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Alternative namesBPH; Benign prostatic hypertrophy (hyperplasia); Prostate - enlarged
The prostate gland produces the fluid that carries sperm during ejaculation. As the prostate enlarges, which happens to almost all men as they get older, it can press on the urethra (the tube that empties urine from the bladder). This causes problems with urination.
Prostate enlargement is often called benign prostatic hypertrophy or hyperplasia (BPH). It is not cancer and it does not put you at increased risk for prostate cancer.
Causes, incidence, and risk factors
The actual cause of prostate enlargement is unknown. In addition to age, overgrowth of the prostate seems to require normal function of the testicles, which produce testosterone. This is known because men who have had their testicles removed at a young age (for example, for testicular cancer) do not develop BPH. Similarly, if the testicles are removed after a man develops BPH, the prostate begins to shrink in size.
The likelihood of developing an enlarged prostate increases with age. In fact, BPH is so common that it has been said, "All men will have an enlarged prostate if they live long enough!" A small amount of prostate enlargement is present in many men over age 40 and more than 90% of men over age 80. No risk factors have been identified other than having normally functioning testicles.
Less than half of all men with BPH have symptoms of the disease, which include:
Signs and tests
In addition, you may be asked to complete a self-screening form to evaluate the severity of your symptoms and the impact on your daily life. Your score on the screening tool may be compared to past records to evaluate progression of the disease.
The choice of a treatment is based on the severity of your symptoms, the extent to which they affect your daily life, and the presence of any other medical conditions. Treatment options include "watchful waiting," lifestyle changes, medication, or surgery.
If you are over 60, you are more likely to have symptoms. But many men with an enlarged prostate have only minor symptoms. Self-care steps are often enough to make you feel better.
If you have BPH, you should have a yearly exam to monitor the progression of your symptoms and determine if any changes in treatment are necessary.
For mild symptoms:
Saw palmetto may ease prostate symptoms. Look for fat-soluble saw palmetto extract that with 85-95% fatty acids and sterols.
Sit in an aisle seat at the theatre or on an airplane. This won't reduce your symptoms, but it may relieve your anxiety about having to urinate often or suddenly.
If these measures are not enough to ease your symptoms, talk to your doctor, who may consider medications or surgery.
Prostate surgery may be recommended if you have:
The choice of a specific surgical procedure is usually based on the severity of your symptoms and the size and shape of your prostate gland.
The majority of men who have prostate surgery have improvement in urine flow rates and symptoms. Possible complications include impotence, urinary incontinence, retrograde ejaculation (semen flowing back into the bladder rather than out the penis), infertility, and urethral stricture (narrowing). Rates of these complications vary, depending on the surgical procedure that you and your doctor decide is best.
Various studies are underway to evaluate the effectiveness of other treatments, such as hyperthermia , laser therapy, and prostatic stents .
Support GroupsSeveral national groups provide information on BPH. See BPH support groups .
Studies show that of the men who receive no treatment for BPH, as many as 31 to 55% actually show an improvement, and only 1 to 5% ever develop complications.
Men who have had long-standing BPH with a gradual increase in symptoms may develop:
Even after surgical treatment, a recurrence of BPH may develop over time.
Calling your health care provider
Call your doctor right away if you have:
Also call your doctor if:
Update Date: 10/27/2003Jacqueline A. Hart, M.D., Department of Internal Medicine, Newton-Wellesley Hosptial, Boston, Ma., and Senior Medical Editor, A.D.A.M., Inc. Previously reviewed by Steven Angelo, M.D., Assistant Professor of Medicine, Yale School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network (10/29/2002).
Last updated: Tue, 06 Jan 2009 00:20:03 GMT