What is benign prostatic hyperplasia (BPH)?
BPH (also referred to as benign prostatic hypertrophy) is a condition in which the prostate gland becomes very enlarged and may cause problems associated with urination. BPH can raise PSA (prostate-specific antigen) levels two to three times higher than the normal level. An increased PSA level does not indicate cancer, but the higher the PSA level, the higher the chance of having cancer.

Some of the signs of BPH and prostate cancer are the same, however, having BPH does not seem to increase the chances of developing prostate cancer. A man who has BPH may also have undetected prostate cancer at the same time or may develop prostate cancer in the future. Therefore, the National Cancer Institute and the American Cancer Society recommend that all men over 50 consult their physicians about having a digital rectal and PSA exam once a year to screen for prostate cancer.

How does BPH occur?
The prostate goes through two main periods of growth. In early puberty, the prostate doubles in size. Then, around age 25, the prostate begins to grow again and continues to grow throughout most of a man’s life.

The continuing enlargement of the prostate does not usually cause problems until later in life. However, the second period of growth may, many years later, result in BPH. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

• BPH rarely causes symptoms before age 40.
  

• More than half of men in their sixties have some symptoms of BPH.
  

• As many as 90 percent of men in their seventies and eighties have some symptoms of BPH.

What happens when the prostate enlarges?
As the prostate enlarges, it presses against the urethra and interferes with urination. At the same time, the bladder wall becomes thicker and irritated, and begins to contract -- even when it contains small amounts of urine -- which causes more frequent urination. And, as the bladder continues to weaken, it may not empty completely and leave some urine behind.

Blocking or narrowing of the urethra by the prostate, and partial emptying of the bladder cause many of the problems associated with BPH.

What are symptoms of BPH?
The following are the most common symptoms of benign prostatic hyperplasia. However, each individual may experience symptoms differently. Symptoms may include:

• leaking or dribbling of urine
• more frequent urination, especially at night
• urgency to urinate
• urine retention -- inability to urinate
• a hesitant, interrupted, weak stream of urine

These problems may lead to:

• incontinence
• kidney damage
• bladder damage
• urinary tract infections
• bladder stones

The symptoms of benign prostatic hyperplasia may resemble other conditions or medical problems. Consult a physician for diagnosis.

How is BPH often diagnosed?
Diagnosing BPH in its earlier stages can lower risk of developing such complications. Delay can cause permanent bladder damage for which BPH treatment may be ineffective. There are several procedures used by physicians to diagnose BPH, including:

• digital rectal examination (DRE) - a test that indicates the general size and condition of the prostate gland. The physician inserts a gloved finger into the rectum to feel for any irregularities.

• rectal ultrasound - a test in which a probe is inserted in the rectum and directs sound waves at the prostate. The patterns of the sound waves form an image of the prostate gland on a screen.

• intravenous pyelogram (IVP) - a series of x-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein -- to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.

• cystoscopy (also called cystourethroscopy) - an examination in which a scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

• urine flow study - a test in which the patient urinates into a special device that measures how quickly the urine is flowing. A reduced flow may suggest BPH.

How is BPH treated?
Specific treatment for BPH will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Eventually, BPH symptoms usually require some kind of treatment. When the gland is just mildly enlarged, treatment may not be needed, as research has shown that some of the symptoms of BPH clear up without treatment in some mild cases. This determination can only be made by your physician after careful evaluation of your individual condition. Regular checkups are important, however, to watch for developing problems.

Treatment for BPH may include:

• Surgery to remove only the enlarged tissue that is pressing against the urethra, with the rest of the inside tissue and the outside capsule left intact. Types of surgery often include:

• transurethral surgery - no external incision is needed. The surgeon reaches the prostate by inserting an instrument through the urethra.
  
  
  • transurethral resection of the prostate (TURP) - a resectoscope -- an instrument that is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels -- is inserted through the penis. The surgeon uses the resectoscope’s wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and flushed out at the end of the operation.
    
    
  • transurethral incision of the prostate (TUIP) - a procedure that widens the urethra by making some small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.

• laser surgery - using laser instruments to vaporize obstructing prostate tissue.

• open surgery - surgery that requires an external incision, often done when the gland is very enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired.

• Nonsurgical treatments may include:
  
  
  • balloon urethroplasty - a thin tube with a balloon is inserted into the opening of the penis and guided to the narrowed portion of the urethra, where the balloon is inflated to widen the urethra and ease the flow of urine.
    
    
  • transurethral microwave thermotherapy (TUMT) - a device called a Prostatron uses microwaves to heat and destroy excess prostate tissue to reduce urinary frequency and urgency.
    
    
  • medications - used to shrink or at least stop the growth of the prostate without using surgery.
    
    
  • transurethral hyperthermia - an investigative procedure that uses heat to shrink the prostate.
    
    
  • prostatic stents - investigative procedure using stents, inserted through the urethra to the narrowed area, which are allowed to expand, like a spring, and push back the prostatic tissue and widen the urethra.

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