Benign Prostatic Hyperplasia (BPH), also known as Benign Prostate Enlargement, refers to a common non-malignant condition that occurs in older men, which causes enlargement of the prostate gland. The prostate is part of the male reproductive system and its secretions help to nourish and protect sperm in the ejaculate. The prostate gland is located below the bladder, where it intimately wraps around the upper part of the urethra tube, through which urine passes out (see diagram). An enlarged prostate gland due to BPH, can compress and obstruct the urethra, thus causing urination problems, which can be bothersome and inconvenient. BPH symptoms tend to progress slowly. Some men may stop passing urine altogether (acute urinary retention), and require insertion of a catheter to drain the bladder until the obstruction is relieved surgically.
As its name implies, BPH is not cancer. About 30-50% of men over the age of 60 years may have urinary symptoms due to BPH. Urinary symptoms can also occur due to other conditions, including cancer of the prostate or bladder. Therefore, it is advisable to see your GP if you have any concerns, or your symptoms are bothering you.
Symptoms Of BPH
- Hesitancy - it may take longer than usual for the urinary stream to start flowing.
- A weak stream of urine, which may stop and start, rather than come out as a continuous flow.
- Straining to urinate.
- Dribbling after urination has finished.
- Incomplete bladder emptying often causing a need to urinate more frequently.
- Urgency - an urgent feeling of needing to urinate which cannot be put off.
- Frequency - needing to urinate too frequently during the day time.
- Nocturia - a need to pass urine more than twice at night.
How is BPH diagnosed?
- History and physical examination including a digital rectal examination to feel the prostate gland.
- Urine test to exclude infection and diabetes.
- PSA blood test to exclude prostate cancer.
- Ultrasound scan of the prostate, bladder and kidneys.
- Urine flow rate test or Urodynamic testing.
- Cystoscopy - telescopic examination of the urethra, prostate and bladder.
How is BPH treated?
Treatment will depend on the severity of the urinary symptoms and the degree of bother that they cause. Mild symptoms may not need any particular treatment. Medication (tablets) may be worth considering for moderate to severe symptoms. Medicines do not cure the problem or completely relieve the obstruction, but they can partially alleviate the symptoms if you keep taking them. Surgical removal of the overgrown prostate tissue is the only treatment that reliably relieves the obstruction from BPH. Surgery is indicated for men with moderate or severe urinary symptoms who do not get adequate relief from medication, or who do not want to take medication long term. Also some men elect for surgery if they suffer significant side effects from the medication. Surgery is usually necessary in those men who develop complications of BPH such as urinary retention (inability to pass urine without a catheter), bladder stones, heavy bleeding from the prostate, or kidney failure.
Sometimes BPH does not need treatment if the symptoms are mild and do not affect quality of life. Life style changes such as reducing the intake of alcohol or caffeine found in tea, coffee and fizzy drinks, may be all that is required.
Oral Medicines (Tablets)
Oral medicines are usually not as effective as the surgical options, but can be considered in men with moderate to severe symptoms, or men who don't want surgery. Medicines do not cure the condition and need to be taken all the time.
Oral medicines may include:
- Alpha-blockers e.g. Minipress, Pressin, Flomaxtra, Hytrin . Relax muscle tension in prostate. Do not stop progression of BPH. Can cause lightheadedness and ejaculation problems.
- Phosphdiesterase-5 inhibitors (also treats erectile dysfunction) - Cialis. Can be expensive. May be good option if you also have erectile problems that you want treated.
- 5-alpha reductase inhibitors (5-ARI) e.g. Dutasteride or Finasteride. 5-ARI block conversion of the male hormone testosterone to a more active from. Prevent progression of BPH in 50%. 5-ARI side effects include reduced libido, impotence, ejaculation problems, breast enlargement, and rarely aggressive prostate cancer can develop. Use condoms if you're sexually active, because both finasteride and dutasteride can have an adverse effect on your sperm. If you get a woman pregnant, there's a risk the baby could develop birth defects.
- Combination of drugs e.g. Duodart – the combination of an alpha-blocker and a 5-alpha reductase inhibitor can be more effective than either drug alone.
- Some men take prostate supplements but studies have not consistently show these to be any more effective than a placebo
Surgery is usually the most effective treatment for men with moderate or severe symptoms. Surgical options may include:
- Urolift Procedure.
- Laser Prostatectomy.
- Transurethral Resection of Prostate (TURP).
- Transurethral Incision of Prostate (TUIP) - also called Bladder Neck Incision (BNI).
- Open Prostatectomy - involves abdominal incision. Not minimally invasive like above procedures. May be recommended for very large prostates >150cc.
- Prostatic arterial embolisation.
For more information on BPH please download a PDF from the Andrology Australia website.