine is retained after urinating, due to the obstruction by the prostate.

    One treatment option is a minimally invasive treatment. Most of these treatments use heat such as microwave or laser to destroy prostate tissue applied through the urethra.

    Surgery is considered the most effective treatment and is used in men with symptoms that persist after other treatments are tried. This is also the best way to diagnose and cure early cancer of the prostate. Surgery is usually done via a tube passed through the urethra, thus leaving no abdominal scars (Transurethral resection of prostate – TURP).

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