BENIGN PROSTATIC HYPERPLASIA (BPH)
This is a noncancerous growth in the prostate, the result of hormonal changes that occur with age. The growth usually puts pressure on the urethra, leading to weaker, more frequent, and/or more difficult urination—think of someone standing on the hose while you try to water the grass. By the age of seventy, 70 percent of American men have BPH, but it only becomes a serious problem in about one in ten cases. Journal of Urology 1984; 132: 474-479 This condition is also known as benign prostatic hypertrophy.
Benign means "noncancerous," prostatic means "of the prostate," and hyperplasia means "a greater number of cells than normal."SYMPTOMS
The symptoms of BPH resemble the earliest symptoms of prostate cancer. For the most part, they are problems with urination, such as a weak stream, urgency, frequency, or the inability to urinate.
Questions the doctor will ask (AUA symptom index for BPH)Cancer and BPH are not the only things that can cause urinary difficulties. An inflammation of the prostate gland or prostatitis (see below) may be relieved with antibiotics, hot baths, (and sometimes with more frequent ejaculation). Eating habits may be part of the problem: avoid alcohol, caffine, spicy foods, and other things that may irritate the bladder. Medications that contain decongestants may also heighten the symptoms.BPH: a brief introduction
BPH: a more detailed introduction
BPH: a very detailed introduction
BPH news
TESTS
If the doctor cannot relieve the problem with medication, one or more tests may be required, among them: rectal ultrasound, urinalysis, PSA, free PSA, biopsy, intravenous pyelogram, urine flow, and cytoscopy.
About some of these tests
TREATMENTS FOR BPH
These include medications, surgery, heat, and other techniques.
Overview of Therapies for the treatment of BPH
MEDICATIONS
Alpha blockers may be used to treat the symptoms of BPH. They relax the muscles of the prostate and bladder, making it easier for the urine to pass. The drugs also lower blood pressure, which can lead to dizziness and a general slowdown. They may affect your PSA. "When medical therapy is indicated for moderate or severe BPH, alpha-adrenergic antagonists exhibit a faster onset of action and produce greater improvement of voiding symptoms than does finasteride." Annals of Pharmacotherapy 1997 Apr; 31 (4):481-6
Check these sites and others for information about side effects and warnings before taking one of these alpha blockers.
Hytrin (terazosin)
Cardura (doxazosin)
Flomax (Tamsulosin hydrochloride)Proscar (finasteride) is supposed to shrink the BPH and relieve the pressure. Proscar reduces PSA levels by about half, so have your PSA tested before you begin to take the drug and again in six months to see if it has dropped the expected amount. It does not change the free PSA ratio. Journal of Urology 1998 Feb;159(2):449-53 (Proscar reduces PSA from BPH, not from cancer.) Proscar may produce such side effects as abdominal pain, loss of sexual desire, impotence, and increased hair growth (it is also marketed as a hair-growth drug called Propecia). Do not take either version without checking with your doctor.
About Proscar: manufacturer's pageSaw palmetto is an herb that is sometimes used to relieve BPH. A review of clinical trials of saw palmetto found that it apparently produces much the same effects as Proscar with fewer adverse side effects. Journal of the American Medical Association, 1998 Nov 11;280 (18): 1604-9. Some trials, however, have found it to have virtually no effect. Bear in mind that if saw palmetto can lower PSA, it may also lead to a delay in discovering a cancer.
Saw palmetto extracts for treatment of BPH
Use Drug Checker at drkoop.com to avoid possible drug (and herbal) conflicts
SURGERY
Transurethral Resection of the Prostate (TURP) An instrument with a small loop of sharp wire is put into the urethra and used to slice away the enlarged prostate tissue. Usually requires a hospital stay.
TURP (pdf)
Transurethral resection of the prostate (TURP)Transurethral incision of the Prostate (TUIP) An incision is made in the prostate to widen the urethra and improve THE urine flow rate. This procedure does not require a hospital stay. However, it may be necessary to wear a foley catheter for a few days after surgery. Possible complications include bleeding, impotence, infection, and a narrowing of the lumen of the urethra (urethral stricture).
Transurethral incision of the prostate (TUIP)—briefProstatectomy This is the same surgical technique used to remove the prostate in the case of cancer.
Prostatectomy (a page on this site)
HEAT
Heat (hyperthermia) is used to "cook" the prostatic tissue that obstructs the urethra. The dead tissue is gradually disposed of by the body. There are several techniques, including direct heat (TUNA), microwave (TUMT), laser (VLAP and TULIP), electrical vaporisation (TUEVP, TUVEVAP, TVP), and high-intensity focused ultrasound (HIFU).
HIFU: Clinical trials using high intensity focused ultrasound (illustration)
HIFU: Localized prostate cancer treatment with HIFU
Overview of thermal therapies TUMT: Transurethral microwave thermotherapy of the prostate
TUNA: Transurethral needle ablation of the prostate
TUEVP: Several articles on electrovaporization
TULIP, VLAP: Laser surgery of the prostate: A review of current options
Other Techniques
Prostatic stents, which are still largely experimental, are short, tight coils (stents) placed in the part of the urethra that runs through the prostate. The stent expands and holds the urethra open.
StentsBalloon urethroplasty uses a tube with a balloon. The tube is inserted in the penis and then inflated to widen part of the urethra. This technique, however, does not address the cause of BPH, the enlargement of the prostate.
Balloon urethroplasty
Return to Symptoms
Return to Research
PROSTATITIS
Symptoms may include discomfort in the general area of the groin or lower back, a frequent need to urinate, a burning sensation while urinating, and painful ejaculation.
Types and treatments The less-common type of prostatitis is caused by an infection that can be treated with drugs. It is usually accompanied by pain or fever. The more-common type is non-bacterial and may be the result of a decrease in the frequency of ejaculation. This may be fairly common in men who have undergone neoadjuvant hormone therapy prior to treatment and have been effectively impotent during that time. It disappears with an increase in sexual activity.
Prostatitis glossary
About prostatitis
Prostatitis: the Merck Manual
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