What is benign prostatic hyperplasia (BPH) or enlarged prostate?

• BPH (benign prostatic hyperplasia) is a progressive condition in which the prostate becomes enlarged and leads to frequent urination, decreased urine stream, difficulty or pain while urinating, or a feeling of incomplete emptying of the bladder³


• BPH or enlarged prostate is not cancer. Although some of the signs of BPH and prostate cancer are the same, having BPH does not seem to increase the chances of getting prostate cancer²


• BPH is one of the most common health problems in older men⁴
  Men who experience severe symptoms of BPH can experience develop serious problems over time such as kidney disease³

How is BPH diagnosed?

• Preliminary Doctor’s Visit: Patients suffering from BPH-associated symptoms should first have a physical exam from their doctor to address their medical history and identify their symptoms⁸



• Urine Test: A urinalysis is a preliminary test to rule out urinary tract infections or other conditions that cause BPH-like symptoms, such as temporary inflammation of the prostate (prostatitis), bladder infection and kidney disease⁸



• Digital Rectal Exam (DRE): If a doctor concludes that a patient’s condition may be BPH, he will conduct a Digital Rectal Exam (DRE) which allows the doctor to assess the size, shape and general condition of the prostate gland⁸



• Prostate-specific antigen (PSA) blood test: The prostate produces prostate-specific antigen (PSA) to help liquefy semen. When this blood tests reflects a higher than normal level of PSA in the blood, it can indicate BPH, prostate cancer or prostatitis⁸



• Transrectal Ultrasound: Estimating the size of the gland can help with the diagnosis. A transrectal ultrasound takes about 30 minutes to administer and uses sound waves to provide an image of the prostate⁸



• Urine Flow Study: This test measures the strength and amount of urine flow when a patient urinates into the test machine. Charting the results of this test over time helps determine if the condition is getting better or worse⁸

• Watchful Waiting: The method is the preferred approach for men with mild symptoms or who have symptoms that don’t bother them. During this observation therapy, the doctor examines the patient and monitors the condition to see if the symptoms are improving or getting worse⁸



• Medications: Medications are the most common way to control mild to moderate symptoms of BPH. This is considered the preferred way to treat BPH, unless the condition is severe enough to require surgery. Medications significantly reduce major symptoms for about two-thirds of men treated⁸
  
  • Alpha-blockers are prescription medicines that relax the muscles in and around the prostate, making it easier to urinate. The most common side effects of alpha-blockers are headaches, dizziness and fatigue⁸
  
  
  • 5-alpha-reductase inhibitors are prescription medicines that can reduce the size of the enlarged prostate in some men. They do not work as quickly as alpha-blockers and generally work best on men with severe prostate enlargement. The most common side effects of 5-alpha-reductase inhibitors are ejaculatory dysfunction, erectile dysfunction and decreased libido⁸
     
• Minimally Invasive Therapies: These procedures are less invasive than surgery and have recently been developed to treat BPH symptoms. Most approaches use heat to destroy prostate tissue that’s pressing against the urethra and blocking urine flow. Generally, minimally invasive therapies require local anesthetic and can be performed on an outpatient basis⁸
  
  • Transurethral microwave therapy- This approach uses microwave heat to remove excess prostate tissue via a small microwave antenna inserted through the urethra. The antenna emits a dose of microwave energy that heats overgrown prostate cells and destroys them without damaging nearby normal tissue⁸
  
  
  • Transurethral needle ablation- Transurethral needle ablation (TUNA), also called radiofrequency therapy, is an outpatient procedure that uses radio waves to heat and destroy the part of the prostate that's blocking urine flow. A special catheter is guided through the urethra where small needles are inserted into the prostate and radio waves then heat the prostate⁸
  
  
  • Interstitial laser therapy (ILT)- During ILT, a small tube containing a laser fiber is inserted into the prostate tissue by puncturing through the part of the urethra that's next to the prostate. The procedure destroys overgrown prostate tissue by directing laser energy at the inside of the enlarged prostate gland⁸


• Surgery: In the past, surgery was the most common way to treat BPH but its popularity has been declining with the advancement of new medications and minimally invasive treatments with minimal sexual side effects. Surgery will be considered if the patient suffers from severe symptoms. The two primary types of surgical procedures currently in use are transurethral surgery and open prostatectomy⁸